New research shows how immersive technology can help patients treat recurring nightmare syndrome.
In the US, between 1/2 and 2/3 of children and up to 15% of adults have frequent nightmares. This has serious clinical effects for sufferers, including not only distress, but chronic loss of sleep and generalized anxiety. And yet, access to effective treatment for the condition is still a problem.
Imagery rehearsal therapy is considered the current gold standard for treatment of this disorder, teaching patients to replace nightmare imagery with less frightening versions. However, success rates tend to vary due to the fact that it relies on an individual’s ability and willingness to conjure up realistic nightmare imagery in their mind’s eye, which can vary greatly from person to person, and is something that usually proves particularly challenging for young children.
Virtual reality-based imagery rehearsal and rescripting treatment (ReScript) aims to enable participants to gain cognitive control over intrusive imagery, and lessen overall anxiety, nightmare distress, or nightmare daytime effects. Center for Mind and Culture cofounders Dr. Patrick McNamara (neurology professor and researcher at Boston University) and Wesley J. Wildman, (professor of philosophy and expert in artificial, computer-simulated environments at Boston University) designed a pilot study to examine if virtual reality therapy could help people with such recurring nightmares.
Over the course of one month, 19 patients who reported having frequent nightmares were able to modify the visuals they found threatening — such as a great white shark swimming closer and closer – using an Oculus headset and joysticks with gesture controls in order to make them less scary.
Participants visited the lab twice a week and were monitored for anxiety, nightmare distress, and nightmare effects – and by the conclusion of the study, participants reported significantly lower levels in all three areas.
Dr.Mcnamara explains that VR therapy is broadly based upon cognitive behavioral principles of exposure therapy – which works on the principle that by exposing patients gradually to stimuli for which they have developed fear responses, those fear responses can eventually be extinguished.
“In the case of nightmares, we could vary the images being presented to patients along 3 dimensions important for nightmare imagery: arousal level (the extent to which the image causes autonomic arousal); dominance level (extent to which image affectively dominates participant feeling response) and valence (positive vs. negative),” adds Dr. McNamara.
The distinct advantage of VR in comparison to traditional exposure therapy is that it allows for realistic, detailed stimuli to be administered with increasing potency. It is also possible to vary the dimensions of that stimuli very systematically, experimenting to gauge which dimension is a more potent contributor to the symptom being treated.
The study concluded that VR takes that burden of imagery generation off of the patient by generating and presenting the images for them. This is a particularly promising avenue for treating younger patients, since they are familiar and willing to interact with technology, and also because the technique can effectively slow down or prevent nightmare disorder conversion into psychosis, ultimately saving lives.
“VR furnishes a solution to the image stabilization challenge that makes existing therapies impractical, particularly given that people vary in their abilities in image stabilization,” explains Dr. Wildman.
Implications of their work is particularly significant for children, as recurring nightmares can be predictors of adolescent and adult psychosis (including anxiety, depression, stress, and suicidal ideation) for kids. This new therapy technique can leverage young people’s ability to adopt emerging technology in order to provide a more tangible approach to treating nightmare disorders.
Immersive technologies are being used for therapeutic purposes in everything from the treatment of phobias to speech impairment – and companies like Limbix and Healium are developing commercial products to meet this increasing demand. However, although research has shown that VR has been used effectively to treat anxiety and other psychiatric disorders, some studies also point to the fact that we know relatively little about the broader and more long-term psychological effects that immersive experiences have on us.
The next steps for the researchers are to conduct a double-blinded, placebo-controlled trial for VR enabled nightmare treatment – and then possibly extent its use to kids with recurrent nightmares.