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VR for Depression
Therapy and Support

Virtual Reality (VR) for Depression : CBT and Other Techniques

Since the 1990’s, doctors have been leveraging Virtual Reality (VR) exposure therapy to treat phobias and PTSD. Does VR also hold promise as a tool to treat one of the most common mental disorders, depression?

A recent article in Frontiers in Psychology highlights various ways in which Cognitive Behavioral Therapy (CBT) and other techniques for the treatment of depression can be translated into therapeutic VR experiences that result in positive outcomes for patients.

Among them are imagery re-scripting, a VR therapy that has been found to improve the mental
state of people with depression. It often times “involves the patient using mental imagery to
either recreate a memory (rescripting) or expand upon an example scenario in a prompted
direction (positive imagery training), in their mind. The patient is tasked with finding alternative
solutions to the imagined situation that reduces their distress, and then rehearses a novel solution
in greater and greater detail.”

Another technique, avatar therapy allows the patient to create an avatar that then engages in verbal hallucinations that would typically be internalized by the user, and then verbalizes them to the patient, which in turn can help them disprove these notions, and help restructure their mental state.

Social skills training is also a generic CBT technique which can be translated to VR. “Such skills may include correctly interpreting and norm-appropriate responding to verbal and non-verbal social cues, conversational skills, assertiveness training, and relationship building. VR is uniquely well suited for training social skills via virtual conversational agents and immersive scenarios.”

Overall, the authors identify a number of areas in which CBT could be translated into VR including:

  • Behavioral Activation and Physical Activity
  • Cognitive Restructuring
  • Social Skills Training
  • Embodiment Experiences
  • Positive Affect Through Virtual Gardens and Animals

Foretell Reality is a virtual reality platform for various behavioral and mental health applications including individual
or group therapy sessions, support groups, and social skills development. We work with our partners to develop experiences tailored to the needs of their business and patients. Schedule a demo here.

Virtual Reality (VR) Support Groups
Therapy and Support

XRHealth Highlights Benefits of Virtual Reality (VR) Support Groups

Our client, XRHealth, recently highlighted the value of anonymity and the ability to participate from the comfort of one’s own home during emotionally loaded support group therapy. XRHealth therapists not only moderate group conversation but they leverage the 3D avatar bodies and the shared environment to include physical exercise and stretches during sessions. 

“Traditionally, groups meet in person, but online and virtual support groups are becoming more popular and accessible due to technology, especially during the COVID-19 pandemic. Online and virtual meetings are particularly beneficial for those who are homebound, have social anxiety, live in a rural area, have hectic schedules, or prefer anonymity.”

Foretell Reality has developed an avatar-based, multi-participant virtual reality platform specifically designed for group therapy. At XRHealth, the ability for our patients and moderators to connect with each other through VR is powered by Foretell Reality”

Read more here and be sure to scroll down to watch the video.

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.  

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.  

Therapy and Support

What is it like to face sexual harassment? VR offers a perspective.

Virtual Reality (VR) is often touted as an ‘empathy machine’ for its ability to change pre-conceptions by providing a convincing experience from someone else’s point of view. Whether to combat racism or bullying or increase medical school students empathy toward patients, VR is increasingly being used as a tool to challenge biases and encourage compassion and understanding.  

There are various ways to design VR experiences that facilitate this type of introspection including role play with avatars, narrative storytelling, simulations, and 360 video. A recent study focused on the latter approach to determine whether a 360 video in VR taken from the point of view of a woman would increase empathy in men about what it is like to face sexual harassment.

The study, titled ‘The impact of 360 video in VR on How Does It Feel to Be a Woman Victim of Sexual Harassment? The Effect of 360°-Video-Based Virtual Reality on Empathy and Related Variables,’ recruited 44 men in Mexico City and had them experience two different conditions. In one condition, participants watched the 360 video in VR to experience what it is like to be a female victim of sexual harassment (SH) from a first-person perspective. In the other,  the same story was presented in text format and the participants had to imagine the content of the story as if it were happening to them. 

Among the findings were:

“A tendency (marginally significant) to experience higher empathy after the 360° video than after the narrative. Furthermore, we found a carryover effect of the 360°-video condition. That is, empathy after the narrative was significantly higher when the 360° video was presented before the narrative task rather than after it.”

“Regarding the sense of oneness and perspective taking, [participants] were significantly higher after the 360° video than after the narrative task. A carryover effect on perspective taking was also found because scores in the narrative condition were higher when the 360° video was presented before the narrative task than when it was presented after it.”

In summary, the researchers concluded: 

“Despite its limitations, this study raises new possibilities in the prevention and treatment of SH toward women. Empathy, perspective taking, and sense of oneness could be target therapeutic components in interventions designed to decrease SH behaviors through a VR tool that is affordable for clinicians.”

Among other features, the Foretell Reality Virtual Reality (VR) platform provides the ability for one or more people to experience 360 video and then meet together as anonymous avatars to discuss the experience. We welcome partners interested in leveraging this and other tools to overcome biases and increase empathy. Click here for a demo or to contact us.

Therapy and Support

Controlling Binge Eating Through Virtual Reality (VR)

Binge eating disorder (BED) is characterized by episodes of eating large amounts of food while experiencing a loss of control. It is the most common eating disorder in the United States, and it can be life threatening if not addressed.

To treat the condition, cognitive behavioral therapy is often applied but, according to researcher Stephanie M. Mannasse, this type of treatment is largely ineffective at targeting the loss of control because it is difficult to transfer treatment gains to real-world eating behavior. 

To address this issue, Mannasse developed a proof-of-concept study and enrolled 14 adult subjects with a recent history of binge eating into a two-week Virtual Reality (VR) training program. The training followed a go/no-go paradigm.

“Throughout a series of trials, subjects were shown realistic 3D models of either a binge food item (e.g., pizza, fries), a fruit or a vegetable, or a neutral item (e.g., bowl, fork). The binge food items were paired with a “no go” cue, fruits and vegetables were paired with a “go” cue, and neutral items were paired with a “no go” cue half of the time and a “go” cue the other half of the time.” 

Clinical interviews were conducted before, during, and two weeks after the training program and the following results were noted:

  • Subjects showed reduced binge eating behavior throughout the training.
  • Bingeing episodes continued to drop during the two-week follow-up period.
  • Subjects rated most aspects of the training favorably, with many indicating that it was easy to use.
  • Participation was high, with subjects missing an average of only one training per week.

The power of VR to change behavior in this study can be further extended and enforced by bringing people together who are also fighting BED in safe, anonymous, moderated VR environments.

The Foretell Reality platform offers features, tools, and spaces for VR support groups, VR group therapy, and other social behavioral treatment approaches like role play and guided exposure therapy. To schedule a demo, click here.  

VR for Mental and Physical Health During Lockdown
Mindfullness, Therapy and Support

Impact of VR on Mental/Physical Health During Lockdown

The recent pandemic has drastically changed nearly all aspects of our lives. Stay at home orders are causing people to feel confined and anxious and the closure of gyms, parks, and community centers have forced millions to suddenly adopt a sedentary lifestyle. The WHO recognizes the pandemic as posing a significant threat to global mental health, stating that quarantine and self-isolation can lead to negative feelings such as “stress, depression, irritability, insomnia, fear, confusion, frustration, and boredom”.

Many studies have shown the efficacy of Virtual Reality (VR) for helping people manage stress, anxieties, and depression. VR has also been shown to promote physical well-being. Physical movements exerted through virtual reality games like Beat Saber can greatly increase heart rate and burn hundreds of calories in a single session. 

Now a study conducted by Alessandro Siani and Sarah Anne Marley, two leading faculty members at the University of Portsmouth’s School of Biological Sciences, has aimed “to evaluate the effectiveness of VR as a physical and mental health aid for people observing social distancing due to the Covid-19 pandemic.”

Here are some highlights of the study which consisted of surveys submitted by 646 participants from around the world:

  • Over 75% of participants agreed or strongly agreed that their use of VR increased during the pandemic.
  • Over 60% of participants agreed or strongly agreed that VR was a good way to keep fit during lockdown
  • Close to 80% of participants agreed or strongly agreed that VR has a positive impact on their mental health during lockdown

In conclusion, the researchers stated: “The majority of the population surveyed in this study, regardless of their gender and age, reported that their VR use has increased during the lockdown, and expressed overwhelmingly positive opinions on the usefulness of VR as a way to keep busy and improve their mental and physical wellbeing.” 

The Foretell Reality platform offers features and environments for support groups, 1:1 and group therapy, and guided stress and anxiety relief.  

Therapy and Support

DoD Leveraging VR to help prevent Air Force suicides

With suicides in the military up more than 20% this year from 2019, the United States Department of Defense recently announced the use of a VR training program designed to help prevent suicide among Air Force veterans. The program features a 30-minute VR training scenario in which participants must convince an airman to seek mental health support during a period of emotional distress. 

Participants must ask the airman, who is powered by artificial intelligence (AI), a series of prewritten questions. Those who struggle to effectively ask these questions will receive assistance from a qualified mental health professional. The coaching is intended to help both veterans and their spouses better understand what questions to ask, how to properly respond, and why one should ask these questions.

“The unique part of this VR training is that it’s voice-activated, so you’re required to say things out loud that maybe you’ve never had to say before,” explained Master Sgt. Shawn Dougherty, a VR facilitator at Travis Air Force Base, which is one of the locations utilizing VR suicide prevention training. 

Virtual reality provides a unique opportunity for individuals to confront challenging interpersonal situations through realistic simulations. In the instance above, this is accomplished through the use of an AI ‘bot’ but the same types of simulations can also take place with other real people. 

Foretell Reality is a social Virtual Reality (VR) platform for support groups, group therapy, guided exposure therapy, and other therapeutic practices like role playing and mindfulness training.

Foretell Reality’s social capabilities can be particularly effective in addressing various behavioral health issues when combined with programs originally designed for single individuals. In the example above, veterans and their spouses could join support groups in VR after navigating the solo training in order to talk about their experiences. Further, the AI bot in the simulation could actually be replaced by another real person which could allow for more unscripted and exploratory treatment options. 

Interested in learning more about social VR for behavioral health? Schedule a demo.

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.

Study: 3d versus 2d Video for retention and engagement
Therapy and Support, Video

Study: 360 Video in VR Increases Engagement and Retention

Three-dimensional (3D) video is a powerful feature of Virtual Reality (VR) because it fully envelopes the viewer within a panoramic scene. The effect is similar to sitting in a darkened planetarium, convinced that you have been transported to the center of our universe.

But is 3D video just another way to watch content or could there be deeper implications for learning and psychology? A recent study set out to determine this by comparing the psychological state and learning ability of subjects who were shown the same three videos in 2D conditions and in 3D conditions (VR).

As they viewed the videos, their brain signals (EEG signals) and facial reactions (EMG signals) were recorded using a value called fractal dimension. Researchers then developed a universal formula to compare the fractal dimension between the two types of viewing experiences.

The results revealed that “the EMG signal had a greater value of the fractal dimension in response to 3D videos compared to 2D videos, indicating that the EMG signal is more complex in response to 3D videos compared to 2D videos. In other words, the facial muscles are more engaged with stimuli where they are presented in 3D rather than in 2D.”

With regard to learning ability, “the rate of correct responses to the questions posed after watching the 3D video was 92.60%, which was higher than that obtained after the 2D videos at 80.87%. This difference suggested that the 3D videos resulted in greater attention paid to the details of videos and therefore increased the learning ability of the students.”

It is worth noting that the headset used in this particular study was based on cellular phone technology and not the latest, much more powerful headsets now in the marketplace. Given the level of clarity and freedom of movement now available, another study with updated hardware should be considered.

The Foretell Reality platform includes the ability to view 3D video within an environment alone or with others in real time. Some use cases include social viewing, mindfulness training, pain distraction, and exposure therapy. Request a demo to experience it yourself.

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