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Therapy and Support

Virtual Therapy Needs Virtual Reality

In these challenging times, more and more patients are turning to virtual therapy. So much so that TalkSpace, a leading telemental health platform that lets patients connect with licensed therapists, has seen a 65% increase in the last month or so.

While there are obvious reasons for an increase in remote therapy given the pandemic, there are also many benefits that will outlast it: not having to travel to an office, not having to take time off from work, not having to make arrangements for childcare while out, and not having to switch doctors if in a different location.

While the benefits of virtual counseling are clear, there are also drawbacks. Sessions over video can be prone to outside distractions, inconsistent video quality, and do not allow for anonymity. Patients and therapists alike may also feel self conscious being on video, particularly in group settings. This is best described by therapist Cynthia Chalker, “You have a mask of invisibility that you impose on yourself, and suddenly you’re seeing yourself seeing your patient, and it’s disconcerting, to say the least. ‘I look like that?’”

Virtual Reality(VR) offers an alternative to video, chat, or audio by creating an immersive feeling of presence free from outside distractions. All participants occupy the same three-dimensional space in the form of virtual avatars. Those who wish to remain anonymous can do so while still retaining a tangible identity. Avatars also allow for group role play and realistic environments can be used to place patients into challenging situations in order to surface memories under the guidance of a therapist.

Just as with other telehealth platforms, virtual reality platforms designed for individual and group therapy are both secure and HIPAA compliant. For example, XRHealth, a VR telehealth company that leverages Foretell Reality for support groups, is both HIPPA compliant and is covered by Medicare and most major insurance providers.

Therapy is an experience that can be difficult to replicate virtually. Ricardo Rieppi, a therapist practicing in New York City speaks about this, “there’s an embodiment that happens when you’re with a person. As therapists, we use our own counter-transference, our watchful, hovering empathy, to do our work. That’s difficult online. All the minutiae, my going out, meeting them at the door, their taking a chair or the couch—you don’t have that anymore. And I’m seeing the patients in their own home.”

If Rieppi were to use virtual reality, he may find more of the embodiment he is seeking. VR can enhance empathy, increase eye contact, and most importantly, allow users to feel present with one another.

With more and more people seeking mental help while remote, the limitations of video, chat, and audio alone are becoming apparent. Virtual reality offers more authentic human interactions in engaging, immersive, and distraction free environments.

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

Therapy and Support


There are hundreds of studies about the effectiveness of virtual reality (VR) in treating a variety of psychological ailments. These three studies were all chosen from the National Institutes of Health (NIH) National Library of Medicine and were published in the past 12 months.

Given how fast VR technology is moving, accessibility and the experiences available during these studies (many conducted in 2018) was significantly behind where it is today.

In addition to summarizing the study and findings, I provide rationale for continuing the study with the current generation of VR.

Study #1: Improving Mood and Emotional Well-Being

Published early this year (prior to COVID-19), this study seeks to answer the question of whether simulated nature environments can provide the same level of emotional well-being as an actual outdoor experience.

Healthy undergraduate students walked for 6 minutes in the woods while others viewed 360-degree nature videos in virtual reality of the same outdoor setting.

Skin conductivity, restorativeness, and mood before and after exposure were measured and compared between the two groups.

The study found that both types of nature exposure increase physiological arousal, benefit positive mood levels, and both were restorative compared to an indoor setting without nature.

Though outdoor exposure still provided a greater degree of benefit to mood than virtual reality, the study concludes that in areas where access to the outdoors is limited or not possible, virtual reality exposure provides tangible benefits.

Given this study was published prior to COVID-19, it takes on greater relevance today and it would be very interesting to see a broader test group as well as a more immersive VR experience than just 360 video. Moreover, the ability to take a walk with someone else (even a therapist) could be particularly powerful especially in times of isolation.

Link to study:

Study #2: Treating Specific Phobia, Social Phobia and Agoraphobia

This study reviewed nine previous studies through June 2019 which compared the effectiveness of in vivo methods of treating Specific Phobia, Social Phobia and Agoraphobia versus virtual reality treatments, specifically exposure therapy.

The study defined the disorders above as follows:

“Patients with Specific Phobia fear specific situations or objects such as animals, heights, thunder, darkness or closed spaces. Social Phobia patients report fear of scrutiny by other people, which leads to an avoidance of social situations. Agoraphobia is characterized by a fear of situations in which fleeing from the situation or help is not easily accessible, such as crowds in public spaces, leaving home, entering shops, or traveling alone in a train, bus or plane.”

Based on reviewing the nine previous studies, the authors concluded that there was “no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms.”

Regarding social phobia, the study goes on to suggest that “a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.”

Given advancements of the past 12 months, we now have the ability for a therapist to easily enter a social VR experience with their patient in order to provide real-time cognitive interventions during the treatment experience.

Similarly, role play and other group therapy exercises are much more accessible requiring only a standalone headset and internet connection. In light of these advances, a new study revisiting social phobia treatment should be considered.

Link to study:

Study #3: Support Groups in VR

Using a 38-item survey which itself was based on a previous randomized trial, this study asked amputee support group attendees to answer a series of questions over a period of months.

The intent of the study was to both understand what participants were seeking in a support group as well as what technologies they would be open to using for remote meetings.

Specifically, the researchers were interested the efficacy of “virtual technology in improving amputee support group engagement.” Virtual technology was defined as follows:

“Characteristics of virtual worlds include persistence, anonymity, 24/7 access to individuals globally, and virtual embodiment [8]. Persistence is the ability of the virtual environment to continue to operate, use, and collect data irrespective of whether individuals are interacting with it via their avatars [8]. Virtual worlds are anonymous because the use of avatars allows the user to mask their identity, which includes the ability to alter their age, gender, physical appearance, and other characteristics including disabilities. Virtual worlds allow amputees to interact globally, overcoming geographic limitations and isolation. Virtual embodiment allows users to interact with their virtual geography including other individuals and objects in the environment and in the virtual world [10]. In other words, the virtual world environment may allow people to participate in support group sessions with a level of access and anonymity that is not possible in a face-to-face support group setting.”

Study participants were provided with an avatar and social virtual environments but did not attend an actual support group. Instead, they were asked about what technology they would use to attend a meeting – Teleconferencing, Video Conferencing or Virtual Technology.

The results revealed that 60% of respondents between ages 20-39 were somewhat or very likely to participate in a virtual amputee support group and over 30% of those age 39-59 said the same. This was higher than video conferencing and slightly lower than teleconferencing.

Given that this study was an exploration of what is needed to create a strong support group as well as what role technology could play in it, the logical next step would be to make VR technology available to those who felt they would benefit from it.

More importantly, the study was conducted in 2018 using 2D virtual environments rather than the immersive 3D social virtual reality that is readily available today. A follow up survey with this same group after attending VR support groups would be very informative.

Link to Study:

Foretell Reality is a VR platform for professional communication and business collaboration.

Therapy and Support

Virtual Reality for AA Meetings

In yet another example about how our lives continue to be upended by COVID-19, a recent piece in the New York Times highlighted the particular challenges of Alcoholic Anonymous members who can no longer attend weekly, in-person meetings.

This is a major health issue given that meetings are central to recovery, and isolation, stress, and anxiety can all act as triggers to relapse. As the author notes:

“During a time ‘people who can drink normally’ — A.A. lingo for nonalcoholics — are stocking up on liquor, A.A. members, and there are some 2.1 million of us, are hellbent on keeping the meetings going,”

And to keep them going, many have turned to Zoom, attending meetings sometimes multiple times a day with as many as 50 other members in the room. While the author notes that the Zoom meetings can be “coherent and powerful” at times, she also highlights several shortcomings of video conferencing for these types of interactions.

The good news is that there is now an alternative to video conferencing. Support groups held in virtual reality (VR) address many of the shortcomings of video while providing additional benefits.

Below are excerpts from the article followed by observations of how virtual reality could improve the experience.

“In my experience, A.A. is about bodies in space — hugs, pats on backs, a tissue when you need it.”

One of the primary differentiators between video and VR is that VR is spatial. Unlike the ‘Brady Bunch’ grid of faces common in video chat, avatars sit in chairs in a life-like room. If I turn to the left, I see those sitting to my left. If I look up, I see the same ceiling as everyone else.

And though we are not quite at the point of replicating the feeling of a hug in VR, fist bumps, high fives, handshakes and other hand gestures provide haptic feedback. In other words, when I turn to my neighbor and we touch hands, I will feel a small vibration. And I can always pass a virtual tissue even if it is just a gesture of support.

“Of course, the applause was silent, since we were all streaming the meeting and we were all on mute.”

Unlike video chat, audio within VR is spatial. So if the person to my right is speaking, I will hear it first in my right ear and, when I naturally turn, the person’s voice will become a bit clearer and louder.

More importantly, voice in VR tends to be sharper than in video chats because audio levels and clarity channeled through a common device (the headset) versus being subject to the limitations of everyone’s unique microphones.

“In short order we have grown used to disclosing our intimate secrets into our laptop cameras, like a bunch of extremely earnest and fully dressed camgirls. It has been weird.”

One of the primary advantages of support groups held in VR is that all participants assume the identity of a personalized avatar. There is no need to stress about how you look on camera or whether the lighting is right or whether someone may walk into the room itself. Everyone in a VR support group is in a shared space with the same virtual views of one other and the environment.

“Still, knowing I’m on the internet discussing the most shameful part of my life, and changing my profile hastily to delete my last name, makes me freshly nervous about how candid I can be in this setting.”

With recent issues around video chat security (Zoom bombing) as well as the fact that anyone can take a screenshot at any time and reveal everyone who was in a meeting, it is understandable that privacy concerns exist when attending support groups remotely.

One of the primary advantages of virtual reality is that identity is fully protected through the use of avatars. Real world names and faces are not visible and hints about the real world location of the participant are not revealed through their camera.

“The memory of that gift, of how bad it once was and how, to my daily astonishment, good it is now, is what I get from the global network of rudimentary 3-D meeting spaces known as “the rooms.”

Virtual reality provides the closest experience to being in a physical room outside of actually being there. Whether the room is meant to be a realistic recreation of an actual meeting room or it is designed to instill calm and focus, the benefits that come with the familiarity and repetition of meeting in the same place each week can be replicated in VR.

“On Zoom, an icon appeared: another “hand” was raised, and the chair of the meeting unmuted someone, who displaced me in the center of the screen.”

Here, the author summarizes one of the biggest overall issues with video conferencing for support groups. The flow of conversation is disjointed and unnatural with the screen jumping from participant to participant based on them triggering their audio. This means everyone has to mute, then unmute and then re-mute every time they wish to speak.

In VR, participants are seated in a circle and anyone can raise their hand and speak at any time without displacing someone else on the ‘screen.’ This creates a much more life-like and free flowing space for interacting and sharing without distraction.

“I heard that alcoholics fear two things: Change. And the way things are right now. The trick is accepting both.”

Attending an AA meeting remotely is certainly a change but virtual reality can make that change feel less abrupt and unnatural. Even after this current situation has passed, here are plenty of people who can benefit from being able to join a remote support group in a realistic, familiar setting without fear of their privacy being compromised.

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

Therapy and Support

More Press About Foretell Reality Support Groups

Here is another article highlighting Foretell Reality’s partnership with XRHealth to bring mediated, virtual reality support groups to those seeking human-like connection and comfort while remote.

Though timely with the outbreak of COVID-19, the goal of virtual reality support groups is to allow anyone with any condition to to meet in a group to share their experiences and treatments. This includes cancer patients at Yale School of Medicine who are also currently using Foretell.

Read more here:

virtual reality (VR) support groups
Therapy and Support

Foretell Reality and XRHealth to Provide VR Support Groups

Foretell Reality, a Glimpse Group subsidiary, has partnered with XRHealth to provide Virtual Reality (VR) support groups to help patients with similar ailments, including people in isolation. The service will launch on April 1st, and is covered by Medicare and most major insurance providers in various states and cities across the US.

The experience replicates that of a real-world support group session. Participants will select a specific support group to attend, customize their virtual appearance as an avatar, and join a circle of up to 8 participants in a zen-like virtual room (see photo). A trained moderator will guide the session and participants will interact through gestures and voice in a life-like, three-dimensional environment.

“We’ve learned that one of the key benefits of virtual reality for support and therapy is the focus it brings to interactions between individuals and groups. The lack of distractions combined with a immersive and realistic environment that surrounds and shared by all participants, while they are physically located afar from each other, is conducive to a highly engaging discussion that is not replicable through other means of remote communications (e.g., video or chat). We also see that the self representation through an avatar helps patients to overcome the initial hesitation of sharing personal information and expose their emotions,” says Dror Goldberg, GM of Foretell Reality.

Noting the current situation many people find themselves in, Goldberg goes on to say that “the ability for a diverse group of people to share experiences and information in an immersive, focused environment will help provide a feeling of comfort in the face of fear and isolation.  Group empathy and understanding are instrumental to our well being and virtual reality provides a tangible feeling of group presence. This is even more acute when people are remote from each other and cannot gather in-person for various reasons – from physical limitations to forced isolation like we unfortunately experience now with this pandemic outburst.”

Anyone who is a patient of XRHealth Virtual Clinic can attend the offered virtual reality support groups. XRHealth Virtual clinic is listed in over 17 states already. The process of joining XRHealth clinic is described here and includes the following stages:

Step 1: Eligibility check and equipment signup. Step 2: Live video kickoff with a clinician. Step 3: 90 days treatment program consisting of personalized VR training, progress reports, and live video check-ups with a clinician. Once an XRHealth patient, user is able to select the application “Connect by Foretell Reality” from the VRHealth application installed on their VR device and join a support group room that they have been scheduled for.

Therapy and Support

Promising Results for VR Cancer Support Group

A joint study between Foretell Reality and Yale School of Medicine that compares VR support groups for cancer patients to traditional group therapy is starting to show some promising results according to a recent article published by MJH Life Sciences.

Ranging in age from 13-30 years old, patients have the ability to share their experiences in a safe and accessible setting without the need to travel back and forth to hospitals where they may be susceptible to infection, physical discomfort, and social unease.

Early indications are that the benefits above, as well as the option to remain anonymous, may reduce levels of anxiety and depression creating more open and meaningful interactions and communication between participants.

VR support groups also open the door to patients in underserved rural areas where travel is prohibitive and the lack of local groups can cause a feeling of isolation during a time when connection can be vital to the healing process.

Foretell Reality GM Dror Goldberg sees this study as the beginning of a paradigm shift in how VR is viewed. “There is plenty of news and case studies about VR and gaming and VR for the enterprise, but we are most interested in the ability for VR to facilitate real human connection by lowering physical and social barriers to one-to-one and group interactions. Seeing the early results of this study is exciting and a great motivator to continue to improve and add additional tools to the social experience in VR for support and therapy patients of all ages.”

As behavioral tele-health gains traction and the accessibility of VR continues to rise, studies like this one should propel large health organizations and insurers to offer VR solutions, like those from Foretell Reality, to patients who would benefit from an experience that is more lifelike and interactive than video or chat.

Therapy and Support

The Case for Kermit

I recently came across a series of interviews of people speaking openly and honestly about very personal challenges and traumas in their lives. A boy seeked solace about being bullied at school, a teenager told her story about being sent to a foster home, and an elderly man reconciled reaching the end of his life.

It wasn’t just their candor or the fact that millions of people viewed these videos on YouTube that struck me. It was that all the interviews were conducted in virtual reality with the interviewees veiled as avatars (one as Kermit the Frog).

Studies show that people are drawn to VR because it provides a feeling of authenticity while facilitating open communication in ways akin to real world interactions. This combined with the ability to move beyond physical appearances, remain anonymous if desired, and connect with people from all walks of life have resulted in more and more young people and adults spending time in highly immersive social VR worlds. And it is in these worlds that some of these same people are opening up and risking being vulnerable in ways they likely would not in a physical setting.

As an indicator of where social VR is heading, Facebook, which acquired Oculus in 2014, recently announced that it will be launching a social VR platform called ‘Horizon’ in 2020. Horizon will allow anyone with a stand-alone Oculus headset to customize avatars, socialize through voice and gestures, play games, and create and share user generated content. Given the sheer reach of Facebook, Horizon will vastly expand the number of friends using VR to connect and communicate. While this will accelerate adoption of social VR overall, it will leave behind those people who want to maintain their anonymity, and it will not address the need for safe, secure environments where those seeking help can receive it from professionals and support groups.

So why should this matter to the healing community? As VR becomes an integral part of the digital landscape much like audio, chat, and video is today, therapists and facilitators have an opportunity to reach those seeking help and support in a medium where their clients spend time and feel comfortable.

Just as teletherapy has expanded access to those who cannot or do not want to attend in-person sessions, VR offers another avenue to reach populations who feel more comfortable expressing themselves in a virtual versus physical setting.

And it is effective. A comprehensive study of 285 studies from the past 20 years showed that VR’s capability “to simulate reality could greatly increase access to psychological therapies, while treatment outcomes could be enhanced by the technology’s ability to create new realities.”

With the recent release of affordable, stand alone VR headsets, there has been no greater time for therapists and support group facilitators to reach out to those in need by embracing this groundbreaking technology.

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

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