Hockenbury Discovering Psychology 5th txtbk

Behavior Therapy591IN FOCUSUsing Virtual Reality to Conquer PhobiasVirtual reality (VR) therapy consists of computer-generated scenesthat you view wearing goggles and a special motion-sensitiveheadset. Move your head in any direction and an electromagneticsensor in the helmet detects the movement, and the computergeneratedscene you see changes accordingly. Turning a handgriplets you move forward or backward to explore your artificialworld. You can also use a virtual hand to reach out and touch objects,such as an elevator button or a spider.VR technology was first used in the treatment of specific phobias,including fear of flying, heights, spiders, and enclosedplaces (Garcia-Palacios & others, 2002; Rothbaum & others,2002). In the virtual reality scene, patients are progressively exposedto the feared object or situation. For example, psychologistRalph Lamson used virtual reality as a form of computerassistedsystematic desensitization to help more than 60 patientsconquer their fear of heights. Rather than mental images, theperson experiences computer-generated images that seem almostreal. Once the helmet is donned, patients begin a 40-minute journey that starts in a café and progresses to a narrowwooden plank that leads to a bridge.Although computer-generated and cartoonlike, the scenes ofbeing high above the ground on the plank or bridge are realenough to trigger the physiological indicators of anxiety. Lamsonencourages the person to stay in the same spot until the anxietydiminishes. Once relaxed, the person continues the VR journey.By the time the person makes the return journey back over theplank, heart rate and blood pressure are close to normal. Aftervirtual reality therapy, over 90 percent of Lamson’s patients successfullyrode a glass elevator up to the 15th floor.Once experimental, virtual reality therapy has become an acceptedtreatment for specific phobias and is now being extendedto other anxiety disorders, such as social phobia, panic disorder,and acrophobia (Botella & others, 2007; Parsons & Rizzo, 2008;Powers & Emmelkamp, 2008). One innovative application of VRtherapy is in the treatment of post-traumatic stress disorder(PTSD) in veterans of the wars in Vietnam, Iraq, and Afghanistan(Josman & others, 2006; Reger & Gahm, 2008). Many PTSD patientsare unable or unwilling to mentally re-create the traumaticevents that caused their disorder, but the vivid sensory details ofthe “virtual world” encourage the patient to relive the experiencein a controlled fashion.For example, a young woman who suffered from severe PTSDafter witnessing and barely escaping the attack on the WorldTrade Center was finally able to relive the events of the daythrough controlled, graduated exposure to a virtual reenactmentof the events. Similarly, war veterans can be exposed to thesights and sounds of combat in a way that could not be accomplishedin the “real world” of a therapist’s office or busy downtownstreet.VR therapy is easier and less expensive to administer thangraduated exposure to the actual feared object or situation. Anotheradvantage is that the availability of VR may make peoplewho are extremely phobic more willing to seek treatment. In onesurvey of people who were phobic of spiders, more than 80 percentpreferred virtual reality treatment over graduated exposureto real spiders (Garcia-Palacios & others, 2001).Techniques Based on Operant ConditioningB. F. Skinner’s operant conditioning model of learning is based on the simple principlethat behavior is shaped and maintained by its consequences (see Chapter 5). Behaviortherapists have developed several treatment techniques that are derived fromoperant conditioning. Shaping involves reinforcing successive approximations of adesired behavior. Shaping is often used to teach appropriate behaviors to patientswho are mentally disabled by autism, mental retardation, or severe mental illness. Forexample, shaping has been used to increase the attention span of hospitalized patientswith severe schizophrenia (Zinbarg & Griffith 2008; Silverstein & others, 2005).Other operant conditioning techniques involve controlling the consequencesthat follow behaviors. Positive and negative reinforcement are used to increase the incidenceof desired behaviors. Extinction, or the absence of reinforcement, is used toreduce the occurrence of undesired behaviors.Let’s illustrate how operant techniques are used in therapy by describing a behavioralprogram to treat a 4-year-old girl’s sleeping problems (Ronen, 1991). The firststep in the treatment program was to identify specific problem behaviors and determinetheir baseline rate, or how often each problem occurred before treatment began (seeFigure 14.2 on the next page). After measuring the baseline rate, the therapist couldtarget each problem behavior individually and objectively measure the child’s progress.