Great conversation with A Fine Time for Healing podcast host Randi Fine this morning. We were joined by XRHealth‘s Dr. Orit Avni-Barron to discuss various applications of Virtual Reality (VR) for behavioral health. The hour flew by and we covered a lot of ground.

The podcast was broadcasted live and will be archived here as well as on Apple Podcasts, iHeart Radio, Stitcher, Podbean, Podbay, TuneIn, Player FM, Podchaser, Listen Notes, Castbox, Podfanatic, and Ivoox.

A recent article in the New York Times highlights the particular challenges of addiction treatment during the pandemic. The article contends that, at its core, addiction is often fueled by feelings of isolation and disconnectedness and the inability for people to meet together and with clinicians and facilitators has lead many to relapse or worse.

How could Virtual Reality (VR) help? The article highlights several areas where the feeling of presence, focus, and connectedness afforded by VR could lessen the feeling of being alone and more closely represent the therapeutic benefits of in-person interactions.

A Shared Experience

Excerpt from NYT Article: “In the 80-year history since addiction treatment began, we’ve never experienced anything as challenging as this,” said Marvin Ventrell, chief executive of the N.A.A.T.P. “You have to put people in social settings to heal, and Covid conspires against that.”

VR replicates the feeling of being physically together with other people. Everyone in a VR environment sees the same thing as everyone else just as they would if they were sitting together in a shared space. If you and I look out the window to our left, we will see the same scene regardless of where we may be in the real world. This is in sharp contrast to video calls where participants are stacked together in boxes, each in their own world, with no common point of view or ability to truly share in the same experience; a situation that can actually lead to greater feelings of isolation.

Avatars that Emote

Excerpt from NYT Article: “What is more supportive than walking into a room and seeing a human you can touch?” asked one client, Maureen. “What’s been missing is body language, our ability to hug each other. All that stuff is important when people are going through the difficult experience of getting off drugs or alcohol.”

The feeling of proximity in VR is unlike any other digital medium. Lifelike avatars can gesture, point, fist bump, high five, and even hug resulting in sensory feedback (haptics) through the controller. Objects like balls can be passed between people sitting in natural relation to one another and spatial audio allows for more authentic conversation flow. Though VR is not an ultimate substitute for physical human interactions, it is as close as we have to that sensation and, with continuing improvements to avatar expressions, movements, and haptics, the line will only blur further between mind and virtual body.

Focused, Distraction-free

Excerpt from NYT Article: “Many of our clients were riddled with fear and anxiety,” said Rose Foley, who runs mental health services for a Hazelden Betty Ford center in Chelsea, Manhattan. “I remember working with clients and hearing the sounds of sirens from outside their apartments. It was a traumatic time.”

Group and one-on-one video sessions are prone to both technical and situational intrusions. For those seeking help, these distractions can be frustrating and can adversely affect the healing process as they break the sense of connection and togetherness. VR headsets are self-contained units that block out visual and auditory interference. Since everyone is using the same device, the experience is consistent among all participants which leads to a more focused sessions in environments designed to induce a sense of calmness and safety.

Accessibility Meets Control Over Identity

Excerpt from NYT Article: Some positives have come from virtual care. John Driscoll, head of recovery services at Hazelden Betty Ford, said the number of patients choosing to attend sessions biweekly has doubled. The organization’s recovery program for families, which used to be local, is now on video and open to families around the globe, serving more than 2,500 people since the summer.

If there is a sliver lining in the challenges of the last year, it is that access to and utilization of telebehavioral health has increased dramatically. While in-person treatment may still be ideal, the ease of joining remote sessions has reduced barriers and stigmas to those seeking help who otherwise might not have tried. Though not yet as omnipresent as smartphones and laptops, VR offers the same ability to connect with anyone around the globe but with the added advantage that those who wish to remain off camera or anonymous are not left feeling excluded. VR creates a level social playing field where identity is fully in the hands of the participant at any stage of the process. This allows people to explore treatments before committing and removes the self-consciousness that comes with appearing on camera throughout the treatment process.

Beyond Four Walls or a Screen

As the vaccine rollout gains traction and we are eventually able to return to our normal lives, there will still be a prominent role for VR in addiction treatment in the following capacities:

• Remote Treatment: Even when the pandemic ends, there will be many people who seek remote treatment for a variety of reasons (affordability, accessibility, anonymity).
• Ongoing support: Those who have left a treatment center can continue to meet with peers and with counselors in a familiar shared space.
• New treatment models: Role play, withdrawal distraction, and exposure therapy both outside and within centers can offer alternatives to traditional treatments.

At Foretell Reality, we work with our partners to develop behavioral health applications that bring patients and clinicians together in VR environments for connection and healing. Both now and into the future, we see a tremendous opportunity to work with addiction treatment centers and facilitators to help those in need of connection and care.

“For patients with physical disabilities or social anxieties that prevent them from participating in support groups, VR provides the opportunity to connect with others and build strong social support networks.”

The above excerpt is from a recently published article under peer review in the Journal of Adolescent and Young Adult Oncology by our partner at Yale School of Medicine, Dr. Asher Marks. Dr. Marks.

In the article, Dr. Marks also discusses the benefits of VR for other areas of physical and behavioral health such as pain distraction, social interaction augmentation, and prolonged isolation.

“During situations requiring quarantine or isolation, such as the COVID-19 pandemic or bone marrow transplant, VR has been seen as a way to cope with the deleterious effects of prolonged isolation,” states Dr. Marks citing another recent study.

Foretell Reality has worked closely with Dr. Marks to develop VR support groups for adolescent cancer patients. This article marks another milestone in the advancement and adoption of the technology to make a real difference in areas of both mental and physical health.

Subscribers to the journal can read more here:

https://pubmed.ncbi.nlm.nih.gov/33296259/

(This post originally appeared on the website of our partner XRHealth and is being reprinted here.)

The way we speak about “being healthy” today sounds slightly different than how it was perceived in the past. Oftentimes, “healthiness” was exclusively associated with fitness, strength, and aesthetics only. What you ate and how much you exercised supposedly determined the entirety of your wellness. However, we know very well that this view of health enunciates only part of the story. Today, the scope has widened, and rightfully so, to include mental health.  

 A change in our collective perception of health isn’t the only paradigm shift that we’re observing this century. Technological innovations have been launching in multiple industries, and the health industry is no exception. The development of virtual reality (VR) tech, paired with a growing emphasis on maintaining a holistically healthy lifestyle, has given rise to a variety of medical VR applications for both mental and physical health. Although still in its infancy, the impacts of VR therapy for patients suffering from a range of health issues looks promising.  

Here are a few physical and mental health conditions that VR is proving beneficial for: 

Physical Health 

• Stroke  
• Cerebral Palsy 
• Parkinson’s disease 
• Multiple Sclerosis 
• Loss of upper limb motor functions 

Mental Health 

• Social Anxiety 
• Stress 
• Depression 
• Isolation 

VR Therapy Impact on Physical Health 

One of the biggest issues that VR helps people overcome is a general lack of physical activity. According to the World Health Organization (WHO), approximately 80% of adolescents around the world are physically inactive due to lifestyle factors. This lack of activity should be no surprise. After a typical 8-hour workday or a long day at school, it’s important that people try to find the time to unwind and move their bodies. VR exercise turns this often dreaded task into engaging simulations that people actually look forward to, such as virtual cycling. The idea began with the development of three-dimensional displays on TVs in which controllers weren’t needed for users who wanted to exercise. VR picked up where this tech left off by jumping from 3D to completely immersive experiences. Studies are now showing the tendency of VR to increase the likelihood of long-term adherence to exercise. 

For those who are seeking to mitigate the effects of disease or recover from physical bodily harm, VR technology has begun to prove effective. Children with cerebral palsy, as well as patients suffering from strokes and Parkinson’s disease are attaining significant improvement on their balance abilities with the use of VR. A recent study suggests that stroke patients may also regain motor functions through VR therapy, “…researchers suggested that VR could promote the lower limb function of patients who suffered from stroke.”  

VR is working to improve upper limb mobility by showing patients avatars of their upper limbs, then having them visualize their attempted movements to perform a task. For example, VR can simulate a sword in a patient’s hand, then tell them to slice through line targets on a screen, making the experience more fun and a source of motivation. Over time, the patients develop improvements to their motor-imagery, enhancing their ability to plan movements and lead to a steady recovery of upper limb motor functions.  

From a physical therapist’s point of view, the use of VR to streamline the processes of gauging feedback and upholding patient accountability is a plus. Through the analytical data gathered from therapy sessions, therapists can track whether patients are showing improvements. Accordingly, they may have the patients progress to more difficult exercises and ultimately normal physical activity. They can also monitor if patients are performing their programs at home, as opposed to assigning pamphlets and pictures to the patients in hopes that they’ll practice them on their own. 

VR Therapy Impact on Mental Health 

 Looking to balance its capability of helping patients on the other side of the health spectrum, VR is making its mark on mental health.  

Anxiety is a mental health issue plaguing a significant portion of the human population, especially in the United States. Most observable in teens, a deepening pressure to succeed and live a certain lifestyle because of comparison to others on social media is a major anxiety driver. Constantly feeling like you’ll embarrass yourself in front of others, a pressing unease in crowded settings or any hindrance to perform day to day tasks as a result of  social pressure are all symptoms of anxiety. Prior to the emergence of VRET, the VR version of exposure therapy whereby individuals are required to confront the source of their anxiety, patients would visit therapists and describe their emotional troubles in the past tense. 

 With the use of VR, therapists can engage patients in real-time simulations that emulate the fears they speak about, and adjust for intensity in the process. The value here is that the therapist and the patient can both be present in the fear-inducing situation at the same time, allowing for immediate and effective confrontation and discussion of how to overcome that fear. Additionally, VRET is often more acceptable to patients than imaginal or in vivo (having the patient directly experience the anxiety provoking stimuli) exposure therapy.  

New research supports VR’s ability to overcome stress and reduce depression in patients. Currently, virtual reality therapy is showing potential to promote distress management, mood enhancement and stress relief. Because depression patients often lack the motivation to step outside their familiar home environments, virtual reality recreates any setting imaginable for the user. For example, patients can dive into coral reefs, watch a sports game, or take a pleasant stroll through the forest to the music of a soft piano melody from wherever they’re located.  

A study aimed to uncover the effects of virtual reality on mental wellness, reports an overall positive impact of using VR to treat patients. The use of the technology yielded lower stress levels as a result of lower heart rate and higher skin temperature. Patients also reported higher levels of relaxation. Because the study tested patients using a variety of immersive technologies, future studies looking at which specific aspects of VR benefits patients are yet to be done. Regardless, VR is currently being used and monitored for patient feedback.  

Shifting the focus to our youth, VR tech can also aid students who display problems in the classroom due to being plagued with anxiety when having to perform tasks in front of peers. Other students who are stressed due to highly competitive education systems may also benefit from the use of VR to reduce stress. Additionally, student athletes who need support to mentally unwind and prepare for games may also turn to VR as a collaborative platform to connect with sport psychologists. 

VR Therapy and What’s Next 

 After getting to know VR’s multifaceted personality in greater depth, it’s apparent that its potential to help patients improve their health abounds. In recognition of its versatility, virtual reality company Foretell Reality is widening its scope beyond using VR for immersive therapy sessions only. Together with XRHealth, Foretell is working to merge VR tech with physical therapy to reap the best outcomes for patients in need.  

The goal is clear: to effectively improve the mental and physical health of as many patients as possible. Today, the means to achieve this goal is with virtual reality.

“On top of improving retention, VR can help providers improve treatment itself. For example, Foretell Reality often sees more genuine responses from patients when using VR, according to Dror Goldberg, General Manager of Foretell Reality.”

Thanks to Bailey Bryant of Behavioral Health Business for including us in her piece about the potential of VR to “change the game” of behavioral health.

Read the article here.