Virtual Reality is often associated with its ability to entertain people in the gaming industry and immerse people in another world. It provides a potentially deep psychological experience, as your physical surroundings are completely blocked out.
It works by tricking your brain into thinking you are in a 3D environment. This is done with the use of a stereoscopic display, with two differing angles of the screen for each eye which simulates depth. In order for it to work properly, The speed at which the image can be refreshed on the headset must match the frames per second of the computer to which the VR headset is connected. For example, if the headset displays the image at 60hz per second, the computer has to match this otherwise a ‘tearing’ effect (where objects become fragmented and displayed in separate locations) will occur.
As the technology has improved and become better understood, other uses have developed. Most importantly, in the healthcare industry where several companies have created a way of using VR in conjunction with psychotherapy techniques to help patients cope with fears, anxieties and other psychological disorders.
We spoke to Claire Cumberland and the team at Psious, a behavioural health technology start-up company who provide VR and other simulated environment techniques to assist mental health professionals in a clinical setting. She gave us more information on how it works, and what it holds for the future.
How is VR used to treat psychological disorders?
A common way in which VR is used, is to show stimuli that the patient may have a fear of and then help them control their response to it.
‘To treat conditions such as fear,’ Claire explains, ‘Psious employs well established cognitive behavioural therapy (CBT) techniques, mainly exposure therapy and systematic desensitisation. The majority of our environments have been designed precisely to facilitate the application of these techniques, since the majority of our scenarios show the phobic stimulus to help address it.’
‘Psious not only applies these techniques nor is directed to only treat phobias. We can treat these and other conditions with other environments designed to train techniques such as diaphragmatic breathing, muscle relaxation, visualisation/imagery and mindfulness. Likewise, our scenarios can provide a good opportunity to work on more cognitive strategies such as cognitive restructuring.’
Cognitive behavioural therapy involves discussing your thoughts and feelings to help you manage them in an effective way. A therapist will usually break down your problems into smaller parts that can be tackled individually, and work out a way to change your behaviour to each part.
Exposure therapy is exposing someone to the thing that they try to avoid and are fearful of. So re-creating a situation but in a controlled safe environment helps reduce the fear.
Systematic desensitisation is the removal of the fear response to the phobia by substituting a relaxation response in its place to the fear stimulus gradually. It begins with deep muscle relaxation followed by a creation of a fear hierarchy for the particular phobia and then the therapist taking the patient through this hierarchy.
VR can be very helpful for these techniques. For example if a therapist was attempting to help someone with their fear of spiders, they could create a simulated room in which spiders were present and, with systematic desensitisation, increase the amount or size of the spiders in the room.
VR is not the only virtual tool currently available. Claire says that Psious has found uses for other similar products:
‘Currently Psious has different tools (virtual environments, augmented reality, 360º videos, 2D videos and psychoeducational videos) to work with a great number of mental disorders, as well as different therapeutic techniques. Specifically, we have tools to address anxiety disorders such as specific phobias (acrophobia, claustrophobia, fear of flying, fear of darkness, fear of needles, fear of animals, test anxiety, fear of driving), agoraphobia, generalized anxiety disorder, social anxiety, fear of public speaking and obsessive-compulsive disorder. Furthermore, Psious has virtual environments to address other problems such as eating disorders, as well as scenarios to practice mindfulness and relaxation, and EMDR (Eye Movement Desensitisation and Reprocessing).’
How effective is it?
Obviously as a relatively new area of treatment, not all practices use or have access to VR presently; but could a day come where VR is considered a first-line or preferred option for certain conditions?
Claire outlines the advantages of using VR, and how it compares to other therapy:
‘VR enables the therapist to expose the client to conditions that might be unsafe or only accessible at high cost in the outside world (for example, buy a plane ticket), and to improve confidentiality by avoiding spectators. Moreover, in the case of exposure therapy, professionals seem to consider VR exposure to be less aversive than in-vivo therapy.’
‘In general, VR provides greater flexibility in intervention timing, greater cost effectiveness and an increased ability to tailor interventions to individual preferences. Furthermore, it has been shown that VR counts with greater patient acceptance compared to other traditional therapies (less drop-outs and an improved adherence to treatment). Finally, our VR platform has shown proof of significant behavior change in patients real life.’
‘For all these reasons, we are confident that virtual reality treatment will develop into a first-line treatment in the future.’
What are the risks attached with these methods?
Because of the immersive nature of VR, there are some potential risks attached to using it in a clinical setting.
Claire believes that these risks are minor, and that the overall style of treatment does not have any long-lasting effects:
‘Virtual reality (VR) is a safe methodology,' she tells us. 'However, some aspects should be taken into account. Sometimes VR can produce some side effects. Usual effects are slight dizziness, blurred vision, eye strain, headaches, or other visual effects. However, this problem can be easily solved through [practice] strategies such as shorter VR sessions with the patient at the beginning of the treatment until they get use to it.’
‘A low percentage of people (approximately 0.025%) may experience seizures, nausea, or disorientation when using VR. It should be noted that seizures caused by flashing lights are more common in epileptic patients, so they should not use this tool or, if they do, be made aware of the risks involved.’
How many practices are using VR presently?
It’s very likely that VR will become more widely-used in health settings in the future, as the technology continues to develop; but also as awareness around mental health grows.
To get an idea of how commonly utilised the technology is today, Claire gave us a break down of where Psious is being administered, and how many practices are using it:
‘There are over 700+ psychologists offering Psious right now.’ Claire tells us. ‘Psious is currently being used in more than 25 countries, mainly in the UK, US and Spain. As for the near future, we want to focus on the UK where our clients have shown an incredible interest and excellent engagement.’
‘We are currently only selling to mental health professionals so they are the ones paying each month for our virtual reality platform. As for the patient, VR sessions don't cost anything extra apart from the regular price of a psychologist session.’ Claire goes onto explain. ‘Our mission as a company is that anybody with a cellphone could be treated using Virtual Reality, wherever they are.’’
What other medical uses are there for VR?
VR is also being used widely as a medical training tool for operations. VR can visually recreate a real-life operation and allow the viewer to access areas of the body without the risk of causing harm to an actual person.
For example, medical students usually train using cadavers, which is not the most efficient way of practising because of the difficulty of sourcing them. VR offers the possibility of a simulation with a body that reacts like a real person.
There are various companies, such as Medical Realities, which are currently programming scenarios that can replicate specific operations. This is done by filming real-life operations and combining the footage with CGI to create a realistic training experience.
Aside from operational assistance, VR can also help patients recovery for pain management and physical therapy, according to a study by the University of Washington Seattle. They claim that VR can act as a distraction which reduces pain levels for patients undergoing physical therapy, and also shorten recovery time.
What does the future hold for VR in healthcare?
In terms of psychological therapy, Claire believes that there is still a long way to go before VR can be used as a first-line treatment despite its potential:
‘Although VR is not yet a fully extended tool, it is clear that there is a lot of potential. VR does not pretend to be a substitute for more conventional therapies, but rather is being used in combination with therapeutic strategies that have obtained a greater empirical evidence, in order to treat patients in the most efficient way possible. In this sense, Psious uses first-line treatments (the vast majority within the framework of Cognitive-Behavioral Therapy and Third Wave Cognitive Behavioral Therapies) while adding certain advantages to them.’
Most of the procedures mentioned in this article are at the early stages of development, so in the years to follow they will be more accurate as the technology continues to improve.
You can read more about Psious and VR technology on their website.