It's a bit funny to think about how our brains can be so easily convinced by things we technically understand are not real. For example, if you are using AR and see a spider, you can know that that spider is not real, you know the room is safe and that whole thing was built by software, but still be pretty much terrified of it. And that's why I think augmented reality can be a pretty cool tool in mental health.

If you think about it, anxiety already kind of works like that... You are not actually waiting for the facts to be perfectly organized in your brain; you react to what something means or what it reminds you of. So when AR can place a fake spider, cockroach, or feared situation into a real room and bring up an emotional reaction, it can make your anxiety become visible right in front of you.

Most people with phobias do not need one more person telling them the fear is exaggerated. They know and that is part of what makes it SO frustrating. The problem is that knowing something in your head and feeling safe in your body are completely different experiences. That's where AR can be incredible, because it allows your body to practice in a fearful situation. The review that looks directly at AR exposure therapy is still small, but it gives us a pretty good idea of the advantages. It found thirteen studies, mostly about specific phobias, especially spiders and cockroaches. The results were promising, with high satisfaction and some evidence that people experienced AR exposure as less aversive than facing the feared object directly in real life (1).

Let's think for a second about how much we are asking when we talk about traditional exposure therapy: If someone is terrified of cockroaches, you need the cockroach, the right setting, the right distance, the right timing, and enough control so the person does not feel pushed too far. That's a lot. AR can bring the feared stimulus into the space without needing the real thing to be there, and because the person still sees the real environment around them, it can make the exercise more controlled and possibly easier to tolerate.

And it goes against the way we usually use technology. Most of it helps us avoid discomfort, whether it's through useful apps or social media algorithms; we are almost always trying to make the "bad" sensations disappear as quickly as possible. Now AR can be used to bring discomfort back, but in a way that has boundaries around it. The experience is manufactured, yes, but the emotional work is still there! A controlled situation can still teach the body how to react, so immersive technology, which we usually imagine as a way to leave reality, can also be used as a way to rehearse returning to it.

The VR studies seem to point in a similar direction. A review on VR and gamification for anxiety and depression found positive effects across the included studies, especially when VR created controlled situations where people could face anxiety-provoking experiences and practice coping strategies. Another scoping review on extended reality looked at 85 studies from 27 countries and found that most reported reductions in anxiety or depression symptoms. However, it's important to mention that these studies are still focusing on developed countries and specific age groups, so we should be mindful that there's still a long way to go in terms of what we need to know about VR and gamification as therapeutic tools (2, 3).

If we look specifically at teenagers, there are some interesting results. One study with 789 adolescents used a three-month VR-assisted intervention and reported better results in cognitive ability, emotional attitude, social behavior, adaptability, and social interaction compared with the control group. That is exciting, especially because young people already live so much of their emotional and social lives through digital spaces, which suggests this could be a useful tool when it is designed with an actual therapeutic purpose (4).

But, since not everything is a one-size-fits-all solution, we need to be careful about how we use it. A review on VR and AR for psychotic disorders found encouraging evidence for VR as an addition to treatment and rehabilitation, but did not find AR studies being used for diagnosis or treatment in that area. That does not mean it's harmful, but we can’t say much about its use in that context yet. AR may be a good fit for phobia exposure because exposure is already part of treatment and we have better evidence backing it up. That does not mean it belongs everywhere in mental health care, at least not until we have more certainty on the effects (5).

So, even though immersive technologies are very futuristic and cool, I think the most interesting part is how they show that our brains are not reacting only to facts. They are also reacting to feelings, memories, expectations, and context too. And maybe we can use technology for that, not as another way to escape life, but as a better way to practice coming back to it.

References: (1) Augmented reality exposure treatments in anxiety and related disorders: A systematic review (2) A systematic review on the efficacy of virtual reality and gamification interventions for anxiety and depression (3) Extended Reality for Mental Health Evaluation: A Scoping Review (4) Virtual reality in adolescent mental health management under the new media communication environment (5) A Systematic Review of using Virtual and Augmented Reality for the Diagnosis and Treatment of Psychotic Disorders