Freeman et al. (Reference Freeman, Reeve, Robinson, Ehlers, Clark and Spanlang2017) provided a comprehensive overview of the scientific literature into virtual reality (VR). In particular, evidence supporting the efficacy of VR in the delivery of graded exposure therapy (Powers & Emmelkamp, Reference Powers and Emmelkamp2008) highlights its usefulness in the treatment of anxiety and related disorders, where exposure is a key ingredient of effective treatment. Enabling clinicians to set up VR exposure situations that are too costly, or impractical to re-create in real life, and deliver them in a controlled and safe manner are particularly appealing aspects of VR.
Freeman et al. (Reference Freeman, Reeve, Robinson, Ehlers, Clark and Spanlang2017) claim that progress has been ‘…slow because hardware and software have been expensive and expertise limited’ but acknowledged ‘this is about to change’. We argue that the technology has already progressed, but the literature has fallen behind. Affordable VR and augmented reality tools and technologies are already available for gaming and other uses, but their full potential has not been realized in the mental health domain. For example, using 360o cameras, we can take images and videos of real-life situations and view them in 360o surround view using a smartphone and low-cost VR headset (costing under $25). These VR tools hold great potential to assess how individuals with mental health problems respond in ‘emotionally charged’ environments, and to individualize and tailor exposure scenarios to target specific fears, whilst maintaining immersion and presence thought to be key components of VR (Ling et al. Reference Ling, Nefs, Morina, Heynderickx and Brinkman2014).
Freeman et al. argued that treatment trials have ‘seldom been conducted to the standards now expected in clinical research’. Although we agree, a more concerning problem is that free VR tools that claim to ‘cure’ mental health problems are being released to the public without being evaluated, similar to the majority of ‘mental health’ apps that have been released without evidence (Donker et al. Reference Donker, Petrie, Proudfoot, Clarke, Birch and Christensen2013). For example, one VR program – Arachnophobia by IgnisVR – claims to help people overcome ‘irrational fears of spiders’, but instead of gradually exposing individuals to spider situations, it floods the VR environment with virtual spiders, potentially worsening spider fears, and contributing to misperceptions of what exposure therapy entails (Fahey, Reference Fahey2016). Another program, Samsung's BeFearless Heights program, claims to help people overcome heights fears, but has never been evaluated in a peer-reviewed study, leaving it unclear whether it is safe or effective.
In addition to the three treatment questions outlined by Freeman et al. (Reference Freeman, Reeve, Robinson, Ehlers, Clark and Spanlang2017), the lack of empirical scrutiny of freely available VR programs in the public domain also needs to be urgently addressed. Our challenge will be to ensure freely available VR programs are tested with the same scientific rigor expected of any mental health intervention. The technology is, as the authors state, ‘developing fast’. A consequence of this fast-developing technology is that there is more technology available in the public domain than research to support it. We also need to keep abreast of rapid developments in affordable and accessible VR technologies, so that their potential to further our understanding, assessment, and treatment of mental disorders is realized, not wasted.
