Free Falling Clinic takes a technological approach to treating anxiety From: Mountain View Voice - 10/09/2003 - page 19 By: Anna Galan Your seat shakes beneath you as you taxi down the runway. In a soothing voice, the pilot tells you your airplane is about to take off. With your seatbelt securely fastetied and your chair in the upright position, you are ready to begin your fight. But this isn't the typical trip in a 747; it's a virtual-reality therapy session meant to help people with a fear of flying - suffered by an estimated 10 to 20 percent of the population. At the Virtual Reality Medical Center in Palo Alto, instead of drinks and pretzels, clients get their physiology measured by sensors. They wear a head-mounted display with visual monitors and earphones, complete with sub-woofer vibrations beneath them. Vintage Pan-Am Airways posters cover the walls. A custer of four seats - taken from a supplier who does Hollywood mock-ups adds to the level of reality. You've heard of virtual reality before, but using 3-D computer simulations to help people get over phobias? It's exposure therapy that places clients in a computer-generated environment where they can experience aspects of situations that make them anxious. Clients learn to monitor their fears, not only mentally through repeated exposure, but physiologically as well. Through careful monitoring of heart rate, respiration rate, sweat gland activity, and skin temperature, patients can see their bodies' responses to anxiety. The VRMC offers treatment for fear of flying, fear of heights, fear of driving, fear of public speaking, and panic associated with agoraphobia, claustrophobia, and post-traumatic stress disorder. "The experience is very relaxing. I pretend my husband is driving the car on a bumpy road", said Kathy Feldman who went through the therapy for her fear of flying. After having a bad experience on a plane in 1994 she tried everything from cognitive therapy to hypnosis and biofeedback in order to overcome her phobia. When she saw a program about virtual-reality therapy on television, she called the VRMC for more information. At the time, their office was located only in San Diego, so Feldman, who lives in Portola Valley, drove down for an accelerated, week-long course. "It was great," she said. "I was so happy to be there." She had about seven sessions and found it especially helpful to see measurements of her heart and breathing rates in real time on the computer. "It so much identified my rough spots in the air, and it gave me more of a scientific perspective of what was going on," Feldman said. "I got more credible information than simply feeling the fear." Now, she said, "I think I'm on the other side of the phobia." Dr. Brenda Wiederhold, executive director of the VRMC, said most people come for eight to 12 sessions for a specific phobia, learning new skifis and thought-processes. "If they practice their skills, I don't see them again," she said. As part of Feldman's sessions, a therapist went through the program step by step with her. Patients at the VRMC also have the option of taking the therapist with them on their real-world practice sessions from Stanford's Hoover Tower for those afraid of heights, to flights to Nevada for those afraid of flying. For her first real-world practice, Feldman flew to Reno from San Francisco, because "that is the shortest distance via jet you can go," she said. She stayed about 45 minutes in the airport, where she gambled a little, then returned to San Francisco. One week later, she flew the route again. "I knew the more I flew, the better it would get," she said. Within three months after her initial ifight, she flew eight to 10 times In the two years since her treatment, she said she has flown more than 25,000 miles. "I no longer have nightmares before I fly, and I don't have anxiety when I do," Feldman said. She even has a ritual these days before she flies. "I meet the fight attendant and say, 'I'm a former fear-of-flying person,' and then I ask to meet the pilot. I spend about five minutes in the cockpit, and the pilots are always really good about it. Once, a pilot even joked with me and said, when I told him I had a fear of flying, 'Oh I have that too.'" Wiederhold was one of the first people in the United States to purchase a virtual reality system for $20,000. In 1997, and she and her husband, Dr. Mark Wiederhold, established the VRMC in San Diego. They also maintain an office in Santa Monica. They began offering services in Palo Alto in November 2002. Wiederhold is working to expand local offerings, which now operate out of two rooms in an office on Hamilton Avenue. The facility in San Diego is more than 10,000 square feet, and is used to treat various phobias and other conditions, including anorexia. The technology has come along way since Wiederhold first began working with patients and virtual reality. Her nonprofit organization, the Interactive Media Institute, is heading up a conference in 2005. She is also currently working with Frank Wilhelm and James Gross at Stanford's department of psychology to develop new and improved therapies. Opportunities for employing the technology have been overwhelming. While the military has used virtual reality to train soldiers for years, more therapeutic and educational uses are being put into place. Recently, Wiederhold worked with 15- and 16-year-olds, teaching them how to drive using the virtual-reality technology. Not only did teens practice dangerous driving situations, such as pedestrians darting out in front of them, they also experienced a simulated experience of attempting to drive while intoxicated. The DMV will follow these 200 teens for two years to see if they have fewer accidents. "Kids were brought up on video games, so we can't always expect them to sit in a classroom with a chalkboard and pay attention," Wiederhold said, of adding the technology to more traditional methods of education. She also discussed her work with smoking cessation, getting children with ADD to learn how to deal with distractions, and helping Vietnam Veterans cope with post-traumatic stress disorder. She is also working to develop programs for young burn victims to place them in a virtual reality environment while they are getting their wounds changed, as using morphine with children, is extremely dangerous. In Italy, scientists are developing ways for obese patients to modify their eating behavior, not only in the virtual world, but in the real world as well. Those with an aversion to doctor's bills might need to desensitize themselves to the price of virtual-reality therapy before they go to VRMC. The clinic charges $300 for the initial intake session and $200 for each subsequent session. However, most insurance companies the center has worked with have covered most of the cost, Wiederhold said.