Noticing the lectern in front of her and the projection screen behind her, research coordinator Jill Peterson calmly began her presentation in front of a five-person audience.

All were paying careful attention, nodding their heads periodically and flashing encouraging smiles in her direction.

Suddenly, the crowd became restless. One man began to adjust his jacket. The others started to talk among themselves. Finally, all five proceeded to fling balled-up pieces of paper at Peterson, expressing their disapproval.

This is just one of a few scenarios awaiting patients at the Fairview-University Anxiety Disorders Clinic who have a fear of public speaking. Using a virtual reality program, University psychologists can allow patients to confront their worst phobias.

ìItís a viable and good choice for exposure when we have problems like fear of heights, fear of public speaking and fear of flying,î said Chris Donahue, a professor in the psychiatry department. ìWeíre always looking for creative, cost-effective and time-effective ways to do exposures.î

Donahue said virtual reality is a good option in eliciting the same response a person with a phobia might experience in the real world.

ìWe have to get people afraid. We have to activate the fear or anxiety in order to modify it,î Donahue said. ìIn terms of therapy, if we can activate the anxiety, we know we can get them to desensitize.î

Donahue and colleague Matt Kushner, also a University professor in psychiatry, implemented the new technology in their therapy last semester. The department bought a virtual reality program created by the company ìVirtually Betterî for about $10,000.

In addition to the computer and software, the new technology features a helmet that covers a patientís eyes for a ìhead-mounted display.î The helmet can display one of several scenarios with recorded video, depending on a personís phobia. The therapist can then interact with the patient through a microphone attached to the helmet.

Donahue said the technology has been used extensively in their therapy to help treat two phobias: the fear of public speaking and the fear of flying.

In the flying scenario, patients can go through an entire flight virtually. The program takes a person through the initial boarding of a plane to the take-off and actual flight and finally through the landing. Subwoofers in the platform underneath the cushioned seat help simulate a planeís turbulence. The authentic dialogue used by the programís flight attendant and captain also help add to the realism of the simulation.

Psychologists even can control weather conditions in the flight simulation. While the plane is in the air, for example, Donahue can bring on a virtual storm and induce flashes of lightning and claps of thunder.

ìYou feel a little bit like the Wizard of Oz when youíre doing this,î he said.

However, Donahue said, the new technology does not take the place of established therapies. They plan on continuing their practices in cognitive-behavioral treatment in addition to using the technology.

ìIt is just one tool in our arsenal for treating anxiety,î Donahue said.

Kushner added: ìVirtual reality is a brand new tool to help us effectively deliver a tried-and-true treatment.î

Since the virtual reality program was implemented, only about 10 to 15 people have used the technology.

ìWe havenít been successful with everyone,î Donahue said. ìMost people have responded with moderate to high levels of anxiety. Theyíre reporting that it feels very real.î

Donahue said that while he still prefers that a patient be exposed to the cause of their fears in a real-life scenario, a virtual one is a close second to the real thing.

ìItís primarily a step to getting into the real environment,î he said.