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February 10, 2020

The futility of cognitive behavioural therapy

By GlobalData Thematic Research

The World Health Organisation (WHO) has claimed that one in four people will face mental illness at least once in their life. Increasing pressure is placed on health systems worldwide to tackle the global mental health crisis. CBT is an umbrella term of all available therapies that address problems with cognition. CBT was developed in the 1960s by Aaron Beck to help depressed patients. CBT is still the frontline treatment to tackle many mental health disorders, but it has lost its popularity among patients due to lack of improvement.

Despite this, National Health England favours its use. By 2012, it was established that patients found CBT ineffective and had high dropout rates. The latest blow to CBT’s supremacy follows a meta-analysis published by the American Psychological Association Bulletin. Following the assessment of CBT outcomes between 1977 and 2014, it found that the efficacy of CBT is declining and patient relapse rates are increasing. A branch of CBT is In Vivo Exposure Therapy (VET), whereby patients are gradually exposed to feared situations, objects or activities.

It is costly and difficult for patients to escape once they are confronted with a feared stimulus and can often lead to further trauma rather than showing any positive outcome for the patient. An alternative type of CBT is Imaginal Exposure Therapy (IET) whereby patients are asked to imagine feared stimuli whilst engaging in relaxation techniques. However, a flaw in the latter is that it is not possible to quantify what the patients are actually imagining.

Virtual reality therapy is a new approach to mental disorder

The introduction of Virtual Reality Therapy (VRT) is a digital expansion beyond the once-revolutionary ‘Computerized Cognitive Behavioural Therapy’ (cCBT), a form of online CBT that allows patients to engage in online self-therapy. VR provides a more immersive experience than a simple computer screen, and consequently, VRT advances basic cCBT. VRT guides patients through digital environments that require the patient to directly confront feared situations (such as a fear of flying) or objects (a black cat). VRT is most commonly used to treat Post Traumatic Stress Disorder (PTSD), anxiety, paranoia, and phobias.

VRT is used as a convenient alternative to exposure therapy. VRT forces patients to accept their emotions in virtual feared situations. A present therapist guides the patient throughout the VRT treatment, encouraging them to use relaxation techniques. VRT is more efficient and convenient than CBT, for both patient and therapist. VRT does not require the patient and therapist to leave the office and enter real-life, fear-evoking situations. Rather, the patient is placed in a controlled environment and can withdraw at any time, which would not be possible in a real-life scenario.

The future of VRT

VRT addresses the gap between VET and IET as patients have the ability to withdraw quickly from the situation, the therapist has control over what the patient is exposed to, it is more convenient and cheaper than VET, and is measurable, unlike IET. Limited clinical trials have shown that VRT is effective in treating anxiety, addiction, Post-Traumatic Stress Disorder, schizophrenia and depression. However, VRT is a costly therapy that has a long way to go before it can be fully embedded as a frontline treatment. With the increasing popularity of VR among gaming industries, it is likely that VR headsets cost will reduce overtime and in turn, VRT should become a more mainstream alternative to traditional CBT treatments.