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Michele Oberly

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Therapy and Support, VR-Related

VR for Treating Anxiety and Depression

If you live in the U.S. where the combined rate of anxiety and depressive disorders among adults is approximately one in three, you likely know someone who suffers from the disorders’ crippling symptoms such as hopelessness and guilt. Perhaps you yourself have experienced a depressive episode and were encouraged to seek help, but for a multitude of reasons that we will touch on later, you didn’t. Virtual Reality (VR) reduces the barrier to engagement in mental health treatment and recent research shows that it can be used as a powerful tool against anxiety and depression.

The focus on anxiety and depression is relatively recent, but the relationship between VR and mental health is decades old. The first mental health breakthrough occurred in the 1990s when VR exposure therapy was used to treat war veterans with Post-Traumatic Stress Disorder (PTSD). VR exposure therapy simulates life-like stimuli in a controlled environment. Under the supervision of a mental health professional, patients confront the object or scenario they fear, thereby diminishing their anxiety over time. VR exposure therapy treatments were also developed for phobias such as claustrophobia, arachnophobia, and fear of flying. Additionally, early VR therapies focused on cue reactivity for addictions like nicotine. Because VR makes the scenario feel real, patients are able to practice their behavior when confronted with stimuli (e.g. a crowd of people smoking) that trigger their arousal and anticipation.

Early VR treatments like exposure therapy and cue reactivity were one-on-one. And often the therapist was not immersed in the space with the patient, but rather was guiding the session from the outside. More recent technological developments have enabled multiple participants to interact in a shared environment, which has made VR  support groups and group therapy a reality. 

In one example, Yale School of Medicine partnered with Foretell Reality to study the viability of VR support groups for adolescent cancer patients. VR allows something that other types of therapy (e.g. tele-health via video) do not – anonymity. If you’ve experienced depression or know someone who has, you’ll be familiar with the heavy burden of social interaction. If you’re losing your hair due to cancer treatments or your depression has taken a toll on your hygiene habits, you can understand why some would avoid group therapies altogether. Because VR is avatar-based, patients do not feel judged as they are not physically “seen.” At the same time, they can still interact with other avatar patients through body movement and gestures as if they are in the same physical space. 

Anonymity helps solve the burden of stigmatization regarding physical appearance, but that isn’t the only barrier that VR addresses. Those suffering from depression and anxiety may experience challenges focusing. With a VR headset on, it isn’t possible to look at your phone or be distracted by the television. A patient is fully immersed in a virtual supportive environment: chairs in a circle, the cushy pillows… everything looks… real. And the possibilities are endless. Perhaps your support group is meeting by the ocean or on a serene clifftop nestled in the clouds. You are there – and you didn’t even have to leave your home. You can use different settings for a daily meditation or mindfulness practice, walk on the beach with your guide while discussing your feelings, or play a virtual ball game with your peers. 

And that brings us to another barrier to mental health treatment: the physical one. Some patients are disabled and literally cannot leave their homes. Others live in a rural area with no accessible support group within hundreds of miles. And depressed patients may at times not feel physically capable of leaving even their beds. A $300 headset and internet connection is all one needs to connect socially from anywhere in the world. 

VR technology has been evolving for over two decades, and has greatly accelerated in the past couple of years. This evolution comes just in time for using VR effectively for various (tele) mental health purposes. In less than ten years, the World Health Organization predicts that mental health disorders will be the leading burden of disease worldwide. We must use every available tool to treat mental health disorders, and VR is here to help.

Coaching, Soft Skills, VR-Related

Virtual Reality (VR) Provides Unique Opportunities for Coaches

Role-play is an integral part of a child’s development and a potent tool for the continuation of skill acquisition and honing long into adulthood. Because it allows participants to learn, not by reading a book or listening to a lecture, but by actually doing and practicing, role-play is experiential learning – an accelerated learning method. Medical students, teachers, and in more recent years, managers, have all benefited from role-play scenarios. Coaching managers using role-play scenarios helps them to build skills through rehearsal and direct feedback. 

Effective managers require competence in many areas with communication as the common denominator across the skillset. Considering that the number one reason employees cite for leaving a position is the relationship with their manager, investing in management coaching is paramount for retention. All types of communication can be rehearsed in role-play scenarios, but of particular significance is navigating difficult conversations, such as delivering a negative performance review. Difficult conversations are inherently uncomfortable for most people, and thus are often avoided or rushed in order to minimize discomfort. Role-play is a type of exposure that desensitizes the participants’ fear and anxiety to engage in conflict, thereby facilitating more productive conversations. 

Given the global nature of modern companies, it often isn’t feasible for an executive team or for regional managers to gather in one place for management coaching. This difficulty has been further exacerbated by the COVID-19 pandemic. And there is an evolving trend of companies offering employees a work-from-home or hybrid (remote/office) model to attract sought-after candidates. Virtual Reality (VR) coaching offers a unique solution: through multi-participant VR simulations, teams can gather in an immersive space, such as a boardroom, without needing to leave their homes. 

Coaching in VR is not just logistically convenient, but it offers features that are not possible with in-person coaching. Foretell Reality’s platform allows users to build their own avatars. This can be an empowering experience but also allows participants to switch roles easily. By choosing a different avatar and playing the role of the employee on the receiving end of a negative performance review, managers can stand in the (virtual) shoes of the employee, thus increasing their capacity for empathy. They can understand what it feels like when feedback is indirect and vague, for example. 

Another unique feature Foretell offers is a playback “hologram”. Role-play scenarios can be recorded and participants are given the opportunity of observing their avatar following the exercise. Rather than a coach giving feedback regarding lack of eye contact, for example, the participant can actually observe her avatar avoiding direct gaze, perhaps by looking down or to the side. In fact, Foretell’s software can even measure the amount of eye contact during conversations. Through  watching the hologram recording, participants can more objectively observe their behavior. They might be surprised to observe that they came across as rather aggressive through their hand gestures or tone of voice. Having these epiphanies through direct observation is more powerful than hearing the feedback second-hand from a coach. Of course, the coach can play an instrumental role by helping the participant process their observations and imparting helpful guidance for the next practice round.  

Recording and playback in Foretell Reality.

Additional features include a personal tablet for each avatar that is not viewable by other participants. This creates a potential for dynamic role-play scenarios wherein each participant has an objective that they need to achieve during the exercise. The tablet may contain information about their role-play partner, perhaps related to their background and performance issues. The coach has the ability to change an objective at any point during the scenario. Additionally, Foretell’s VR software includes a “whisper” feature that allows a coach to speak to one of the participants, and only that participant can hear the feedback. In the middle of a heated scenario, a coach might whisper a tactic to help diffuse tension, for example. 

The potential for virtual reality coaching is limitless. It does not require travel or other logistical hurdles. Rather, managers can be instantly transported to a shared space with a coach, to build the confidence and skills needed to be more effective managers. Foretell Reality’s features create the perfect environment for creative role-plays and instant feedback. 

Therapy and Support, VR-Related

Study Compares Face-to-Face and Virtual Reality Interactions: What it means for tele-health.

Tele-health options are on the rise in recent years, and have especially flourished during the COVID-19 pandemic. Mental health therapy has evolved from largely in person-only to including other methods like web-based applications (e.g. Zoom) and Virtual Reality (VR) that make health care accessible in the comfort of one’s home without the constraints of transportation and other logistical barriers. Researchers are beginning to study the dynamics of virtual communication and how this medium compares with face-to-face conversation. Findings can be especially relevant for mental health therapists who seek to provide the ideal environment for patient comfort to disclose thoughts and feelings, thereby facilitating more effective therapy. 

At Edith Cowan University in Australia, researchers studied social interaction in two contexts – one in which participant and researcher engaged in casual conversation, and the other in which the participant was instructed to disclose both positive and negative personal experiences to their research conversational partner. These contexts were studied within a face-to-face condition as well as a virtual condition, wherein the researcher was represented via avatar in real time through face and body motion capture.

While participants had an overall slight preference for face-to-face interaction, one of the findings is of particular relevance to mental health practitioners. In the disclosure of negative information context a significant portion of the participants (30%) preferred the interaction with the avatar over the in-person conversation, specifically on the facets of self-disclosure, comfort, and being able to relax and be oneself. The researchers suggest, “the increased sense of interpersonal distance in VR may be why some of our participants indicated such preferences for VR over face-to-face for negative disclosure”. Furthermore, they surmise that a study conducted specifically with a socially anxious participant population could yield an even greater preference for virtual reality when disclosing negative experiences.

It also makes sense to consider that participant comfort level with the avatar could be higher in conditions that more closely align with communication norms. In the present experiment, the virtual partner, represented through an avatar, was standing while the participant was sitting.  This dynamic of the participant sitting while the avatar stood had the potential to lessen participants’ level of comfort and ability to relax, as it may have felt more unnatural. Ideal study conditions would have mimicked the typical conversational interaction of two people sitting and speaking (as was the case in the face-to-face interaction), but researchers had the avatar standing behind a desk in the VR condition to avoid a potentially distracting technological effect of the avatar “clipping” with the table. Clipping is a technical glitch that can be easily avoided with a careful design of the VR environment.

Also, in this study, only the research conversational partner was represented via avatar while participants were not. Participants were aware that they were not anonymous as their conversation partner could see them sitting with a VR headset on. Further studies that allow participant anonymity that shields identity through an avatar could be useful to mental health practitioners. For many suffering with anxiety and depression, their physical appearance (for example, due to hair loss associated with chemotherapy or body image issues) can be a deterrence to participating in group therapy. It may be possible that the avatar anonymity in VR could increase their willingness even more to disclose information and participate in group discussion.

Foretell Reality is a VR platform that provides safe, secure environments, customizable avatars, and moderation tools for clinicians to facilitate individual and group therapy sessions, support groups, and other behavioral health treatments.

virtual reality (VR) anhedonia
Therapy and Support

Positive Scenes in Virtual Reality (VR) Offer Hope for Those Suffering Anhedonia

A recent pilot study shows that Virtual Reality (VR) can help people with anhedonia experience positive affect. Anehodia describes a lessened ability to experience joy and those who suffer with it are at an increased risk of suicide. It is common across mental disorders including depression, social anxiety, schizophrenia, and substance abuse disorder. 

Due to factors such as fear of positive emotion, it has proven very difficult to treat, and most therapies have been largely ineffective because of their focus on negative affect. Even cognitive behavioral therapies that focus on positive reinforcement are hindered because anhedonia sufferers may lack the motivation to engage in rewarding activities.

Viewing positive imagery in VR has shown to increase positive affect in participants in pain management and anxiety studies. Because the immersive qualities of VR allow greater access to reward circuitry and require minimal effort to engage in positive activities, researchers of this pilot study hypothesized that virtual reality would help lessen anhedonia in depressed patients. 

Six participants with clinically significant depression experienced VR behavioral activation with imaginal recounting in 13 hour-long sessions over a period of seven weeks. After viewing positive scenes in VR, participants were instructed to choose one scene and write down the positive emotions and sensations they experienced while immersed in that scene. Then they were asked to recount a personal memory with similar positive emotions in order to transfer the VR experience to their own lives. 

Results showed a significant decrease in anhedonia. This is encouraging news for further study of a possible treatment to a disorder that lacks effective treatments. VR can help sufferers savor pleasurable moments and offers access to pleasurable activities with minimal access, thereby counteracting the lack of motivation to engage in activities.  

virtual reality (VR) for depression
Therapy and Support

Going back in time to heal yourself, a VR study on self-compassion.

Words are powerful and the way we talk to ourselves can have profound effects on self-image, how we interact with others, and how we handle life’s stressors. And even if we understand the value of compassionate words, we may find it much easier to extend them to family, friends, and strangers than to ourselves. 

Our internal voice can be overly harsh and critical at times, but for those suffering from depression, that negative self-talk can lead to a debilitating cycle that is difficult to escape. A recent Science Focus article on VR’s impact on mental health highlights a recent study that seeks to dampen this voice. Professor John King and Dr Emma Jayne Kilford at University College London are creating a virtual reality intervention that supplements face-to-face therapy with the goal of strengthening one’s ability for self-compassion. 

The intervention consists of a virtual room that includes two avatars – a child and an adult. The avatars can be designed to look like the participant presently and as they looked in childhood. Before entering the virtual room the participant learns a “compassion script” that includes three strategies to improve the mood of someone in distress – validating experience, redirecting attention, and activating a positive memory. The participant then enters the room in the role of the adult with the task of speaking to the child until the child’s distress is lessened.

Next the participant enters the room as the child and watches the play-back of the avatar representing their adult self. As the child avatar, the participant is experiencing receiving compassionate words from his/her adult “self”. 

A larger trial is now taking place, based on initial results of a sample of very self-critical or depressed patients. The initial results are promising, showing a reduction in depression and self-criticism and improvement in self-compassion. 

Foretell Reality can not only create scenarios for practicing self-compassion but as a multi-user platform, we can create role-play scenarios with other participants to increase empathy, which is fundamental to implicit bias and other types of training or therapy exercises.  

virtual reality (VR) group therapy
Therapy and Support

Virtual Reality Group Therapy Shows Benefits in Recent Study

Patient benefits of cognitive behavioral group therapy (CBGT) are well-supported and include group cohesiveness and interpersonal learning. And from a therapist perspective, the delivery of treatment to multiple patients at once is time-efficient.  CBGT is a particularly effective treatment for depression, but due to factors such as inaccessibility and social anxiety, a significant number of patients with depression drop out of therapy or do not attend at all. 

To reduce barriers to treatment for depressed patients, digitally-enabled formats are on the rise in healthcare. Virtual reality group therapy (VRGT) allows patients in any location to gather and interact in a computer-generated environment that feels real.  Two VR studies have shown a decrease in depression symptoms in widowers and patients with disabilities, but neither study used group therapy as the format, nor were the studies specifically developed for depressed patients.  For the first time, a recent qualitative study assessed the views of stakeholders (patients and therapists) on CBGT experienced in a virtual reality format.  

The study’s findings were generally positive and coalesce around several themes. Patients cited the ease of attending a session from home, which is particularly useful for those with physical disabilities and social anxiety. The use of an avatar was also generally regarded as positive, since depressed patients may not be motivated to tend to their personal appearance and appreciate the anonymity that the avatar provides. Avatar usage may increase engagement because “a patient talking about their problems cannot see whether other patients are judging them or look bored and disengaged.” Patients and therapists both cited the anonymity of avatar-based group therapy as minimizing patients’ social anxiety because it takes away the fear of being recognized. 

Foretell Reality has developed an avatar-based, multi-participant virtual reality platform specifically designed for group therapy. We work with our clients to customize the software to fit their needs. Click here to view a short video or here to schedule a live demo.

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