You might associate Virtual Reality (VR) with entertainment and nothing else. But for a rather long time now, VR has been used for education, military, sport, medical training, and the topic of this article ― mental health. But first, let’s define Virtual Reality.
What is VR?
There are many definitions of Virtual Reality. I chose the following one because it is cited in mental health studies: “Virtual reality refers to immersive, interactive, multi-sensory, viewer-centered, three dimensional computer generated environments and the combination of technologies required to build these environments.” The environments are presented as a set of images and sounds that come together as a real or a made up place or situation. The user can interact with this environment using special equipment, usually a headset and a remote control.
To understand virtual reality better, it might be helpful to step back and get to know the whole concept. There are different extents to how real or virtual the world is. The world that we see, real or virtual, is broadly divided into four categories:
- Reality: the real world
- Augmented Reality: computer-generated data are merged into a real-world image
- Augmented Virtuality: real-life data are merged into a computer-generated world
- Virtual Reality: the world has been created entirely by a computer.
Augmented Reality and Augmented Virtuality tools have also been considered for mental health therapy, but in this article, we’ll focus on Virtual Reality.
How can VR help with psychological disorders?
Psychological disorders are more widespread than most people believe. Only in the US, 20.6% of the population suffer from mental illness. This is 1 in 5 adults, or 51.5 million people. The worldwide statistics shows that 10.7% of the worldwide population has a mental health disorder, but the main reason for such a difference is the number of undiagnosed people in less developed countries. With more people worldwide getting proper diagnosis, we can confidently predict that this number will grow over time. More importantly, as mental health rapidly becomes less stigmatized and more understood, people are more open to seek help. And this, in turn, leads to the growing supply of different treatment methods.
The past decade saw a huge increase in studies that explore how VR can be used in healthcare software development to assess and treat psychological disorders. In August 2020, a systematic review of reviews was published in Complementary Therapies in Mental Health journal. This is the most comprehensive summary of research in this area to date. The authors concluded that there is plenty of evidence showing that VR can have a positive impact in different psychiatric disorders. So, how does it work?
VR produces scenarios which are difficult or impossible to recreate in real life. For example, a battlefield or a fire. It can create situations where a patient has to endure it (look in the eyes of a spider!) or to make decisions: talk to someone, choose the right turn, attack, or hide.
These scenarios can be helpful both for assessment and treatment of psychological disorders, or either one of those depending on a psychological disorder. For example, an “exposure therapy” used for treatment of anxiety, phobias, PTSD (post traumatic stress disorder), and other disorders implies gradually increasing exposure to fearful stimuli. With VR, a therapist has the opportunity to create a situation, making it more disturbing each time. A therapist can also recreate the actual traumatic event that has caused the problem: for example, a battlefield, which is the common reason for PTSD. A patient can enter simulations and be coached with responses. In psychosis, with the help of virtual reality, a patient can learn which factors worsen or improve symptoms. This is when VR can help with the actual treatment.
When it comes to assessment, VR can be used for disorders where a therapist has to observe people’s behavior closely. Therapists can create scenarios where each step would help with the assessment. This can be done for patients suffering from psychosis and/or paranoia. Not only will this help with symptom assessment and diagnosis, but it will show psychologists how symptoms are correlated and what are the predictive variables, causal factors, differential predictors, environmental predictors.
The actual conditions differ in terms of how many studies have been done on them and how many have shown the usefulness of VR for each disorder. Here’s a quick recap on what’s been found for every studied psychological disorder and condition related to mental health.
Pain perception
While obviously not a psychological disorder, VR research for pain perception is an exciting field that’s worth our attention. Plenty of studies researched the effect of VR as a method of distraction for patients with burn pain, cancer-related pain, dental pain, experimentally induced pain, acute and chronic pain, musculoskeletal pain, phantom limb pain and spinal cord injury pain exist, and it is only studies concerning phantom limb pain that present inconclusive results. Research has also shown that immersive VR reduces pain for both paediatric and adult patients during medical procedures.
Anxiety/phobias
Most VR research focuses on the role of the tool as the add-on therapy in different versions of anxiety. This means that VR doesn’t substitute traditional therapy, but works as an additional method. VR research covers general anxiety disorder, phobias, PTSD, fear of driving, fear of flying, arachnophobia, agoraphobia and claustrophobia. Mostly, VR is used for exposure therapy described above. Using VR technology, the patient is exposed to the source of their anxiety. With the therapist, he or she learns coping mechanisms, and with every new exposure, each more serious one than the one before it, the feelings of anxiety decrease. The review of reviews of these studies has shown that the effect of VR therapy is significant.
Neurodevelopmental disorders
VR research for neurodevelopmental disorders includes autism, ADHD, cerebral palsy, fetal alcohol syndrome and perceptual auditory impairments. The review of these studies concluded that there is a doubtless positive effect. When it comes to neurodevelopmental disorders, VR is used in different ways depending on the disorder. Most often it’s used to help learn new skills. For example, children with autism learn to identify facial expressions and how facial expressions are connected to emotions.
Despite the overall usefulness of VR, It’s been pointed out that more studies should be done to lay out specific rehabilitation scenarios that VR can provide and assess their efficacy.
Alzheimer’s and other neurocognitive disorders
A VR program has been found to be a method that works better than traditional pen-and-paper methods for Alzheimer’s diagnosis. The patient’s ability to complete navigation tasks via VR predicted whether they would develop Alzheimer’s with 93 percent accuracy. Traditional pen-and-paper tests have a 60-80 percent accuracy depending on a test.
Researchers claim that these findings are vital for the future Alzheimer’s drug trials. Right now, the drug’s efficacy is tested with pen-and-paper tests of memory, while testing in animal trials is done using water-based mazes. If drug efficacy will be tested with navigation tasks both in humans and in animals, the results will be more accurate.
VR interventions were also successfully used for helping patients with neurocognitive decline. VR interventions improved memory, dual tasking, and visual attention.
Other mental disorders
Not as many studies have been done on patients with other mental disorders: depression, substance disorders, schizophrenia, spatial neglect cognitive impairment. Yet the reviews of studies that were done, all accept one, showed strong beneficial results of VR methods compared to traditional therapy. The single review that stood out concluded that there is no strong evidence for or against VR interventions.
Other mental health factors
Not all psychological issues could be classified as disorders. However, this doesn’t mean one can’t improve them, also using virtual reality. Guided by this logic, researchers studied the effect of VR interventions on improving the psychological conditions of children who are overweight or suffer from obesity. VR helped to improve self-esteem, self-efficacy, and motivation for change.
What are the challenges of VR interventions?
Even though the price for VR technology is gradually decreasing, the problem with the availability due to the high cost is still valid. It is expensive not only to introduce, but also to test and later support VR equipment.
VR sickness is another problem that exists with virtually reality. People often suffer from dizziness, nausea, headache, and eye strain. Besides, patients can develop reduced limb control, reduced postural control, decreased sense of presence, and the development of responses inappropriate to the real world. As with almost every therapy, there is a group of people who should not attempt VR interventions. These are the people who develop seizures when watching television or playing video games.
Another serious issue is that patients may develop VR addictions similarly to how they develop game addiction. Especially, one should be careful when working with patients with serious mental conditions, such as psychosis, schizophrenia, and addictions disorders.
How are healthcare software companies catching up?
For the past couple of years, the whole mental health tech field is evolving with the speed of light, attracting attention and funding. Companies creating VR and outsource VR solutions are not falling behind. Many create content for therapeutic purposes.
For example, Psious developed a mental health focused VR platform for therapists and health professionals. The tool offers more than 70 VR therapy environments that can be used for therapy.
BehaVR encourages the user to “escape your happy place, while building mindfulness and emotional regulation skills”. The company creates personalized experiences that activate cognitive, emotional and physiological responses with the goal of improving health.
Limbix software offers digital therapeutics for adolescent mental health and Oxford VR offers scenarios for anxiety, psychosis, fear of heights among other features.
Why is VR the future of mental health therapy?
Virtual Reality is often presented as the future of psychology. We can only expect healthcare software companies that focus on mental health to increase rapidly in the following years. Not only because there is enough evidence that VR therapy works, but also because there are benefits that traditional therapeutic methods lack. With the right healthcare IT solutions, VR can be practiced at home, or sessions at the doctor’s office can be repeated and assessed at home. More importantly, VR allows things that no traditional methods can recreate: a high degree of ecological validity (environments are complex and believable), including difficult-to-arrange scenarios; simple control over the environment and degree of exposure, and high degree of personalization. And, perhaps, the most important argument for VR therapy is that patients report high levels of satisfaction with VR treatment. This is because the therapy is effective, but also because VR is truly exciting and offers a sense of control that people with mental health issues, as well as many people without them, often lack.
