Coaching patients with integrated VR exposure therapy
An interview with Dr. Elizabeth McMahon
by Kristi Hansen Onkka
I first met Dr. Elizabeth McMahon at UploadVR’s Healing with VR event in April 2017. As I mingled around the Upload Collective, I noticed many of the high-end HTC Vive VR demonstrations had quite a few people queued to try them out. I was deciding which one to get in line for when I noticed an unassuming older gentleman with a laptop and a Samsung Gear VR set up on a small table in the corner of the room. I wandered over and introduced myself asking what he had to show. He quickly smiled and gestured over my shoulder saying, "oh you need to talk to my wife." I turned around to see the petite Dr. McMahon.
Dr. McMahon is not the typical Silicon Valley early adopter. On the contrary, she is a seasoned psychologist who specializes in treating, among other things, anxiety disorders. She was invited to the Healing with VR event to speak on the panel, demonstrate the software she uses in her practice and offer her insights on virtual reality in health from a clinician’s perspective.
She is a healthcare professional in every sense of the word. Passionate and caring, she comes from a long line of doctors driven to give the best care possible. For Dr. McMahon, that means treatments which are based on evidence, not just the newest and shiniest trend.
“I have an open mind with rigorous requirements. Every approach has value, but I want to spend my energy using those that are the strongest and most effective.”
Dr. Elizabeth McMahon
After reading a report called Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis in a 2008 edition of Journal of Behavior Therapy and Experimental Psychiatry, she knew that virtual reality could possibly fill a gap she had noticed in her practice. She searched for therapists who had used virtual reality in psychotherapy and drove all the way from the bay area to Fresno, California to see a demonstration from a family therapist. She remembers the visceral feeling of her first VR experience. “I know I am testing this in the office. But this feels real.”
Those first virtual reality exposure therapy experiences weren't exactly ready for mass clinical adoption. There were virtual environments for only three fears. They were clunky and required a lot of set up. Still, she was able to write a grant to get VR exposure therapy into her services at Kaiser.
When she left Kaiser in 2013 to open her own practice, she wanted to continue offering VR exposure therapy. She aligned with a new startup software called Psious that uses mobile-based Samsung Gear VR, a less complicated headset than she previously used. As one of the first beta testers for the software, she was able to work with the developers to modify and extend the exposure scenarios. One example of her influence is in the “fear of heights” simulation. The developer’s initial application started the user up high at the top of a skyscraper. Dr. McMahon helped Psious understand the need for graduated steps in optimal exposure therapy. They needed to start the experience with the user lower to the ground, and then give the psychologist the options for increasing that distance.
An integrated approach
“An athlete is out there day to day running the plays. The coach sees the big picture and tailors their vast knowledge of the game to the individual.”
Dr. Elizabeth McMahon
In her coaching of anxiety patients, Dr. McMahon follows four sequential steps to treatment.
1. Uncover the source
In anxiety disorders, it’s important to understand the underlying source and trigger. Dr. McMahon’s practice uses non-VR techniques to explore and illuminate anxiety issues so they can be properly analyzed. For instance, a person’s perceived fear of flying might be a larger indication of fear of lack of control. Once the actual fear is isolated and questioned, the therapy can be better focused.
2. Strengthen the tolerance
The next step is helping to build up tolerance for the anxiety. In this part, Dr. McMahon guides patients through breathing, mindfulness and relaxation techniques. If distraction or concentration is an issue, Dr. McMahon may provide virtual reality therapy to help patients focus.
3. Rationalize with facts
The third step sorts out fact from perception. In this step, patients learn credible facts about the situations that cause them anxieties. They use this information to create more rational counter statements that help center their internal conversations.
4. Test what you’ve learned
Only after the first three steps can a patient begin to expose themselves to their fears. Armed with a better understanding of these anxieties, patients are guided through graduated immersion exercises. Immersive exposure can begin with imagining or talking about facing fears. But before virtual reality, there was still a big gap between imagining facing a fear and actually confronting it in real life.
Virtual reality bridges that gap between the office and real life. VR exposure allows patients to practice what they have learned in a controlled environment. They gain experience, skill, and confidence.
Controlling the scenarios
The Psious VR therapy Dr. McMahon uses gives her a real time view of what the patient is seeing throughout the session. While the patient wears the Samsung GearVR virtual reality headset, she can control and monitor the virtual reality exposure therapy experience via a laptop computer interface. This allows her to adapt the experience according to her patient’s individual needs. She can also monitor biofeedback data thanks to the additional sensors provided with the platform.
Thanks to active participation in software development and real-world integration into practice protocols, hundreds of professionals like Dr. McMahon are helping Psious extend their clinical utility into numerous pathologies like ADHD, OCD, agoraphobia, PTSD and stress management.
Psious VR is featured on our infographic Your Human Journey: A Prescription for Virtual Reality. Check it out!