Treating Anxiety Disorders: Balancing the Real World and the Virtual World

Barbara Olasov Rothbaum, PhD, is the Associate Vice Chair of Clinical Research in Emory School of Medicine’s Department of Psychiatry, a professor in the Department of Psychiatry and Behavioral Science, and director of Emory’s Veterans Program and Emory’s Trauma & Anxiety Recovery Program. Dr. Rothbaum specializes in treatment of anxiety disorders, with a focus on Post-Traumatic Stress Disorder (PTSD). With over 200 scientific publications, Rothbaum has changed the field of PTSD and was a forerunner in the use of virtual reality in treatment of anxiety disorders.

What initially drew you to the field of psychiatry?

I went to UNC-Chapel Hill as an undergrad. I actually went as a math major and that didn’t last long; My freshman year I decided to take a freshman seminar course, which meant there were only fifteen students, on how to design an experiment. It was a psychology course and I had no interest in psychology going in, but it sounded interesting. The course had the kind of teacher you always hope to have, or hope your kids have; the research bug bit me and I loved it. I kept taking more psychology classes and then got involved in research.

Who has influenced you the most in your career and why?

Barbara Rothbaum

Barbara Rothbaum

I learn every day. I learn every day from somebody, from every patient I see. When I think of real turning points; I think of my first professor my freshman year. He changed everything, I gave up all my math courses and went into psychology. When I was an undergraduate, I worked in a fetal alcohol lab under Carrie Randall, PhD, a professor at the Medical University of South Carolina, for a summer. I learned methodological control and precision from her. I also learned that I wanted to work with people after working with animals in Carrie’s lab. Working here at Emory with Michael Davis, PhD, Yerkes Researcher and Robert W. Woodruff Professor of Psychiatry, I started to get into translational research, asking questions of animals and then translating to humans and translating back to animals.

What was the process of integrating virtual reality and anxiety disorder work like?

In 1993, Larry Hodges, PhD, an Associate Professor in the College of Computing at Georgia Tech, contacted me about an Emory-Georgia Tech seed-grant program. Larry specialized in virtual reality and he found out that I was an exposure therapist, meaning that I help people confront their fears in a therapeutic manner. We originally wanted to do the research on fear of public speaking, but in the 1990s virtual reality was clunky. Virtual reality at the time worked more in angles, and people move in arcs. This made it difficult to do public speaking, so we decided to do fear of heights because of the angles and you can easily represent height in virtual reality. Our line at the time was, we “weren’t sure if we were on the cutting edge or the lunatic fringe.”

Could you describe the development process for the first virtual reality treatment incorporating computer scientists and clinical psychology?

Virtual Reality Therapy

Virtual Reality Therapy

I would go to Georgia Tech and I would explain exposure therapy to Larry’s brilliant computer science graduate students to help them understand why people get anxious. For example, we were working on the virtual airplane, there was just way too much room. About half the people who fear flying have a claustrophobia-focused fear that induces panic. Part of the trigger is feeling closed in so you need to remove the feeling of roominess. I would work with the programmers to help them understand the fear cues so they could go back and create them.

Your work has been brought to the marketplace through an Emory start-up Virtually Better – what was that experience like?

The first study was published in 1995, and the response was really amazing. Emory and Georgia Tech thought that there might be a marketable product, so they took us [as inventors] by the hand and drove us to a lawyer to incorporate, and that was Virtually Better. As soon as we incorporated, I received a letter saying that I had a conflict of interest since I was doing research in that area. That freaked me out, and I didn’t understand conflicts completely at the time. I ended up serving on the School of Medicine’s Conflict of Interest Committee for six years. It did limit my research for a while. Now we’ve learned how to manage conflicts; as a result I am able to do more research with virtual reality.

What types of challenges are there for the utilization and growth of virtual reality in psychiatry?

At Virtually Better, we often looked more like an academic department rather than a company trying to make money. This allowed us to get numerous grants, which supported more R&D. Every product we released had good data on efficacy. What scares me now is that people can be working on virtual reality in their garages. We have always had the input from clinical psychologists and computer scientists, we were cutting edge in both fields and releasing what we knew was a good product that a person can benefit from therapeutically. I worry now about quality control and efficacy.

Do you think virtual reality will be a game-changer in Post-Traumatic Stress Disorder (PTSD) treatment?

Well nothing works for everyone. One of the most important things we can have is alternatives and choices. Research has shown that if a patient with PTSD can choose their course of treatment they are more likely to respond positively. With this generation of veterans, which is a video generation, they tend to like virtual reality. It feels a little bit less like therapy to them and feels more “techie.” There was a study done with active duty military populations, that showed that people who feel less comfortable going to therapy would try virtual reality therapy.

What has been the personal satisfaction for you in seeing the progression in PTSD research and treatment?

It has been satisfying and challenging. When I started working in PTSD, there were no indicated treatments, it was just a diagnosis. Psychologists were extrapolating from other treatments for other anxiety disorders. It’s really nice to see that evidence-based treatments for PTSD exist now, but what’s still challenging is that none of them work for everyone. Also, I think some of it is the nature of the beast [with PTSD]. People with PTSD are avoidant; they don’t want to talk about it or go in for treatment. We need to not only develop effective treatments, but also acceptable treatments.

Many who work with PTSD, and other psychological disorders, experience burnout; how do you avoid burnout or compassion fatigue?

I exercise; I do yoga, I ride my bike. We talk about experiences at work in a group setting with supervision as part of the Emory Veterans program. There are some cases that we are talking about that bring tears to our eyes. It’s important that we are able to support each other, it’s not something you can go home and talk about over the dinner table. We hear the worst of the worst. So it’s about work-life balance.

What advice would you give to your younger self?

Problems and roadblocks used to really upset me. I now have the attitude that problems will occur daily, some large, some more manageable, and my job is to navigate them, so I can approach them with more equanimity, wisdom and creativity. I have also had to learn to not take things so personally, for example not receiving a grant or a paper rejection, and to bounce back and start working on the next one. I do give myself a little time (not more than a day) to “wallow” (I wouldn’t use that word for anyone else) following big disappointments. We are only human.

To learn more about Virtual Reality Therapy view our success story. To learn more about Virtually Better go to their website.

Emory Female Inventors

Emory University is home to many brilliant female inventors, whom have contributed ground breaking research and innovation to the society at large. From new treatment methods to life threatening diseases to new accessible techniques of health education, Emory women help shape the world we live in today. March is Women’s History Month and we will be highlighting historical female inventors as well as Emory’s historical female figures and inventors through a series of five blog posts. Here five Emory inventor’s. We hope you enjoy.

  • Marcia Holstad: Consistent and regular dosage of antiretroviral medication is an absolute necessity for all HIV positive individuals. Without strict adherence to a daily treatment regimen these individuals risk further illness or spread of the disease. To combat this problem, Marcia Holstad DSN/RN-C/FNP created the LIVE network, a music program used to educate and motivate HIV positive individuals about living with HIV and the importance of regular medication. The network features multiple music genres; all of which contain original content that is not only accessible and enjoyable, but also informative. The initial response to this music program by a focus group of HIV positive patients was extremely positive with many participants asking to share the network with their loved ones. Holstad used this innovative education method to not only help improve HIV treatment, but also to make learning about the disease and its treatment more fun.

  • Lily Yang: Lily, professor of surgery and radiology, and Nancy Panoz, chair of surgery in cancer research, came to Emory with the goal of exploring the use of nanotechnology to fight disease, with a focus on cancer. She is currently conducting groundbreaking research to develop multifunctional tumor-targeting nanoparticles to detect and identify primary and metastic tumors. She hopes to further the use of these particles to deliver therapeutic agents to targeted tumors. Though a final treatment method has yet to be produced, Yang’s work shows great promise in revolutionizing cancer treatment. (Read read more on our website here.)

  • Cecilia Bellcross: Although the general population is acutely aware of the possible genetic heritability of certain strains of breast cancer, the referral process of at risk patients to undergo genetic testing has been historically erratic. Cecilia Bellcross (TITLE) noticed this discrepancy between at risk patients and genetic testing and saw the need for a more efficient screening tool that would suggest whether a woman should consider further genetic counsel regarding susceptibility to heritable breast cancer. Thus, the B-RST screening tool was born. This method asks women 6 basic questions regarding their personal and familial cancer history to identify individuals particularly vulnerable to heritable breast cancer. The results of this screening tool can then recommend whether those individuals should seek further medical council and genetic testing. The B-RST tool was such a success it is used by individuals and medical professionals around the world.

  • Sheila Angeles-Han: Approximately 5 million children in the U.S. suffer from some degree of visual impairment, however many available diagnostic surveys regarding visual ailments are written for adults. Recognizing the need for an age appropriate diagnostic tool, Sheila developed a new survey made up of questions to assess the effect of visual impairment on the quality of life and function in youth. This survey has vastly improved both the accuracy and efficiency of diagnosing and treating impaired vision in children. (Read more on our website here.)

  • Rani Singh: When it comes to metabolic disorders like Urea Cycle disorders or Phenylketonuria, the use of drug or vitamin supplement based treatments is often less successful than the use of a strict dietary regimen. These types of disorders are often negative reactions to intake of certain amino acids or compounds. Therefore, using a structured dietary plan, including restriction and or avoidance of certain foods, many metabolic diseases can have minimally disruptive symptoms. However, active and diligent adherence to medically suggested dietary guidelines is often extremely complex and arduous. Knowing this, Rani, the director of metabolic nutrition program at Emory’s division of medical genetics, developed a pocket-sized food list booklet that contains clear and accessible information on specific metabolic diseases as well as medically recommended dietary restrictions. (Read more on our website here.)

Interviews with two female inventors
Barbara Rothbaum – Treating Anxiety Disorders: Balancing the Real World and the Virtual World
Harriett Robinson – From Academic Researcher to Startup Scientist: Leaving the Lab to Pursue Your Innovation

From Academic Researcher to Startup Scientist: Leaving the Lab to Pursue Your Innovation

Each year OTT helps launch a number of startup companies based around discoveries made by Emory faculty or staff.  In most of those cases the faculty member remains at the university as a researcher or clinician while he or she simultaneously serves in some type of advisory role for the company. In some instances however faculty leave the university environment to strike out into the exciting world of startups. In this piece we talk to former Emory professor Harriet Robinson, PhD, who is now the Chief Science Officer at GeoVax, an Emory startup developing HIV vaccines based on previous work from her lab.

Before you created the HIV vaccine technology, had you ever given much thought to the commercialization of university discoveries?

Yes, I had previously wanted to commercialize a different vaccine technology that I discovered while at another university. At that time it was not possible due to state restrictions that limited the ability of faculty to license their own findings from the university. Those limitations stemmed from legislation created to curb legislators from awarding contracts to themselves or relatives.

What made you decide to follow the technology to a startup company rather than stay in academic research at Emory?

Harriett Robinson, PhD Photo

Harriett Robinson, PhD

At a certain point, the vaccine technology needed expertise that was not present at Emory, for example, manufacturing, formulation, and regulatory expertise. It also needed full-time effort which was not compatible with being a full-time professor.

What has been the biggest challenge in moving out of the academic lab and into industry?

Maintaining funding focused on the commercial development of a product. For HIV vaccines in the developed world, funding is primarily from the NIH. This means that one has to steer a course that meets study section approvals as well as company objectives.

What is the biggest difference (or multiple differences) between an academic lab and an industry lab setting?

The biggest difference is that in industry, one is part of a team that has set out to achieve a goal. If something doesn’t work, the team figures out how to make it work rather than just going on to some other project that is interesting at the moment.

What advice would you give younger faculty interested in technology commercialization?

The small biotech world is very different from the university. Make sure you are really interested in working towards specific products and willing to give up the freedom (and resources) one has in the university to explore multiple different areas of research.

Many Thanks to Dr. Robinson for agreeing to participate! For more information on OTT’s efforts to support faculty entrepreneurship & startups check out our website: and For additional information about GeoVax and their clinical stage HIV vaccine please see their website