Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain

Abstract Pain-related fear and concomitant avoidance behavior have been identified as major contributors to development and maintenance of chronic musculoskeletal pain and disability. While graded exposure therapy (GEXP) is advocated as one of the most effective strategies for reducing pain-related fear and disability, its practical utility and large-scale dissemination have been limited. The current chapter describes a novel virtual reality (VR) methodology to optimize exposure-based treatment for individuals with chronic pain, focusing specifically on chronic low back pain (CLBP). Virtual Reality Graded Exposure Therapy (VRGET) promises to address several major limitations characterizing traditional GEXP approaches and to incorporate cutting-edge disability-relevant assessment and intervention. Specifically, VRGET is able to mitigate costs traditionally associated with GEXP treatment, enhance participant engagement with treatment, provide real-time assessment of important metrics such as affective response and kinematic adaptation, and promote generalizability of rehabilitation gains across clinic and home environments.