Virtual reality (VR) is finally becoming a reality for consumers, thanks to a new generation of affordable gear that could expand its use beyond travel and entertainment to medicine. But what you might not know is that VR is already in use for therapy and has been for the past 20 years, although its long-term effects remain a mystery.

At California’s Virtual Reality Medical Center, the technology has been treating phobias like fear of flying, driving, heights or public speaking, post-traumatic stress and war-related trauma since the early 1990s. “We call it VR-enhanced Cognitive Behavioral Therapy,” said Brenda Wiederhold, Executive Vice President of the center.

Coupled with traditional techniques like diaphragmatic breathing and cognitive reframing, virtual reality gives patients “a nice, sweet spot in-between imagination and real world” – a virtual setting where they learn to use their coping skills to deal with the experience.

Therapists guide their patients through worlds created by 200 clinically-validated virtual reality software packages and monitor their heart rate, breathing, sweat gland activity, and physiology in real time.

“We don’t want to move them through the world too fast and re-traumatize them, nor have them have a panic attack,” said Wiederhold. “And we also don’t want to put them in the world and have no response because we have to have a little bit of activation of the subjective anxiety, the suggestive stress, as well as the physiological stress or anxiety.”

The VR environment also awakens memories the patient might not be aware of.

“We want to solidify, consolidate those fragmented memories they still might have about that trauma and then have them move through that memory, through the emotional processing that is necessary to them to desensitize or overcome that traumatic memory.”

The treatment has been relatively successful – 92 percent for phobias and 80 percent for war-related traumas. The rates could go higher with better equipment.

As more accessible and more immersive equipment becomes available, Wiederhold believes virtual reality will become more prominent in cognitive therapy for diagnosing, assessing and rehabilitating pre-dementia, for example, or to help stroke victims with brain injuries.

We used to sit around and say ‘what if, what if.’ Well, the technology has caught up with the imagination … and it really is limitless now.

Side effects

However, some VR headsets are known to cause nausea, motion sickness, flashbacks and other effects. About two percent of the center’s patients, who are only exposed to virtual reality for 30 minutes at a time, suffer from motion sickness or queasiness.

But Wiederhold believes the technology does not have long-lasting effects. She cited flight simulators that have been training pilots since the 1960s as an example. “Those individuals have not suffered any long-term effects. We don’t think there will be long-term effects.”

Neurophysicist Mayank Mehta of the University of California, Los Angeles, is not so sure. After all, virtual reality is unlike any other media that came before it

Virtual reality reacts to the subject’s actions … on a millisecond-to-millisecond basis. … Watching television is not different than looking outside your window … It does not react to what you do.

This is important because up to 99 percent of brain activity takes place behind the scenes. “You don’t perceive it,” he said, “but it is going on. And then it can do something many years later. Then you notice it.”

The nature of the brain is such that whatever people experience changes it or gets stored in it. “When it gets stored somewhere, it means that the brain has to change,” said Mehta. “It means the brain is very plastic.”

Brain on VR

So what happens when the brain is exposed to virtual reality?

A courtesy picture shows UCLA’s rat in the virtual reality environment. (Mayank Mehta/UCLA)

To find out, Mehta and his fellow scientists created a virtual 3×3-meter room – simple and empty – and placed a rat in it.

As the rat paced around, not tasked with any activity, researchers studied the Hippocampus – a part of the brain crucial for spatial mapping, learning, memory and emotions. It also figures prominently in neurological diseases like epilepsy, Alzheimer’s, PTSD and others.

The results were surprising.

First, 60 percent of the neurons shut down; and scientists don’t know if that is good or bad. “That’s a massive shutdown,” said Mehta. “Why did they shut down? We think it’s because the virtual world is not real.”

Secondly, researchers found that the Hippocampus generates a distinct rhythm “crucial for learning and memory.” It is found in humans and rats. “We can’t feel the rhythm,” he said. “You can’t see the rhythm, but it’s there.”

Any disruption in this rhythm leaves long-lasting effects on the subject’s learning and memory processes. And that was the second surprising finding for Mehta.

The rhythms too were actually significantly altered just because the rat was in the virtual world.

The team then turned its attention to the remaining active neurons and found that “the spatial map containing these neurons was also severely disrupted in virtual reality and also in very sophisticated ways.”

“These are pretty major effects … that no scientists, including us or others, had expected,” he said.

Festival goers experience Samsung Gear VR at The Samsung Studio at SXSW 2016 on March 12, 2016 in Austin, Texas. (AFP)

It is unclear if these observations have long-term positive or negative effects. That’s why Mehta believes longitudinal studies on the same rats are needed to find out if the Hippocampus activity pattern is normal in virtual reality, and whether or not it leads to long-term changes.

There might exist a virtual reality system that does not cause these things, but Mehta said no one has shown that so far. “I don’t want to either raise an alarm or say we should ignore it. We should definitely study this.”

Mehta’s message is for people to wake up before millions start using this technology for hours at a time.

“These rats are doing it for only 10 minutes to half an hour a day,” he said. ‘What are the long-term consequences that need to be measured? It’s not the same old television. And that’s all we want – the message to go across.”