Scientific discovery is a form of problem solving, and... the processes whereby science is carried on can be explained in the terms that have been used to explain the processes of problem solving. Simon, 1 966

We are entering the second wave of virtual reality (VR) applications in medicine. Surgical simulations and training, three-dimensional anatomy, and the new field of real time three-dimensional physiological imaging are some of the more notable uses and applications of VR in the first wave in clinical medicine. Because first wave applications required and continue to require significant Computing power, many of the Silicon Graphics and workstation-based technologies were well-suited to meet these demands. Until recently, the application of VR technology in mental health was severely limited by the lack of inexpensive, easy-to-maintain and easy-to-use personal-computer (PC) based Systems. The very expensive and high-powered computational systems are out of the reach of most practicing mental health professionals. The development of PC-based VR platforms with more user-friendly programming software is helping to launch this great second wave.

Two successful areas of VR application in psychology include treatment of specific phobias (such as fear of heights, fear of flying, fear of driving, fear of public speaking, and claustrophobia, etc.) and neuro-psychological evaluation and testing. Well over one hundred publications from at least fifteen centers around the world addressing these two areas are in the literature. Early results seem to indicate that virtual environments are not only effective but have multiple advantages over conventional therapies in the treatment of specific phobias. In addition it seems to make intuitive sense that this application will work. Before a wider acceptance of this new technology occurs however it is crucial that clinical trials and comparison of outcomes are published and are evaluated by peer-reviewed groups.

Neuro-psychological evaluation and testing is another area that can easily be transitioned to a virtual environment. Again, multiple advantages seen by performing these tasks in virtual environments are suggested. Clearly the three-dimensional testing would seem a better predictor of function in our three-dimensional world. Smaller numbers of studies are seen in a much wider area of mental health testing, evaluation, and delivery as demonstrated by the excellent work in this current volume.

It is now the time to continue exploring additional applications of this exciting technology. Several barriers remain however. The PC-based system, while inexpensive and easy-to-use, still suffers from a lack of flexibility and capabilities necessary to individualize environments for each patient. There is a question as to whether the admittedly more cartoonish graphies have wide acceptance by patients. On the other hand, in those circumstances the clinical skills of the therapist remain the most important factor in the successful use of VR systems. It is clear that building new and additional virtual environments is important so therapists will continue to investigate applying these in their day-to-day clinical practice. Possible scenarios for success could involve multi-disciplinary teams of engineers, computer programmers, and therapists working in concert to attack specific clinical problems. Information on advances in VR technology must be made available to the mental health Community in a format that is easy-to-understand and invites participation. For example, an inexpensive System that would allow the therapist and patient to enter the VR world together provides a basis for a number of interesting potential therapeutic interactions. It is important that the technical-oriented members of the team understand the aims, requirements, and scope of the therapeutic intervention so they may effectively bring advanced Computing tools that specifically address the problem. Future potential applications of VR are really only limited by the imaginations of talented individuals. The second wave is expanding rapidly, and the international community has already provided the basis upon which continued growth and development will occur. It is hoped that by bringing together this community of experts further stimulation of interest from granting agencies is accelerated.

Mark D. Wiederhold, M.D., Ph.D.

Editor-in-Chief CyberPsychology and Behavior La Jolla, CA, USA