The technology has vast potential for insights into the functioning of the human brain
Experts used to worry about virtual reality (VR) could damage our brains. These days, however, it seems more likely that virtual reality for mental health will help our gray matter.
A new wave of psychological research is paving the way for virtual reality to diagnose and treat medical conditions, from social anxiety to chronic pain to Alzheimer's disease. Many of these solutions are still in the laboratory testing phase, but some are already making their way into hospitals and therapists' offices.
VR: new business or new bubble?
This use of VR to test and modify the brain is still very new. And with enthusiasm for virtual reality entertainment and gaming having exploded since peaking in 2017, it's reasonable to wonder whether VR therapy is the real deal or just another bubble. The evidence so far is strongly in favour, however, with recent research suggesting that psychology-focused virtual reality will live up to the hype.
VR (Virtual Reality) THERAPY: PROVEN AND TESTED
Riding a wave of interest in mental health technology, companies creating VR content for therapeutic outcomes are receiving tremendous attention and funding. And, while VR has been used successfully to treat post-traumatic stress disorder (PTSD) since the 1990s, these new programs address a much broader range of conditions.
limbix (https://limbixitalia.it/) for example, includes VR content designed to address issues such as alcohol addiction, claustrophobia, and teenage depression.
psious (https://psious.com/), based in Barcelona, offers treatments for eating disorders and intellectual disabilities.
Today's VR content is primarily designed to aid exposure therapy. It is a treatment for anxiety disorders in which patients are exposed to anxiety-inducing stimuli in a safe and controlled environment. Eventually learning that the “threats” they are worried about aren't actually very dangerous.
For example, someone who fears heights might visit progressively taller buildings under the guidance of their therapist (in vivo exposure). Someone with PTSD may revisit traumatic memories during therapy sessions (imaginary exposure).
Previously, and still today, exposure occurs primarily in carefully controlled real-world scenarios. However, virtual reality allows therapists to create that safe, controlled environment inside a VR headset. It is a much safer, faster and less expensive option.
Virtual reality for “controlled” experiences
Using virtual reality also gives therapists much greater control over the intensity of their patients' experiences, which can lead to better treatment outcomes, he said Stephane Bouchard, Canada Research Chair in Clinical Cyberpsychology at the University of Quebec. VR therapy patients can also do things they couldn't do in the real world. “In one of our studies, we asked patients who are afraid of heights to actually jump off a cliff,” Bouchard said.
However, not all VR therapy content is created equal. “At least two or three times a year, I attend conferences where I see startups showing videos of VR environments that are incomplete, untested and definitely have not been proven by psychologists,” Bouchard said. Clearer rules and standards will make it easier for patients and professionals to identify products that work.
First goal of VR: to understand who is best suited to VR
Establishing these rules requires further research into what makes VR therapies effective. One major area of focus should be “predicting who will have a positive response to virtual reality, compared to other methods,” he said Albert “Skip” Rizzo, director of medical virtual reality at the University of Southern California's Institute for Creative Technologies.
For example, studies show that patients with post-traumatic stress disorder who also suffer from depression tend to respond much better to VR exposure therapy than other treatment methods.
Imagery exposure can be a struggle for patients who also suffer from depression, “as a depressed person is less able to engage in memory of the trauma,” Rizzo said. Exposure to virtual reality, which simulates battlefields and other traumatic and triggering events, can help bring traumatic incidents to life for depressed patients so they can begin to unlearn their anxiety response.
Optimizing VR content could also mean experimenting with other sensory stimuli beyond images. The biggest question is: What types of interventions make the most difference in therapeutic outcomes, Rizzo said: “Is it the addition of good immersive audio? Does haptic feedback add anything? Does adding virtual smells into the session help? “
Diagnosis of elusive symptoms
In addition to potentially providing better outcomes for treatment, VR can aid in diagnosis. For example, because the technology can immerse every patient in the same scenario, some researchers believe that VR-based diagnostic tests for conditions such as schizophrenia, ADHD and autism could offer more objective results than methods based on today's interviews.
Virtual reality for mental health: the fight against Alzheimer's
Additionally, because virtual reality for mental health mimics the patient's daily environment, it also allows doctors to test for symptoms that are usually out of reach. In a 2017 study, researchers from the University of Cambridge and University College London have described their proof of concept for a virtual reality program to diagnose Alzheimer's disease. The researchers said the VR test allowed them to diagnose early-stage patients much more accurately than “gold standard” pen-and-paper cognitive tests.
Alzheimer's affects navigation ability and memory, but until VR headsets became portable and affordable, it wasn't possible for doctors to test those deficits. Like one of the researchers, the Cambridge neuroscience lecturer Dennis Chan, said: “It would not be practical for me to test a patient's navigation by driving them to Cambridge and asking them to return to the clinic.”
In contrast, the researchers' VR test asks participants to navigate between a sequence of landmarks in a simple 3-D landscape. Each landmark disappears once reached; at the end of the test, the subject is asked to return to the position of the first reference point. The patient's ability to find the correct spot predicted whether she would develop Alzheimer's with 93% accuracy, compared to only 64% and 79% accuracy for pen-and-paper tests.
Does this mean that neurologists will start fitting their patients with HoloLens 2s or Oculus Rifts?
Not necessarily, says Chan. He thinks the most important application of virtual reality testing will be in clinical trials for new Alzheimer's drugs. Currently, researchers typically test a drug's effectiveness on human subjects with pen-and-paper memory tests, while tests in animal studies are performed using water-based mazes.
But the use of different tests limits the comparability of study results between different species. This problem can be overcome if drug trials test navigation similarly on both animal and human subjects, using VR to provide human tests comparable to those used on animals.
A promising future
It is also possible that virtual reality for mental health may augment or replace traditional mental health therapy for some patients. Smartphone apps like Joyful they accompany users through five-minute activities based on the principles of cognitive-behavioral therapy (CBT).
Why not a VR equivalent? A 2018 study revealed good clinical gains from a VR therapy scenario to treat fear of heights that included a “virtual” therapist in the VR environment.
Incorporating AI therapists into VR programming could have many benefits. For example, it could make mental health treatment more accessible. First and foremost to people who don't have the time or money to see a professional in person. Bouchard said self-guided VR therapy could work similarly to self-help books. “It's a relevant advance for patients who don't have access to treatment or who don't need such personalized treatment,” she said.
There are also risks
However, Rizzo warns that self-guided VR therapy carries risks. For example, in a human-guided VR therapy session, therapists monitor the patient's heart rate, breathing, and other vital signs. They can change scenes or stop the session if a patient becomes too anxious. AI therapists may not respond as well to these difficult situations.
“When people start self-diagnosing and self-treating, buying software off the web, you're opening the door to a slippery slope of mistreatment,” Rizzo said. “The next biggest controversy [in] psychology will be: How far can we go with AI and virtual therapists?”
While it may be some time before virtual reality completely replaces traditional diagnostic techniques or the proverbial therapist's couch, it will certainly take on an increasingly important role in the treatment and diagnosis of mental health and brain disorders. Like any powerful emerging technology, virtual reality for the brain is vilified by some and considered a panacea by others.
Only time will tell the true result. For now, however, virtual reality for mental health is here to stay and to change the future.
Bianca Stan – Graduated in Law, writer with several books published in Romania and journalist for the group "Anticipatia" (Bucharest). It focuses on the impact of exponential technologies, military robotics and their intersection with global trends, urbanization and long-term geopolitics. He lives in Naples.
