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virtual reality (VR) binge eating
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.  

Air Force Suicide Prevention
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.

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.

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.

virtual reality (VR) public speaking
Soft Skills, Therapy and Support

Study: VR Effective in Treating Public Speaking Anxiety

Public speaking anxiety (PSA) is one of the most common phobias affecting approximately 73% of the population. It is so common that it actually beats out the fear of death, spiders, or heights.

As with many phobias, one common treatment for PSA is exposure therapy. Exposure therapy involves confronting the situation you fear most while being observed and guided by a trained therapist or clinician. Through repeated exposure to what appears to be an insurmountable fear, the level of anxiety and stress are diminished over time.

Traditional exposure therapy can also involve guided visualization. If you are afraid of spiders, you are asked to visualize a spider approaching you. Over time, a real spider may be introduced in a controlled setting.

For public speaking anxiety in particular, the introduction of a realistic but “safe” scenario is more difficult to achieve. How do you bring together a room full of people to play the audience (let alone in a pandemic)? How do you expose people to different types of room set ups? Different size crowds? Different types of people?

In response to these challenges, a recent study looked at the effectiveness of guided exposure therapy in Virtual Reality (VR) to treat PSA. The study, which intentionally leveraged affordable hardware and psychologists only minimally trained in VR, concluded:

“VR exposure therapy can be effective under routine care conditions and is an attractive approach for future, large-scale implementation and effectiveness trials.” 

Among the studies finding were that patients’ self-reported a “robust” decrease in PSA following VR-assisted therapy and that the “exposure therapy exerted these benefits by reducing patients’ fear of negative evaluation and catastrophic beliefs.”

The study also found that “patients rated the quality of their speech performances higher after watching the avatar perform a playback of their speech.”

As the authors of the study point out, using VR to treat anxiety in general is not new.

“Dozens of high-quality trials since the early 2000’s support the efficacy of VR exposure therapy (VRET) for anxiety disorders (Carl et al., 2019; Fodor et al., 2018; Opriş et al., 2012), showing effect sizes similar to in-vivo exposure therapy (Wechsler et al., 2019) and that treatment effects generalize also to reduced fear of real-world equivalent phobic stimuli (Morina et al., 2015).” 

Using it to overcome fear of public speaking, however, seems to be particularly effective because it confronts one of the primary fears of public speaking – brain freeze. Ironically, the fear of being judged or negatively perceived by others can actually cause the exact outcome a speaker is trying to avoid.

“If your brain starts to freeze up, you get more stressed and the stress hormones go even higher. That shuts down the frontal lobe and disconnects it from the rest of the brain. It makes it even harder to retrieve those memories,” explains Dr. Michael DeGeorgia of Case Western University Hospitals in an article published by the National Social Anxiety Center.

Through the ability to repeatedly practice public speaking in front of convincing audiences of real or simulated people, VR provides a safe environment to reduce the stress and anxiety that leads to brain freezes. This in turn increases confidence which leads to less chance of a brain freeze, a virtuous cycle.

Foretell Reality works with partners to design therapeutic VR experiences that reduce stress and anxiety in different ways. One example is our work with Fordham University in which business students were placed in VR simulations with other students to practice presenting and pitching both to large crowds and to small groups of peers. Students donned VR headsets and entered environments replicating real world board rooms, auditoriums, and networking spaces.

For more information about Foretell Reality and our various partners and use cases, please visit our site or schedule a demo.

Therapy and Support

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.

virtual reality (VR) addiction treatment
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.

virtual reality (VR) virtual embodiment
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/

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