Virtual Reality in Evidence-Based Psychotherapy

non-specific ingredients which make psychotherapy, in general, work (Lambert, 1992;Lambert & Ogles, 2004).This focus on research and its results have led to the justification of psychotherapy as a legitimate practice.Indeed, hundreds of studies show that psychotherapy works better than no intervention (Kopta et al., 1999), with some forms (e.g., cognitive-behavioral therapy) faring somewhat better than others (see, for example, the National Institute for Health and Clinical Excellence -NICE -guidelines for evidence-based treatments). www.intechopen.com Virtual Reality 446Despite the notable progress, research also systematically points to a segment of patients who are non-responsive, prompting professionals to advocate for improving the efficacy of treatments and for exploring and developing new efficient and cost-effective intervention strategies (David et al., 2008).One such direction has been the integration of new technological developments (e.g., computer technology) into the therapeutic process.The current chapter discusses some of the main applications and advantages of virtual reality (VR) technologies in psychotherapy assessment, intervention and rehabilitation, using cognitive-behavioral therapy (CBT) as a case example.We have chosen to focus on CBT for at least two reasons: it is the best researched form of psychotherapy and it is (both in which research and intervention are concerned) the most likely and frequent "host" for VR intervention strategies. Evidence-based psychotherapyThe number of available psychological treatments has grown exponentially during the last decades; in the field of psychotherapy only, there are over 200 distinct schools and hundreds of individual techniques (Bergin & Garfield, 1994).In a review of the scientific foundations of clinical work, published in 1966, Edward Bordin concluded that "The present state of our knowledge is such that strong doubts can be expressed about virtually all psychological practices . . .none of them rest upon a firmly verified foundation of knowledge" (p.119).Increasing criticism eventually led to a more firm commitment to research in psychotherapy.In this context, one of the significant changes in the field has been the development, validation and dissemination of evidence-based treatments for various clinical conditions.This movement is consistent with the past 20 years of work in evidence-based medicine, advocating for improved outcomes by informing clinical practice with research data (Woolf & Atkins, 2001).Among the factors that have converged in recent years resulting in the evidence-based movement are an increased understanding of the mechanisms of various disorders, leading to the need of developing interventions specifically targeted at these mechanisms, the improvement of clinical research methodologies, resulting in higher quality data, and the rising costs and inadequacies of health care, prompting governments to advocate for quality and evidence-based services (Huppert et al., 2006).During the mid 1990s, the Task Force on the Promotion and Dissemination of Psychological Procedures (Society of Clinical Psychology, Division 12, American Psychological Association; APA) published specific guidelines to determine if a treatment was empirically validated (Anthony & Rowa, 2005).A decade later, the APA Presidential Task Force on Evidence-Based Practice defined Evidence-Based Practice in Psychology (EBPP) as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences" and stated that "the purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention."(APA Presidential Task Force on Evidence-Based Practice, 2006).The definition of evidencebased practice argues for the importance of the harmonious integration of the three components (i.e., research, clinical expertise, patient characteristics).Many medical and psychological scientists, however, consider research to be the most important element of this partnership (Goodheart, 2006).Although the need for data supporting the accountability, efficacy, effectiveness and costeffectiveness of various assessment and intervention strategies is widely recognized, there www.intechopen.com