Anxiety — The Vague Unease from Within

The chapter lists the tools technology has given psychology — MRI, EEG, galvanic skin response — before turning to virtual reality: a technology that, through a head-mounted display or helmet, «tricks» the user's senses into feeling physically present in an artificial environment. The book distinguishes two roles of VR in medicine: a simulation tool for surgeons and an interaction tool for behavioural medicine. Used clinically since the mid-1990s, the method is applied most widely to anxiety disorders, PTSD and OCD.

The theoretical basis is explained clearly. One of the most effective treatments for anxiety is «exposure», delivered in three forms: facing the feared situation in real life, imagining it, and virtual reality. According to Foa and Kozak's emotional processing theory, changing a fear structure requires first activating it and then introducing new information incompatible with earlier learning. Three conditions are needed: the person must feel present in the environment, the environment must provoke physiological arousal, and what is learned must generalise to real life.

The chapter's strength lies in concrete studies. In the first controlled study in 1993, with people afraid of heights, Rothbaum and colleagues exposed participants for eight weeks to virtual environments with lifts, bridges and balconies; although participants knew the environment was artificial, their palms sweated and their knees went weak, and in the end their anxiety fell significantly. In Carlin's 1997 spider-phobia study a sense of touching a virtual spider was created, and later research turned the engines of computer games such as Half-Life and Unreal Tournament into therapy environments — a detail as intriguing as it is unexpected.

The section on fear of flying is also informative: a virtual helicopter flying over rivers and lakes, a vibration device adding a sense of touch, anxiety measured through skin temperature and brain waves. The book also reports that no difference in effectiveness was found between the expensive CAVE system and a simple head-mounted display (HMD), that motion simulation added no benefit, and that in claustrophobia a person who had lived with the fear for 40 years was able to ride a lift alone after seven sessions. These examples convincingly show the method's potential.

Yet the problems of the chapter — and of the whole book — show here too. The text is as dry and repetitive as if lifted from an academic article: phrases like «it is noteworthy» and «it reveals» recur in almost every paragraph, and none of the cited studies is given a full reference. The most recent examples date from 2010, whereas consumer VR headsets have since transformed the field. Moreover, the back-cover promises about trauma, neuroplasticity and «four skills» do not match the contents — readers may feel they are reading the blurb of a different book.

In the end, this chapter is the most original and informative part of the book: it shows clearly why and how virtual-reality therapy works and on which phobias it has been tested. But as a whole the book does not deliver on the «You Are the Solution» promise in its title — it gives readers suffering from anxiety clinical information rather than concrete steps. For anyone experiencing serious anxiety this book is no substitute for seeing a professional, only a starting point for understanding the terms.

• Systematic chapters using medical terminology
• Summaries of concrete clinical studies
• The Liebowitz Social Anxiety Scale in full
• Colour photographs and margin notes