The study, published in The Lancet Psychiatry journal, is the first to use virtual reality technology as a treatment without a therapist, providing a proof of concept for how some psychological interventions might be offered in future.
About 100 people with clinically diagnosed fear of heights who were not receiving any psychological therapy were given either the new automated virtual reality treatment (49 people) or usual care, which was typically no treatment (51 people).
On average, participants had suffered a fear of heights for 30 years.
All participants completed questionnaires on the severity of their fear of heights at the start of the trial, at the end of treatment (two weeks later), and at follow-up after four weeks.
Participants given the virtual reality treatment had roughly six 30-minute sessions over two weeks, where they wore a virtual reality headset.
In the first session, participants discussed their fear of heights with the virtual coach, explaining what caused their fear (for example, fear of falling, fear of throwing oneself off the building, fear of the building collapsing) while the virtual coach gave basic information about fear of heights.
Participants then entered a virtual office complex with ten floors and a large atrium space, where they took part in activities that challenged their fears and helped them learn that they were safer than they thought.
These started with simpler tasks, such as watching a safety barrier to a drop gradually lowering, and built up to harder tasks, such as walking out on a platform over a large drop.
Other tasks also included rescuing a cat from a tree, playing a xylophone near an edge, and throwing balls over the edge of a drop.
Throughout the activities the virtual coach offered encouragement, and afterwards they explained what the participant had learnt from their activities and asked whether they felt safer than before.
The virtual coach also encouraged participants to try real heights between sessions.
Of the 49 participants offered the virtual reality treatment, 47 took part in at least one session, and 44 completed the full course of treatment.
At the end of treatment and at follow-up, control group participants rated their fear of heights as remaining similar, but all participants in the virtual reality treatment group rated that their fear of heights had reduced.
By follow-up, 34 of 49 people in this group were not rated as having a fear of heights, compared with none of the 51 people in the control group.
There were no adverse events reported by any participants.
"Immersive virtual reality therapies that do not need a therapist have the potential to dramatically increase access to psychological interventions," said Daniel Freeman, a professor at University of Oxford in the UK.
"We are carrying out clinical testing to learn whether automation of psychological treatment using virtual reality works for other mental health disorders," said Freeman.
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