Virtual Reality: Educating, Delivering Therapy & Facilitating Support

Our unpacking continues and this post we look at how virtual and mixed reality is being leveraged in the mental and behavioral health spaces.

Virtual? Augmented? Mixed? To start, it’s important to make a distinction between what is virtual reality versus augmented reality versus mixed reality.

Virtual (VR) is an immersive reality (content) that may consist of real-world or computer generated elements.

Augmented (AR) is real world reality content that has assistive computer generated content.

Mixed (MR) combines real world and computer generated content to create entirely new worlds. The mentaltech applications I have seen are virtual, versus augmented or mixed.

Virtual Rules for Exposure Therapy
In this space, VR is the predominant application I have seen. I am curious to hear if you have seen AR or MR applications. These are not new applications as much as they are newly therapeutized [is that a new word?] and commercialized.

Today, we see VR applied most readily as a delivery channel of exposure therapycognitive behavioral therapy and embodiment therapy for this suffering with anxiety, PTSD, and even schizophrenia. They are proving to be therapeutically and financially effective in that they allow a better-dosed “exposure experience”, assisted by treators, and biometric sensors which track anxiety levels and observe real-time effects on the structure and behavior of the brain and body. They also allow a repeated exposure to traumatic scenarios while avoiding the expense of primary reality reproduction. Think: I can be repeatedly exposed to my fear of flying without having to purchase multiple plane tickets, or of a combat zone, without having to go back to the physical place where my trauma occurred.

VR for Anti-stigma, Psycho-Education/Support, Pain (and Anonymity)
Additionally, going back more than a decade, virtual and augmented reality have been used to give users the experience of schizophrenic hallcinations as a way of battling stigma towards, and increasing empathy for, those who suffer. We see an example of at least one company, Kognito, which uses VR avatars to simulate role-play scenarios as part of the therapy & support education process for educators, caregivers, law enforcement, veterans, etc.. Demonstrative of the multi-category nature of this space, we see here how Kognito, in their application, is also a form of psycho-education. We also see companies like AppliedVR and AlohaVR who have applications related to pain reduction as chronic pain contributes to mental unwellness. Because there are offering in this space which can be used with good effect privately, this application gets anonymity points for those concerned about stigma. One of the most remarkable anonymous uses of VR I have seen is the conduct of mental health support groups in the virtual world, SecondLife, where one can anonymously show up as their avatar and engage others from around the world in discussions that are supportive to mental health. While I have not seen this, I can also imagine that MMOGs like World of Warcraft or The Sims, could also have game scenarios that allow teams of players work together in scenarios which provide connection and support, thus enhancing mental health.

VR’s Game Potential
A further look, also calls up how VR applications in this space is leveraging “games” as exposure simulations can be forms of “serious games. It is also important to acknowledge that VR games, using the right approach can be facilitators of mental wellness, supporting prevention. This is particularly poignant in light of the WHO’s recent classification of game addiction as a mental disorder. A search for VR apps in the GooglePlay or IOS App Stores show a small but growing sub-category of apps related to relaxation, meditation you will find a considerable number VR apps developed for meditation, relaxation, etc.

Mental Health VR Players
The companies I am most familiar with in this space are PSIOUSAppliedVRStressJamRealiteerOneCaringTeam [AlohaVR] and Kognito. I am also curious to hear if there are any I have overlooked, which I can add to my database. In addition to commercial plays, there are myriad academics doing work in this application space. One example I have come across is Julian Leff’s Avatar Therapy at University College London, and Skip Rizzo’s research at USC’s Institute for Creative Technologies and a Google search will call up numerous others.

Mental Health VR Challenges
Despite is effectiveness and promise, like with all sectors, VR has its

challenges. Some are:

  1. funding that enables R&D and commercialization activities, critical to increased adoption and value delivery
  2. technical limitations related to hardware form practicality, mobile device processing & image resolution limitations,
  3. clinical organizational barriers, like bureaucracy and change resistance, tech infrastructure integration (bluetooth, privacy) & interoperability (eMRs) and procurement,
  4. lack of practitioner and consumer application knowledge & experience
  5. lack of critical mass of research studies in healthcare
  6. lag in insurance reimbursement and mature regulatory policy
  7. need for better understanding of cultural barriers to adoption of this healthtech application.

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More Reading:

1. Definitions of VR, AR and MR: https://www.foundry.com/industries/virtual-reality/vr-mr-ar-confused

2. Overview of VR applications in healthcare: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622235/

3. Article on VR adoption challenges in healthcare: http://www.thevrara.com/blog2/2017/6/10/key-challenges-to-adoption-of-vrar-for-healthcare

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