When psychologist Ralph Lamson first put on a virtual-reality helmet at an exhibition of new technology in San Jose two years ago, he unexpectedly collided with his worst fear: his terror of heights.
He found himself in a tall building looking through floor-to-ceiling windows at a panorama far below. But instead of ripping off the helmet that displayed the illusion, he took a deep breath and began inching toward the windows, reminding himself with each baby step that he was safe--and that what he was experiencing was not real.
Lamson says he walked out of the exhibit hall cured of acrophobia and thinking to himself: "I'd better research this."
Last year--with hardware and software on loan from Division Inc. of Redwood City--Lamson conducted what is believed to be the first, and perhaps only, clinical trial of virtual reality in any health-care field. Lamson, a psychologist at Kaiser-Permanente Medical Group in San Rafael, used the new technology in an attempt to relieve the fears of 36 people who had a 20- to 30-year history of acrophobia.
After just one 50-minute treatment, 90% of the participants were able to complete self-assigned goals such as walking across a bridge or riding a glass-enclosed elevator, he told 700 health-care professionals who recently attended the "Medicine Meets Virtual Reality" conference in San Diego.
"It's clear that the time has come for this technology to be applied for therapeutic use," said psychiatrist Hans Sieburg, director of the Laboratory for Biological Informatics and Theoretical Medicine at UC San Diego.
"But we're still very much at the beginning. We need to know what the brain is doing, if virtual reality changes its neurophysiology. Will it help people or will it fry their brains?"
The other members of a panel of psychiatrists and psychologists who listened eagerly to Lamson's presentation raised more questions:
What other phobias or emotional illnesses could virtual reality be used for? What syndromes would the technology aggravate? What people might be harmed by immersing themselves in a world that isn't real? Is it an advisable treatment for children? With current systems such as the one Lamson used costing between $50,000 and $90,000, will virtual-reality therapy ever be economical?
There were no answers because the technology is too new. (The only voices of concern, so far, are those urging caution.) Lamson, however, is already preparing to expand the clinical trials. "I think it can be used for a range of anxiety disorders," he said, "from public speaking to obsessive-compulsive behavior."
For Marianne Descalzo, who suffered from acrophobia for 46 years, there were no drawbacks. "It's wonderful," she said. "It's a big breakthrough."
A native of San Francisco who now lives in nearby San Rafael, she never walked across the Golden Gate bridge until a few months ago. "Before I did virtual-reality therapy, I visited the Grand Canyon twice and never saw it."
Descalzo was one of 88 people who volunteered for Lamson's study. Forty-four people were randomly assigned to virtual-reality treatment; eight dropped out before receiving the treatment. The others were randomly assigned to one of two traditional treatments--medication or six to 10 cognitive therapy sessions--or placed on a waiting list that provided no treatment, in effect forming the control group.
The virtual-reality treatment consisted of one 50-minute session in which the volunteers wore a virtual-reality helmet for 30 minutes, and two 30-minute follow-up evaluation sessions. The helmet covers the eyes and peripheral vision to block out the real world and contains a small computer screen that displays a computer-graphics environment. The volunteers moved through it by pressing a button on a hand-held grip. Lamson monitored their progress on a small computer screen.
"When they put the helmet on, they're in a cafe," said Lamson. "They see colorful booths and lighting on the walls on one side of the cafe. They turn their head, and see a counter. At one end of the room is a door."
Through the door a plank extends from a patio toward a bridge, but doesn't join it. The bridge resembles the Golden Gate Bridge without railings. Beyond the bridge are mountains; below, water.
"Some people don't want to go out the door at all," said Lamson. "When they do, they wobble, spread their arms for balance, shake, or cry," all while standing in the middle of his office. Some thought the plank was 10 feet above the ground; others perceived it as high as 10 stories.
Lamson monitored their heart rate and blood pressure and talked to his clients as they inched their way across the plank, looked down the side of the patio to the ground, stepped timidly across the gap onto the bridge and looked over the edge to the water. He encouraged them, helped them become aware of their breathing and muscle tension, and guided them to the next part of the virtual environment once they became comfortable in the place they were standing.