How does it work?
Cognitive Behavioral Therapy (CBT) has always been combined with a form of exposure therapy in treating phobias. In the past, exposure was accomplished by either putting the person in the actual situation or through imagery. While putting the patient in the situation was impractical, it was even more unreasonable to expect a patient to conjure realistic imagery of something they had spent their entire life trying to avoid. Virtual reality is a perfect way to expose the patient to the feared object or situation within the safety of the doctor’s office. Combining VRT with biofeedback makes it possible for the patient to learn to control the physiological responses that result in anxiety.
In addition to practicing speeches in front of a virtual audience, how does biofeedback help with public speaking phobia?
Heart rate variability biofeedback teaches the patient breathing patterns that dramatically reduce anxiety. Breathing air into the lungs produces an increase in heart rate, while breathing air out of the lungs results in a decrease in heart rate. Diaphragmatic breathing at a rate of approximately 5-7 breaths per minute causes the largest variability in heart rate in approximately 95% of people.
The breathing rate that produces the biggest drop in heart rate is known as the person’s “sweet spot” and results in a state of total relaxation, incompatible with feelings of anxiety. Once the patient’s “sweet spot” is established, the patient practices the optimal breathing rate for a suggested 20 minutes per day. Although a timer can be used, I have found making patients a recording using the sound of a harmonica for timing breaths in and breaths out to be very helpful.
How long is treatment?
Generally, sessions will be weekly for 45 minutes to an hour with treatment lasting 12-16 weeks. More recently, and specifically for cases in which time is of consequence, we have been suggesting 6-8 double sessions over about 2 months which has proven to be extremely effective. VRT combined with biofeedback has a success rate exceeding 90%.
From the day treatment ends, it’s crucial to get up and practice speaking publicly. The patient needs to confront their fear on a regular basis to avoid falling back into a pattern of protective behavior. This can be accomplished through exercises like making toasts among groups of friends or asking questions at meetings. Once the phobia is resolved through VRT and biofeedback training, practice will yield the greatest long term results.