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Podcast: VR Therapy Now and in the Future

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.

Therapy and Support

How VR can fight addiction through remote human connection.

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.

Collaboration, Soft Skills, Therapy and Support

Virtual Embodiment In VR Raises Questions

In its simplest form, Virtual embodiment is the perception of sensory feedback related to a person’s virtual, non-physical body, also known as an avatar, and the effect it has on the particular person behind the avatar. Virtual embodiment comes as an offshoot of the study of embodiment cognition, which is the idea that the mind and body are in unison, with the two working in harmony. Embodiment cognition research shows how the aspects of a person’s body seem to generate built-in tendencies in how that person views the world around them. Those aspects include motor functions, height, number of limbs, handedness, and the body’s interactions with the environment.

Given we cannot control many factors like our height or handedness, the most common way we seek to control our identity in the physical world is through clothing, accessories, make-up, tattoos, piercing, hair styles, hair coloring and now, masks. We display these attributes to show our personal style and to provide non-verbal clues about our personalities.  If we want to be seen as diplomatic and professional, chances are we wear business attire and keep ourselves well groomed. If we want to be viewed as someone who is bold and anti-establishment, we may choose ripped clothing and cyan colored hair. We rely on these outward signals, whether consciously or not, to frame interactions with other people before any words are spoken.

As our bodies and minds become more integrated with virtual mediums, the same avenues of expression we have in the physical world are finding their way into the digital world. From the more basic Bitmojis on Snapchat to full-fledged 3-D avatars in a Virtual Reality simulation, we continue to seek ways to express and represent ourselves in order to provide non-verbal clues as to who we are underneath.  The difference with virtual embodiment, however, is that the only limitations to creating an outward identity is the level of customization afforded by a particular platform. Skin color, gender, height, facial features, number of limbs – all potentially alterable within minutes. Staying within our own species is not even a requirement in some cases.

No where is virtual embodiment taking on more meaning than in Virtual Reality (VR) where interactions between avatars are convincingly lifelike and the range of customization options is broader than any other digital medium. Take entertainment-based social environments like Rec Room, AltSpace or Facebook’s Horizon. Many people in these worlds engage and interact purely through virtual identities without ever knowing what someone looks like in real life.

While this level of anonymity and freedom of identity is fine in that context, those same attributes do not necessarily lend themselves to a business or professional environment. With VR being used more and more for corporate collaboration, mental and physical healthcare, and training and education, the role of the avatar brings up more nuanced questions around virtual embodiment that need to be thought through. 

For example, in the case of a pitch meeting held in VR, is there a responsibility for both parties to represent themselves as close to who they are in the real world as possible? Since pitching is partially about the person or people behind the product or service, an argument can be made that they should not appear younger, a different ethnicity, or a different gender than they are in real life. Or maybe that actually shouldn’t matter at all and non-realistic should be encouraged in order to weed out implicit bias in the process.

Therapy sessions also produce an interesting use case. It may be that the therapist should adhere closely to his or her real world identity whereas the patient may benefit from a virtual embodiment that they feel expresses themselves better. The very act of customizing one’s virtual appearance to better represent how one would like to be seen can be a part of the therapeutic process itself. Or maybe there is a benefit in the therapist playing a particular role or roles throughout the therapeutic process in order to elicit responses from the patient.

Foretell Reality recognizes the importance of virtual embodiment, particularly in professional settings. Through our work with partners like Yale School of Medicine, Fordham University, and XRHealth, we see firsthand the importance and promise of virtual embodiment in VR to redefine digital identity as a whole.  Toward that end, we recently expanded our avatar selection tool to include many more customization options.

Therapy and Support

Dr. Asher Marks Highlights Healing Benefits of VR in Peer Review Publication

“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/

Therapy and Support

VR Benefits both Mental & Physical Health

(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.

Therapy and Support

Foretell Highlighted in BHB

“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.

Therapy and Support

Fighting Isolation with VR

When isolating inside for the collective wellbeing of humanity, it’s easy to feel down without the stimulation of being able to constantly interact with others. Virtual Reality (VR) simulations present a unique opportunity in helping people connect. Video interviews and work conferences through VR are becoming increasingly popular and allow you to feel more immersed in your work environment. Being able to see your colleagues and interact, even if only virtually, creates a greater sense of community that can’t be communicated over the phone or even through Zoom calls.


VR technology is also incredibly powerful in its ability to create an interactive classroom setting. With a VR headset, there are no incoming distractions from the outside world. Students can continue to learn distraction-free without worry of exposing themselves to COVID-19. Additionally, sites such as opencolleges.edu show that VR improves student’s motivation so that they feel more inclined to make the most of their learning experiences.


It’s also important to acknowledge how VR is shifting the realm of psychology and what this means for psychologists to interact with their patients. Psychologists are working with VR to develop experiments in which they can create studies that allow them to have control over a variety of social scenarios. They can create virtual avatars that all look the same to control all the variables. They can then test them against each other and find out how to better reach and communicate with certain people.
A recent study focused specifically around this premise. In the study they concluded the utility of VR for psychology by acknowledging the context of VR in the psychological realm, exploring the hardware itself, and analyzing various projects and systems that are combining psychology and VR/AI. A cool example included a socially aware robot assistant (SARA) created by the ArticuLab at Carnegie Mellon University that is able to “recognize both non-verbal (visual and vocal) and verbal signals and utilizes AI to form her answer”.

VR can also be used to connect with a therapist or with a therapy group during this time. These sessions can often be even more convenient and effective than an-in person sessions, and are particularly useful in this time of isolation.


VR is not only expanding technology, but the field of psychology. It demonstrates how we are adapting to these isolating times and creating new and effective ways to interact with others. Talking to friends and teachers is easier than ever before thanks to VR, and technology is continuing to evolve, leading to endless possibilities. Companies such as Foretell Reality see the opportunities this pandemic gives to create new ways of interacting that can benefit everyone in more convenient ways than ever before.

Therapy and Support

VR Exposure Therapy for Eating Disorders

Influencers. Thought leaders. Foodies. Models. Instagram. Sound familiar? It’s 2020, and it’s noisy. The struggle between people and eating disorders, such as anorexia nervosa and bulimia, dates back centuries ago. The human need to be viewed as aesthetically pleasing and acceptable in the eyes of others has intensified in recent years, in parallel with the raging popularity of social media. No, social media isn’t the scapegoat for all of our problems. It does provide us with a place for sharing and receiving information, keeping up with market trends and providing entertaining content after a strenuous day at work.

However, we can’t forget that it’s called social-media. As in, the places we share our media with the rest of the world. Comparing ourselves to others has never been easier, has never been quicker, and has never been a stronger driver behind body self-consciousness. People with eating disorders possess a negative body image of themselves, where what they see is shaped by negative attitudes and perceptions of how they think they look. As a consequence of the distorted lens they can’t but peer through, they tend to overestimate their body weight and shape, and live in a cloud of depression, anxiety and shame as a result.

Rather than turning to drug therapy, a form of psychotherapeutic treatment called Cognitive Behavioral Therapy is commonly used to aid in reducing the automatic, negative mental responses people with eating disorders internally struggle with. However, it is limited. Discussing how you feel with your therapist when you’re not actively immersed in that headspace isn’t as effective as sharing your feelings right as they come. But how can that be made possible? With simulated environments.

Virtual Reality (VR) technology is increasingly being used to assist in many mental health conditions that involve managing complex emotions. A study on the use of virtual reality to help individuals with eating disorders outlines that, “Body image disorder in patients with eating disorders are related to a deficiency in their ability to update their negative body image stored in their memory…with sensory motor and proprioceptive inputs in real time.”

By virtually reproducing situations that trigger destructive emotions to flood patients’ minds, therapists are able to step in at that very moment and help them become aware of their body image distortions. This method of creating realistic anxiety inducing simulations, or exposure therapy, is made especially effective with the use of VR tech, and has been developed by numerous companies such as Foretell Reality to help patients in need

The virtual environments are supervised, allowing the therapist to adjust the simulation for the stress level. The patients create their virtual “body”, or the avatar, that reflects how they perceive themselves. The therapist can then generate a silhouette based on the patient’s real body dimensions in order to make apparent the difference between perception and reality to the patient.

Potential for creating all sorts of emotion provoking environments unique to each patient- either who suffer from the mental effects of eating disorders or other mental illnesses- is large with Virtual Reality. Re-living the very environments that arouse negative emotions on the spot allows therapists to help their patients confront their issues right on the spot, and therefore handle them more effectively.

Foretell Reality is an enterprise VR solution for interpersonal communication and business collaboration. Learn more here.

Tech, Therapy and Support

VR Support Group Pilot: “Very Encouraging”

We have had the pleasure of working with Dr. Asher Marks over many months on a pilot program that provides Virtual Reality (VR) support groups to patients in the Adolescent and Young Adult (AYA) Oncology clinic at Yale New Haven Hospital.

With the pilot nearing its end, Dr. Marks has published an article highlighting the role of VR in telepsychiatry including the specific benefits of VR support groups. Below are some key takeaways:

  1. Telephone and video conferencing fall short when it comes to “sharing a therapeutic physical space, being able to communicate via non-verbal cues, and being able to interact without distraction,”
  2. Of all immersive technologies, VR is the most “mature, available, and studied.”
  3. Availability of consumer ready headsets over the past year “has greatly expanded VR’s potential to be incorporated into telehealth and telepsychiatry.”
  4. Early hurdles to leveraging VR included ensuring physical and emotional safety, infection control measures, and the ability to collaborate with rapid tech industry timelines.
  5. Initial findings of the pilot program are “very encouraging.”
  6. After this pilot has concluded, “the intention is to move forward with a larger, multi-institutional Phase 2 trial assessing risks and benefits of VR based support groups as compared to other viable solutions to the remote care problem.”
  7. Though the population for this pilot was younger and therefore more comfortable with new technologies, another pilot showed the viability VR support groups for older patients dealing with grief.

Read the full article here.

Foretell Reality is an enterprise VR solution for interpersonal communication and business collaboration. Learn more here.

Lifestyle, Tech, Therapy and Support

The Mental Health Puzzle

Mental health. What it means today in 2020 is largely different than how a vast number of people perceived it nearly a decade ago. The stigma of its importance is often perceived as being secondary to its tangible counterpart, physical health. Thankfully, more people are recognizing the relationship between mental health and physical wellbeing—especially due to the aid of awareness campaigns, such as Bell Let’s Talk, and increased advocacy from public figures. But what happens when an unprecedented pandemic forces millions to stay at home just as the world has started opening up to the idea of seeking real help?

Although digital alternatives such as videoconferencing, phone calls and email have shown to be effective in helping a scope of mental health illnesses, a piece remains missing. An essential element that links one human to another in order to cultivate an environment of trust and ease of mind is feeling the presence of another human.

When living in isolation and a constant state of uncertainty, there is value in having communication that fosters a sense of connection. Out of all telehealth platforms, Virtual Reality (VR) is the first form of communication that reaps the same advantages as face-to-face meetings and offers additional benefits that would be impossible to execute in a shared, physical environment. Thankfully, technology has been advancing prior to the outbreak of COVID-19, and VR is now surfacing in our new age of remote-health needs.

Companies such as Foretell Reality specialize in creating immersive platforms designed to foster nearly real interpersonal human experiences. A patient’s comfort doesn’t need to be compromised when taking part in VR therapeutic sessions. One VR experience with partner company XRHealth is purposed around ensuring a comfortable environment for its patients by providing relaxing décor and customizable avatars.

Receiving mental and emotional support isn’t a one time thing. Yes, doctor-patient follow ups are possible over the phone and through video call, but VR brings its people closer to each other. That feeling of going into the office and trusting that your doctor has been monitoring your progression is made possible with VR because it minimizes the robotic element that comes with using technology. A recent article from HealthTech outlines, “…In the arena of pain management or mental health, immersion in virtual worlds can produce better results.”

The human species is an incredibly social one, relying heavily on the subtle nuances of eye contact, hand gestures and posture to communicate. COVID-19 has disrupted this mode of communication by forcing a lifestyle of isolation- an especially harmful phenomena to mental health patients in need of real human help. Thankfully, virtual reality is working hand in hand with the healthcare industry to connect patients with doctors in immersive environments that stretch far beyond what video and chat are able to offer.

Foretell Reality is an enterprise VR solution for interpersonal communication and business collaboration. Learn more here.

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