Facilitation Technique Category: Assistive Technology

Activity Title: Virtual Reality Therapy: Exposure Therapy; Flooding and Graded
Exposure Technique
Source: Dattilo, J., & McKenney, A. (2011) Facilitation Techniques in Therapeutic
Recreation. State College, PA: Venture Publishing, Inc
Equipment: Virtual Reality Headset, Specially Programmed Computers, Visual
Immersion Devices, Artificially Created Environments and/or Data Glove
Activity Description: Assistive Technology (AT) is defined as any item, piece of
equipment, or product system, whether acquired commercially, modified, or customized,
that is used to increase, maintain, or improve functional capabilities of individuals with
disabilities. Too much dependence on others can severely inhibit quantity and quality of
leisure participation, however AT allows people with disabilities to become more
independent and self-determined. It has been proven that as the range of recreation
activities decreases, opportunities for enjoyment and development decline. But
technology is able to promote leisure experiences for everyone because it facilitates
opportunities for successful and independent participation as well as competitive and
cooperation. Other benefits of technology include: expression of creativity in activities,
provides multiple opportunities for choice, can stimulate inclusion and equal participation
with peers, increased physical outcomes (improved hand-eye coordination, fine motor
skills, bilateral coordination), and improved cognitive and linguistic skills. The activity
chosen for this week is called Virtual Reality Therapy. The number of participants is
limited to the capacity allowed by the Virtual Reality machinery/computers, which in
most cases is just one person. Virtual Reality Therapy (VRT) is a type of psychotherapy
that uses virtual reality technology to treat people. VRT employs special programmed
computers, visual immersion devices, and artificially created environments to give the
patient a simulated experience that can be used to diagnose and treat psychological
conditions that cause difficulties for people/patients. Examples of VRT treatment may
include adjusting the virtual environment, such as intensifying a certain smell or
adding/adjusting vibrations, while allowing the clinician to determine the triggers and
triggering levels for each clients reaction. One of the many benefits of having VRT
technology available is that it allows the ability to replay virtual scenes, with or without
adjustment, in order to accustom the client to a specific environment. One technique
available for Virtual Reality Exposure Therapy includes flooding, which is the most
intense approach, where stimuli that produce the most anxiety are presented first. For
example, for clients who have PTSD from combat, the flooding technique would involve
first exposing them to a virtual reality scene where their fellow troops are being shot or
injured, and would then be followed by less stressful stimuli such as the sounds of war.
On the pother hand, with graded-exposure, first provides the client with the less
distressing stimuli at first, and then gradually intensifies the amount of exposure as the
process moves on.

Leadership Considerations: A CTRS will function as an instructor for this activity, and
he/she will assist the client if any help is needed. If there are any limitations that a client
may have or that has already been diagnosed as having, it is essential that the CTRS
gather this information as early as possible. This is done so the leader can have time to
prepare/adjust the activities, according to the specific clients needs. The level of
closeness between the leader or between the clients is all up to the client, they can be as
far or as close as they feel comfortable being. Although there are many advantages and
advances in the field of AT, service providers still underutilize AT, largely due to the fact
that not enough participation and involvement into the field has occurred by Recreational
Therapists. Provision and support are essential in carrying out the activities relating to the
AT field, such as teaching individuals and families how to use devices and systems,
disseminating information and resources, and assessing and reassessing needs. As far as
leadership considerations go, it is also important to note that the leader must be very
careful when trying to achieve self-determination with clients. It is a common occurrence
for the client to become dependent on the technology, where its doing too much for
them, which leads them to getting discouraged about reaching their full potential.
Practitioners are encouraged to use technology when it is needed, but must continue to
facilitate skill acquisition so that participants can be as independent as possible. To
address the issue of practitioner competencies in AT, TR professional organizations have
established AT committees and networks. AT knowledge and skills can be obtained from
interdisciplinary groups and agencies, such as Closing The Gap, United Cerebral Palsy
Association, and the Easter Seals Society.
Adaptations: Participants with Anxiety Disorder: Anxiety Disorder is a mental health
disorder that is characterized by feelings of worry, anxiety, or fear that are strong enough
to interfere with ones daily activities. It is normal for someone to feel anxious, however
for people who have this disorder, the anxiety does not go away, and it gets progressively
worse over time. And the one distinguishing factor that makes this anxiety a clinical
disorder, and not just your average anxiety, is when the persons anxiety prevents them
from performing their daily activities such as going to work, attending school, etc.
Adaptations for the disability can include, asking the client beforehand what are possible
triggers that might make them feel uncomfortable, such as certain sounds, or
images/visuals. So for example if someone has social anxiety, then you must discuss with
the client/or their medical professional to discuss whether or not Flooding or Graded
Exposure Therapy is best for their treatment. Also if/when the client gets too over
stimulated/uncomfortable it is best to have a quiet room (with dark lights and preferably
sound proof) where the client can go to relax/clam down if they feel too uncomfortable
and wish to leave the activity (Powers & Emmelkamp, 2008).
Adaptations: Participants with Phobias: A phobia is a type of anxiety disorder, defined
by a persistent fear of an object or situation. Phobias are persistent, irrational, intense fear
of a specific object, activity, or situation that is recognized as being excessive or
unreasonable by the individual himself. The distinct characteristic that separates a
medically termed phobia from, something you think may be a phobia, is when that
phobia is deemed as causing a significant amount of distress, or it interferes with social
functioning. Examples of other forms of phobias include acrophobia (fear of heights),

claustrophobia (fear o closed places), or hemophobia (fear of blood). For adaptations

pertaining to these clients, I would recommend using the graded exposure technique at
first, to slowly expose them into getting over their phobia. I would also provide
awards/achievements within the VR simulation that could award them things such as a
virtual trophy or start, for completing each task/milestone. I would also tell the staff to
provide ample positive reinforcement to encourage the client that they are progressing
through the program well, while also boosting their self-esteem. Additionally, there
should be a headset between the client and the head of the VR simulation, where both
parties can relay information to each other. Like if the client is uncomfortable he can talk
through his headset to the programmer and say, please lower the exposure level. And vice
versa, if the programmer wants to get feedback on how the client is feeling/their comfort
level, then they could communicate via the headset (Klinger et al., 2005).
Adaptations References
- Klinger, E., Bouchard, S., Lgeron, P., Roy, S., Lauer, F., Chemin, I., & Nugues, P.
(2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A
preliminary controlled study. Cyberpsychology & behavior, 8(1), 76-88.
- Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for
anxiety disorders: A meta-analysis. Journal of anxiety disorders, 22(3), 561-569.