Thursday, September 11, 2008

VRET: Serious Games Treat Anxiety Disorders in Netherlands

Serious Games rewiring brain’s pathways

Via: Virtual Reality and Phobias - Virtual Reality Exposure Therapy (VRET)

VR Phobia is a research project developed by the
Delft University of Technology, Man-Machine Interaction Group, in collaboration with the University of Amsterdam, which has started in 1999.

Patients with a phobia are traditionally treated with behavior therapy, where they are gradually exposed to real life situations they fear, such as a high staircase for people with acrophobia (fear of heights), flying on an airplane for people with fear of flying, or taking an elevator for people with claustrophobia.

The research project focuses on recreating these situations in a virtual setting that is safer, less embarrassing, and less costly than reproducing the real world situations.

Fear of Heights

Fear of Flying


The Delft VRET architecture addresses both the therapist and the patient side. From the console, the therapist control the patient’s exposure experience: in the case of fear of flying the therapist controls the behavior of the plane (taxiing, taking off, weather conditions, pilot calls, and turbulence); in the case acrophobia, the therapist navigates the patients upwards on the staircase.

With extensive empirical research the project has already demonstrated the effectiveness of VRET in case of the above mentioned phobias.

In Vivo, In Vitro, and VR

Phobias can often be treated effectively by using gradual exposure therapy. During gradual exposure therapy patients are subjected to anxiety-provoking stimuli in a gradual order, from the least difficult stimulus to the most difficult one.

Traditionally those stimuli are looked for in actual physical situations (in vivo) or by having the patient imagine the stimulus (in vitro).

Virtual Reality (VR) allows a third option of exposure therapy. Research in this area is still in its infancy, but progressing rapidly.

Current Focus

Building on its international success, the project is now focusing on social phobias.

Here patients have a strong fear of one or more social situations, such as talking in public, entering a room with other people, ordering food in a restaurant etc. The VRET system allows patients to be exposed to social situations where they have to interact with others. Patients talk with virtual humans, who respond to their verbal actions.

To make treatments even more cost effective and better accessible for patients, research also focuses on Internet deliverable VRET systems.

In this set up, a therapist can monitor simultaneously multiple treatment sessions over the Internet. Cognitive workload, situation awareness and engagement of the therapist are key research factors in this context. Furthermore, on the patient side, the VRET system automatically creates the appropriate anxiety-evoking situation and monitors the fear level of the patient.

The Case for Action

Phobias are the most common form of anxiety disorders, which themselves are the most common psychiatric disorders.

In 1998 a study was done in the Netherlands on the prevalence of psychiatric disorders in the general population (Bijl, Ravelli & van Zessen). This study shows that the lifetime-prevalence of agoraphobia, social phobia and specific phobias are respectively 3.4, 7.8 and 10.4 %. This means that 3.4 % of the general population is or has been suffering from agoraphobia during his life. 7.8 % and 10.4 % of the population is or has been suffering from respectively a social phobia or a specific phobia during his life.


The latest information about the project can be found at or contact
Willem-Paul Brinkman, Charles van der Mast, or Mark Neerincx
Man-Machine Interaction Group {w.p.brinkman, c.a.p.g.vandermast, m.a.neerincx}