Summary form only for tutorial. After an early period of inflated expectations and limited delivery, Virtual Reality (VR) technology has emerged as a viable tool for cognitive/behavioral mental health and rehabilitation applications. VR allows for the systematic presentation of stimuli that target human behavioral and cognitive processes relevant for assessment and intervention purposes. The capacity of VE technology to create dynamic interactive three-dimensional (3D) stimulus environments, within which all behavioral responding can be recorded and measured, offers clinical assessment and intervention options that are not available using traditional methods. These applications have shown promise for addressing: fear and anxiety with phobic and PTSD clients, distracting patients during painful and anxiety-provoking medical and dental procedures, treating eating disorders and obesity, navigation and spatial training in children with motor impairments, functional skills in persons with developmental disabilities and autism, and in the assessment (and in some cases, rehabilitation) of memory, attention, spatial skills, and executive cognitive functions in populations with CNS dysfunction. Functional VE training scenarios have also been designed to test and teach instrumental activities of daily living such as street-crossing, automobile driving, meal preparation, supermarket shopping, use of public transportation, and wheelchair navigation. The therapeutic targets chosen thus far for these clinical applications reflect an informed appreciation for the unique assets that are available using virtual technology and these initiatives have formed a foundation of work that provides support for the value of further development of VR Mental Health/ Rehabilitation applications.

Virtual Reality (VR) technology continues to evolve from the realm of an “expensive toy” into that of a functional technology. Although media hype may have oversold VR’s potential during the early 90’s, data has now emerged that supports its use as a valuable tool for cognitive, behavioral, physical, mental health and medical applications. Much like an aircraft simulator serves to test and train pilots under a variety of controlled conditions, VE simulations can model processes that are vital in the assessment, rehabilitation and treatment of clinical populations. In this regard, a growing number of laboratories are developing research programs investigating the use of VEs for these patient purposes and some of these systems have now made the transition into clinical practice. The presenters for this workshop have all developed and/or implemented VR applications that have shown promise for addressing fear reduction with phobic clients, pain and stress reduction for cancer patients, post traumatic stress disorder, physical therapy, anger management, driving abilities with Multiple Sclerosis and brain injury patients, and in the assessment and rehabilitation of motor skills, attention, memory, and vis uospatial processing in persons with central nervous system dysfunction and the elderly. These therapeutic targets reflect an informed appreciation of the unique assets that are available when using VR technology and provide a foundation of work that is supportive of the further development of these “healing” applications. The presenters will detail their work and support the case that these areas represent the “Kinder Killer App”!

Virtual reality therapy (VRT), based on this sophisticated technology, has been recently used in the treatment of subjects diagnosed with acrophobia, a disorder that is characterized by marked anxiety upon exposure to heights and avoidance of heights. Conventional VR systems for the treatment of acrophobia have limitations, over-costly devices or somewhat unrealistic graphic scenes. The goal of this study was to develop an inexpensive and more realistic virtual environment (VE) in which to perform exposure therapy for acrophobia. It is based on a personal computer, and a virtual scene of a bunge-jump tower in the middle of a large city. The virtual scenario includes an open lift surrounded by props beside a tower, which allows the patient to feel a sense of heights. The effectiveness of the VE was evaluated through the clinical treatment of a subject who was suffering from the fear of heights. As a result, it was proved that this VR environment was effective and realistic at overcoming acrophobia according not only to the comparison results of a variety of questionnaires before and after treatment but also to the subject's comments that the VE seemed to evoke more fearful feelings than the real situation.

Virtual reality (VR) is usually described in biology and in medicine as a collection of technologies that allow people to interact efficiently with three-dimensional (3-D) computerized databases in real time using their natural senses. This definition lacks any reference to head-mounted displays (HMDs) and instrumented clothing such as gloves or suits. In fact, less than 10% of VR healthcare applications in medicine are actually using any immersive equipment. However, if we focus our attention on behavioral sciences, where immersion is used by more than 50% of the applications, VR is described as an advanced form of human- computer interface that allows the user to interact with and become immersed in a computer-generated environment. This difference outlines a different vision of VR shared by psychologists, psychotherapists, and neuropsychologists: VR provides a new human-computer interaction paradigm in which users are no longer simply external observers of images on a computer screen but are active participants within a computer-generated 3-D virtual world. This special issue investigates this vision, presenting some of the most interesting applications actually developed in the area. Moreover, it discusses the clinical principles, human factors, and technological issues associated with the use of VR in the behavioral sciences.

The goal of this study was to determine if virtual reality graded exposure therapy (VRGET) was equally efficacious, more efficacious, or less efficacious, than imaginal exposure therapy in the treatment of fear of flying. Thirty participants (Age = 39.8 +/- 9.7) with confirmed DSM-IV diagnosis of specific phobia fear of flying were randomly assigned to one of three groups: VRGET with no physiological feedback (VRGETno), VRGET with physiological feedback (VRGETpm), or systematic desensitization with imaginal exposure therapy (IET). Eight sessions were conducted once a week. During each session, physiology was measured to give an objective measurement of improvement over the course of exposure therapy. In addition, self-report questionnaires, subjective ratings of anxiety (SUDs), and behavioral observations (included here as flying behavior before beginning treatment and at a three-month posttreatment followup) were included. In the analysis of results, the Chi-square test of behavioral observations based on a three-month posttreatment followup revealed a statistically significant difference in flying behavior between the groups [chi(2) (4) = 19.41, p < 0.001]. Only one participant (10%) who received IET, eight of the ten participants (80%) who received VRGETno, and ten out of the ten participants (100%) who received VRGETpm reported an ability to fly without medication or alcohol at three-month followup. Although this study included small sample sizes for the three groups, the results showed VRGET was more effective than IET in the treatment of flying. It also suggests that physiological feedback may add to the efficacy of VR treatment.