Background and Presentation of the Patient
A woman in her mid-40s came forward with the desire to address her severe fear of flying. Although she had never flown before, just the thought of a flight triggered intense anxiety. The catalyst for her desire for therapy was an upcoming concert of her favorite band abroad, which she wanted to attend with her son. As a single mother, she also felt it was burdensome to have denied him this experience until now.
Therapeutic Approach
After a relationship-building initial conversation, the VRET system Lab E virtuallythere was used in the preparation phase to select suitable exposure scenes on the topic of "flying." The system offers a modular scene structure that allows for the targeted selection of specific stages of a flight journey – for example: check-in, security check, boarding, seat selection, takeoff, flight with/without turbulence, landing.
Initially, these stations were mentally reviewed. The patient showed no signs of anxiety at first, even when imagining boarding the plane. The first sign of irritation appeared only when walking through the gangway – this caused a vague discomfort, although the patient could not specifically explain it.
VR Exhibition and Emotional Reaction
In the next session, the exposure was conducted using a VR headset. The therapist initially chose a standardized flight scene without any intervening events. The patient reacted neutrally to interested, asked technical questions about the cabin, and showed no signs of fear – not even during a subsequent scene with moderate turbulence.
Only when she independently selected a scene from the available module options that depicted waiting in the gangway and boarding the airplane did clear signs of fear reactions emerge. The VT system from virtuallythere offers a realistically filmed boarding situation with authentic sound, waiting noises, and a feeling of tightness. The patient suddenly exhibited physical signs of stress: reddened skin, trembling, and sweating. Upon entering the airplane, this escalated into a panic attack.
Thanks to previously practiced relaxation techniques and therapeutic support, she was able to endure and cope with the situation.
Debriefing: Uncovering Repressed Content
In the debriefing, it became clear that the patient did not actually have classic flight anxiety in the true sense. The intensive VR exposure activated a repressed childhood memory. The patient spontaneously described images from her childhood: she remembered a long-forgotten flight with her family to a Mediterranean island. During this vacation, she became seriously ill. On the last day of the trip, her parents also informed her that a move was imminent – an event she experienced as a deep cut and loss of her then social environment. The patient had completely repressed these experiences until then. The VR exposure activated the emotional connection between the specific spatial situation (aisle/airplane) and the trauma from that time.
Outlook
After the exposure, the patient was able to temporally organize and cognitively differentiate the emotions experienced. The symptoms referred to as "fear of flying" were thus decoupled – as a result, no renewed anxiety behavior was observed during further exposure attempts. She plans to undertake a test flight trip with her son before Christmas. The therapy will continue to address any potential emotional aftereffects.
Conclusion
The case demonstrates how helpful real filmed VR-supported exposures can be – not only for targeted confrontation with anxiety content but also for differentiating anxiety triggers, or in this case, for differentiating genuine phobias from trauma-related reactions. The modular selection option in the VT system aids in diagnosis and individual adjustment of stimuli.
Source: Silvester Schmidt, Alternative Practitioner for Psychotherapy - www.psych-si.de
Note on Technology:
The VT system used by virtuallythere allows for a finely graded selection of situations in over 60 psychotherapeutic diagnostic variants through its structuring of the VR video library. Its practical usability was assessed positively during the course of therapy, as the patient was able to independently select scenes.
