Virtual Reality to Treat Agoraphobic Avoidance

by Jonathan Collins

May 19, 2022

As defined by the Mayo Clinic, agoraphobia is “a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.” This can range from using public transportation to standing in line in a grocery store. Most people diagnosed with agoraphobia fear public spaces and crowds, thus they confine themselves to their home in order to avoid having a panic attack. Treatment involves psychotherapy and medication, but it takes time for symptoms to improve. Cognitive behavioral therapy is the most widely used treatment because it gradually exposes patients to anxiety-inducing situations, teaching them how to manage their symptoms and overcome their fears.

A recent study out of England analyzed the effectiveness of virtual reality therapy to treat agoraphobic avoidance and patients with psychosis. Researchers analyzed 346 patients who were clinically diagnosed with psychosis and “had self-reported difficulties going outside due to anxiety.” Over the course of 26 weeks, researchers conducted “a parallel-group, single-blind, randomized, controlled trial across nine National Health Service trusts in England.” They split patients into two groups – a VR therapy group and the usual care alone group (control). The VR group was immersed in several different environments over the course of treatment. Whether it be visiting a coffee shop or entering a waiting room, patients were coached the entire way through and encouraged to let go of defensive behaviors. Compared to the usual care alone group, the VR therapy group showed “significant reductions in agoraphobic avoidance and distress” in everyday situations. VR therapy “particularly benefited patients with severe agoraphobic avoidance, such as not being able to leave the home unaccompanied.”

The results of this study indicate VR therapy as a powerful adjunct to cognitive behavioral therapy. This means that, with the use of immersive technologies such as VR, therapy will become much more widely accessible and affordable to patients, especially those who may be too anxious to leave their homes for treatment. Foretell Reality is a social VR platform that provides safe spaces for therapy and support, soft skills development, and other interpersonal activities like real time collaboration and group events. Please visit our website for more information or to schedule a demo.

Therapy and Support, VR-Related

VR for Treating Anxiety and Depression

by Michele Oberly

May 12, 2022

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

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

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

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

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

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

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

Soft Skills, VR-Related

Three Examples of Virtual Reality (VR) in the Courtroom

by Jillian Renken

May 2, 2022

An increasing number of educators and attorneys are bringing immersive virtual environments (IVE’s) to the courtroom in different ways. Below are three examples of how VR is being leveraged in legal settings.

Moot Court

The law school at The University of Ottowa is among the first programs to conduct moot court sessions in VR. Moot court simulates a court hearing in which students argue to appeal a case. They must prepare legal research, write briefs, and complete oral arguments in front of a panel of judges. Although these simulations are typically held in classrooms made to look like courtrooms, the COVID-19 pandemic halted all in-person trials, forcing the university to explore other options for holding moot court. They decided to implement VR into their curriculum to solve this problem, but as physical courtrooms became available again, faculty pushed to continue using the technology. According to Ritesh Kotak, a third-year Juris Doctor student, virtual reality “includes everything you can imagine from customizing a courtroom” to “doing training, and getting students excited.” Kotak asserts “The metaverse is here to stay so, from an educational perspective and a judicial perspective, there’s a lot of merit to using it.”

Crime Scenes/Evidence Viewing

In a recent study at the University of South Australia, researchers measured the discrepancy in jurors being shown a crime scene through a series of photographs versus being immersed in the same exact crime scene in virtual reality. Two groups of 15 participants were asked to come to a verdict on a deadly hit and run scenario. Not only were the VR participants “significantly more accurate in remembering the correct placement of evidence items”, but they came to a nearly unanimous decision, while the other participants were completely divided in their decision. Overall, 13 of the 15 participants who viewed the crime scene in VR ruled “death by dangerous driving”, while 8 of the 15 people who only viewed photographs voted on a more lenient “death by driving without due care.” Because more information can be presented in VR, participants were able to better understand the situation at hand, and thus were 9.5 times more likely to choose the “death by dangerous driving “ verdict. Although some people may be hesitant to implement VR due to its high price tag, the cost would be negligible juxtaposed to the immense cost of organizing on-site crime scene visits. Between transporting the jury and scheduling the trial to work with everyone’s schedules, it can cost thousands of dollars, whereas recreating a crime scene in VR is relatively inexpensive. If virtual reality presents the evidence of a crime in a more accurate manner, thousands, if not, hundreds of thousands of trials could reach different, more just verdicts. Dr Andrew Cunningham, from UniSA’s Australian Research Centre for Interactive and Virtual Environments, believes that this study “provides unequivocal evidence that interactive technology leads to fairer and more consistent verdicts, and indeed could be the future of courtrooms.”

Pre-trial Exposure for Lawyers and Those Taking The Stand

From a preparation standpoint, VR offers benefits to both lawyers and those taking the stand. Lawyers typically practice their cases in front of other experts to test their performance under the pressure and stress that they will most likely face in the courtroom. With the help of virtual reality, lawyers can practice arguing their case in front of a virtual crowd, which is proven to simulate a similar emotional experience to that of a real courtroom. Furthermore, if lawyers view a crime scene in VR, they will have a better understanding of the witness’s perspective pre-trial and may even increase out of court settlements. With VR, witnesses can also prepare themselves for questioning and depositions. By running through a trial beforehand, they will be better prepared to tell their story, be questioned by lawyers, and avoid experiencing the emotional rollercoaster that many witnesses face.

Foretell Reality is a VR platform for simulations and role play training including features like personalizable avatars, realistic environments, and 360 video viewing. Visit us today for a demo.

Coaching, Soft Skills, VR-Related

Virtual Reality (VR) Provides Unique Opportunities for Coaches

by Michele Oberly

April 29, 2022

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

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

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

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

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

Recording and playback in Foretell Reality.

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

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

Mindfulness, Therapy and Support, VR-Related

Four Real World Examples of VR for Mindfulness and Meditation

by foretelladmin

April 25, 2022

According to a Harvard Health, mindfulness is “a key element in stress reduction and overall happiness” and is known to “help relieve stress, treat heart disease, lower blood pressure, reduce chronic pain, improve sleep, and alleviate gastrointestinal difficulties.”

Despite its benefits, however, mindfulness training can be intimidating to non-practitioners and particularly difficult for remote participants. This has lead researchers to investigate how Virtual Reality (VR) can be used to lower the barriers and increase the efficacy of meditation practice for a variety of purposes and populations. Below are four recent examples.

To Increase Positive Emotion in the General Population

A recent study out of Melbourne, Australia is one of several that points to VR as a viable option for improving mental health and mindfulness. Mindfulness is a great way to improve mental health, however, under normal circumstances, is a difficult habit to adopt due to environmental and personal distractions. Virtual Reality (VR) directly addresses these challenges “by providing an immersive environment for practicing mindfulness and by supporting the user to orient attention to the present moment within a tailored virtual setting.” A group of 37 participants were recruited to trial a VR mindfulness app in which users were presented with 360 video of a “peaceful forest environment with a guided mindfulness voiceover.” Researchers analyzed participant scores on the State Mindfulness Scale, Simulator Sickness Questionnaire, arousal, and positive or negative emotion before and after users participated in the simulation. Although there were initial concerns about simulator sickness and negative emotion, neither of these variables produced any notable changes following the simulation. However, state mindfulness and positive emotion significantly increased, participants reporting that “the use of VR helped them to focus on the present moment by using visual and auditory elements of VR as attentional anchors.” The spatial presence of virtual environments allowed participants to practice mindfulness and meditation, positively affecting their mental health and well-being.

To Reduce Stress In the Workplace

A study out of England analyzed workplace stress specifically in the National Health Service (NHS) and tested the effectiveness of Virtual Reality in decreasing levels of stress and promoting overall well being. “Work-related stress, defined as ‘a harmful reaction that people have to undue pressures and demands placed on them at work’ is one of the most important emerging risks in occupational management and health.” This stress is threatening not only the quality of services provided, but the sustainability of vital healthcare systems and corporations around the world. Researchers provided a 10-minute VR relaxation experience to 39 trauma staff working in a fast-paced environment. Following the session, participants “reported significantly increased feelings of happiness and relaxation, and significantly decreased feelings of sadness, anger, and anxiety.” Furthermore, patients experienced a significant reduction in heart rate and yielded high acceptability ratings. Ultimately, the study found that VR relaxation sessions were beneficial to the health and well-being of healthcare workers, and many were excited at the opportunity to implement it into their everyday lives.

To Help Treat Opioid Addiction

VR mindfulness and relaxation are also being implemented in the midst of the opioid epidemic. This epidemic is an ever-so-present problem in our society, and the key to preventing further damage is by exploring viable alternatives to pain relief. According to The Gate Theory of Pain proposed by Melzack and Wall in 1965, “a person may interpret pain stimuli differently depending upon mental/emotional factors such as attention paid to the pain, emotions associated with the pain, and past experience of the pain.” Believe it or not, we can essentially “distract” our way out of pain. Virtual Reality addresses two of Melzack and Wall’s points – attention and emotional state. Through VR technology, patients can escape to an alternate reality, sending positive signals to their brain and subsequently lessening the pain they are experiencing. This technology dates back to 1996, when the Harborview Burn Center “successfully piloted the use of VR for burn patients with severe acute pain,” which inspired other providers to make VR technology accessible to patients experiencing acute pain. Recent studies have shown promising results for relieving chronic pain as well, patients reporting high levels of satisfaction and a significant reduction in overall pain. Although VR cannot fully take the place of opioids, it can definitely be used as an alternative for certain candidates, considering their level of pain and potential risk factors.

To Act As A Moderator of Psychedelic-Assisted Psychotherapy

Virtual Reality is another promising candidate as a moderator of Psychedelic-Assisted Psychotherapy (PP), a “unique psychopharmacological model that leverages the profound effects of the psychedelic experience.” PP is highly reliant on two key factors – the patient’s mindset and their surrounding environment. Consequently, meditation, relaxation, and visualization are supplemental tools in creating the most effective environment for this therapy. Virtual Reality is a promising candidate to provide these tools, given its evidenced capacity to “aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy.” Because there was little empirical evidence on the joint application of VR technology in Psychedelic-Assisted Psychotherapy, researchers aimed to gather evidence on the ability to achieve a deeper sense of consciousness in a virtual environment.

They found 7 different ways that VR can be used to support psychedelic treatments:

1. Mitigate psychological side effects through enhancing the state of relaxation,

2. Help participants sustain their focus on intention by removing familiar cues that keep them tethered to their external world,

3. Encourage entering the inner world of experience by inducing a mindful presence,

4. Deepen the intensity of acute psychological and emotional states via simultaneous targeting of ME-evoking pathways,

5. Prime the capacity to achieve an altered states of consciousness (ASC) through familiarization and comfort with the ASC experience,

6. Enhance and maintain a hierarchy-free therapeutic alliance that is consistent throughout treatment,

7. Strengthen resilience and a sense of agency around facing challenging experiences.

It is also important to note the comfort and safety of the environments that VR provides, allowing patients to temporarily distract themselves from the emotionally taxing process of overcoming and treating PTSD or related disorders. Researchers ultimately recommend that VR be introduced into PP, as long as it is “developed in accordance with a robust protocol…and accompanied by thorough training of any practitioners involved in therapy.” Virtual Reality has the ability to transform the future of psychedelic treatments, as long as appropriate precautions are taken to not introduce disturbing or traumatic triggers or distract from the inner narrative.

The Foretell Reality platform provides safe VR environments to support various mental health treatment protocols including those that incorporate mindfulness training and relaxation experiences as part of the protocol. To learn more about our platform, please reach out to us for a demo.

Therapy and Support, VR-Related

How VR can address shortcomings of video-based group telemental health sessions

by Jillian Renken

March 30, 2022

In person group-based intensive outpatient programs (IOPs) have shown promising results for adults with serious mental illnesses. At the start of pandemic, these IOPs were forced to meet remotely through video-based telemental health (TMH) platforms presenting an opportunity to better understand the benefits and drawbacks of online group therapy.

A recent study from the Mayo Clinic focused on TMH group-based IOPs, providing insight into the effectiveness of and overall patient satisfaction with this type of treatment. Researchers interviewed 76 patients with diagnosed serious mental illness (SMI) who participated in an online video group based IOP.

Researchers gathered their data using a 17-item questionnaire covering 3 areas: “IOP TMH satisfaction, future recommendations, and video technology challenges.” According to the feedback they received, “the majority of patients reported high satisfaction, comfort, appropriateness, relevance, and compatibility” of the TMH service, 92.5% of them reporting “that they would recommend this service format to a friend or family member.” Most patients were glad to have the option for treatment during COVID, one even commenting that it was “just like being in a room full of people” and it “saved [their] life.”

Despite the fact that group telehealth was viewed favorably overall, there were reported challenges during the program. Slow internet connection, poor video camera quality, login problems, and accidental removal from the session were the most highly reported of these challenges. One of the participants noted that the Zoom meetings didn’t feel as welcoming, and “’there couldn’t really be a discussion [as if they were] sitting in the same room.’” Another wanted “more collaboration among the patients.”

Other participants wished they had used “’more of the Zoom features such as the whiteboard,’” or recommended “’some tabs to find things [easier].”’ There seemed to be a large disconnect with the learning materials in general. Patients suggested that administrators work on “improving the structure of the binder.” Some of the patients didn’t like the program at all because of the video format and desired something more immersive and interactive.

Though the study affirms that remote group therapy was well received in general, there were clear deficiencies noted. Virtual Reality (VR) for group therapy addresses many of these concerns and offers other benefits not possible through video-based TMH.

“poor video camera quality”

Instead of sitting in front of a camera, group therapy in VR allows participants to sit, lie down, or walk around in their physical environment. More importantly, everyone is portrayed as a personalized avatar which creates a consistent visual and auditory experience regardless of room lighting or camera or microphone quality. The need not to be on camera also takes away judgement of physical appearance and removes outside environmental distractions.

“there couldn’t really be a discussion [as if they were] sitting in the same room”

Unlike group video sessions in which everyone is arranged on a flat grid, VR sessions are held in a shared, 3D environment. This means that participants who look around the room will see one another from the same perspective as they would in the physical world. For example, to see the person who is slightly out of view to my left, I would turn my head in that direction and they would appear in front of me. Since everyone is sitting in a shared environment, they also see the same things as one another creating a stronger sense of connection.

“more of the Zoom features such as the whiteboard”

Just as with Zoom, VR offers many tools for collaboration and instruction including white boards, sticky notes, and media presenting. But VR also provides the ability to manipulate and pass 3D objects, draw in space, and watch fully enveloping 360 video.

“more collaboration among the patients”

True collaboration in Zoom in a challenge because we as humans collaborate in 3D space. VR provides the ability to collaborate in ways not possible on Zoom whether that means team building exercises, collaborative role play with avatars, or simple games that bring people together.

“improving the structure of the binder”

A foundation of many IOPs is the presentation of a structured curriculum which is outlined in binders provided to patients who follow along during each session. With limited space to view and absorb material, video sessions present a challenge when it comes to conveying this material. With VR, patients can reference their binder from their own personal screen while also collectively viewing material on the therapists screen(s). Navigating between materials and interacting with them is much more intuitive as it mimics the 3D world.

VR also provides benefits not identified above. For example, avatars allow for exploration of identity, role play activities and anonymity if desired. All or parts of sessions can be recorded and played back in 3D allowing for analysis and reflection from the group. And analytics such as time spent speaking and direction of gaze provide insights for both patient and therapist.

Foretell Reality is an avatar-based, multi-participant virtual reality platform specifically designed for group therapy and support. Please click here for more information or to schedule a demo.

Soft Skills, VR-Related

Virtual Reality (VR) For Teaching Interpersonal and Professional Skills in Special Needs Education

by Jillian Renken

March 15, 2022

With its ability to simulate real world learning exercises and ‘teleport’ students to historically accurate or imagined worlds, Virtual Reality (VR) is being used to teach academic subjects ranging from STEM to Shakespeare. These same features of VR are also being explored to teach a different type of subject matter to those with learning disabilities. One that focuses more on interpersonal development and professional skills development.

Spaulding Academy & Family Services is among multiple special education schools implementing VR into their curriculum and seeing measurable results. Their goal was to meet the needs of all their students, centering their experiences around “physiological and sensory regulation, emotional regulation, skill-building, social interaction, and transitions.” Students with limited mobility were directly catered to; their sensory needs being met by using a VR headset and essentially “tricking” the “vestibular-ocular system into feeling that it is receiving needed movement stimulation.” From an emotional regulation outlook, VR provides a calming experience if students are overstimulated throughout the day, ruling out the possibility of heightened emotions or a classroom crisis. Results have been very promising for Spaulding Academy; VR has opened the door for students to control their emotions, find a safe space when needed, and strengthen their communication skills.

Implementation goes beyond emotional control – students on the autism spectrum are also utilizing VR for job preparedness. A pilot study was conducted in an effort to improve interview skills among autistic adolescents. Participants were divided into an experimental group and a control group. The experimental group underwent 10 hours of interview training with a virtual avatar, resulting in overall improved interview skills and employment outcomes. Further research will likely be conducted to predict the efficacy of implementing VR training into special education programs across the country.

A study conducted back in 2018 was one of the first indicators that VR technology could be used for more than just gaming – Using virtual reality to train emotional and social skills in children with autism spectrum disorder. Researchers studied 94 children who were diagnosed with autism spectrum disorders (ASD) and displayed poor social and communication skills. One of the most significant obstacles faced in this disorder is responding with appropriate facial expressions when in conversation. The subjects took part in “six VR scenarios depicting the daily lives of typical children in Hong Kong”, followed by a debriefing session to apply what they learned in real life. Results suggested that “children from [the] training group scored higher on emotion expression and regulation” as well as “higher on social interaction and adaptation” following the training. In the weeks after the study, “many parents expressed that their children were much more proactive in greeting and communicating with neighbors and relatives,” which led to engaging more in conversations and subsequently making more friends. Since the results of this study were released, there have been countless other studies with similar results – increased self-awareness, communication skills, and expression recognition.

Foretell Reality is a VR platform that provides safe, secure environments, customizable environments, and tools for trainers and educators to facilitate role play and simulation training for skills for the real world.

Therapy and Support, VR-Related

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

by Michele Oberly

February 28, 2022

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

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

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

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

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

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

Soft Skills, VR-Related

6 Examples of VR Increasing Empathy

by Jillian Renken

February 28, 2022

Virtual Reality (VR) is often called an ’empathy machine’ for its ability to alter ingrained perspectives and unconscious biases. Unlike watching a video, reading a book, or hearing a lecture, VR acts as a focused lens into a fully realized world and, through that lens, provides experiences that are deeply moving and difficult to ignore.

What does this mean in practical terms? Here are six examples of how VR is being used right now to increase empathy both personally and professionally.

#1: Business

With the state of the current job market, employees are leaving businesses faster than ever in search of a better company culture. According to a recent survey of U.S. employees, HR professionals, and CEOs, 93% of employees reported they would stay with an empathetic employer, while 82% of employees would leave their position to work for a more empathetic organization. Major companies like Accenture are already using VR empathy training for their leadership and employees to increase retention, morale, and productivity. And Bank of America recently launched VR training programs in 4300 financial centers for the purpose of “strengthening and deepening relationships with clients, navigating difficult conversations, and listening and responding with empathy.”

#2: International Relations

In a recent study out of France, a team of researchers analyzed the effectiveness of VR empathy training to increase global empathy and interest in learning about other counties. This included exposing U.S. high school students to cultures and environments around the world.

In that case, researchers found that VR allows “users to literally step into the shoes of others and see the world from their perspective,” which has “shown significant plasticity of empathetic abilities even after the experience by decreasing implicit racial biases and increasing of mimicry of outgroup members.” The team ultimately concluded that immersive VR experiences are a powerful tool in developing empathy, awareness, and altruistic behavior.

#3: Social Work

Social work is a profession that often requires empathy on a daily basis. A recent pilot study from a New York social work program leveraged 360 video to transport students to a realistic urban environment “with the goal of helping them learn about how its history, resources, demographics, and physical space impacts its inhabitants. The study found that participants felt that the experience, combined with reflective questions, “made them feel engaged and thoughtful, and able to better learn social work concepts.”

VR also provides the ability to virtually embody an avatar and enter a simulation with other students in order to practice various scenarios in real time. The ability to personalize the avatar opens up exploration of biases in dealing with different genders and races in a safe, practice environment.

#4: Medicine

It can be difficult for doctors to empathize with their patients for a variety of reasons. It is also essential to a healthy recover for doctors and patients to have a strong, trusting relationship . In a recent study, medical students leveraged VR technology to simulate being in the shoes of a patient with age-related conditions such as macular degeneration, high-frequency hearing loss, or even Alzheimer’s disease.

Following VR exposure, students exemplified a stronger “understanding of age-related health problems and increased their empathy for older adults” with various diseases or disorders. Another way VR is being applied in medical education is by staging difficult conversations with family members about terminal illnesses or end-of-life steps. By witnessing a variety of different reactions, doctors can tailor their delivery in order to be accommodating, patient, and prevent overly chaotic interactions.

#5: Law Enforcement

Empathy training has also been a staple for many law enforcement agencies. In a recent study, a group of police officers underwent empathy training, which significantly affected their behavioral patterns and led to “roughly 26 percent fewer arrests one week after the training.” Officers were also “over 50 percent less likely to use force in an encounter,” which increased cooperation and strengthened communication between officers and citizens. Overall, empathy training is leading to better outcomes within the community as a whole.

#6: Conflict Zones

Empathy is especially crucial in conflict zones and disaster response. The International Committee of the Red Cross recently ran an immersive VR workshop in order to generate empathy for those affected by conflict and violence. By the end of the session, participants were equipped to “understand humanitarian approaches to storytelling in conflict zones and representing people affected by violence.” Aside from the storytelling aspect, emergency responders are given the tools to understand other people’s pain and trauma responses before being thrown into a conflict zone or responding to a natural disaster.

Promising results in many research studies across multiple fields and professions show that VR is an effective method of empathy training. Now that headsets more prevalent and affordable, it is time to bring VR empathy training from studies into the forefront. Foretell Reality is a VR platform that provides safe, secure environments, customizable environments, and tools for trainers and educators to facilitate role play and simulation training for empathy and other human skills for the real world.

Soft Skills, VR-Related

Virtual Reality for Learning a Second Language

by Jonathan Collins

February 23, 2022

A recent study asked twenty-one university students who were studying Spanish as a second language to compare the experience of practicing face-to-face with the experience of practicing in Virtual Reality (VR). Students carried out three sets of two dialogues each, one dialogue in VR using a head-mounted display and one with a fellow student in a physical space. Each set of dialogues was completed with different partners and content and participants. At the end of the experience, students were asked to fill out a survey about their experience.

According to researchers, “the survey showed overall positive experiences with social VR, and comparisons between F2F and VR conversations also yielded statistically significant findings indicating that VR can be a more fun way to practice speaking that can also reduce feelings of self-consciousness. A thematic analysis of the survey’s open-ended responses supported quantitative findings by highlighting lower stress when speaking in VR, increased enjoyment of being in virtual environments, and heightened engagement when speaking in VR.”

Virtual Reality offers various features which make it a unique tool for practicing spoken language and contextual word learning. Below are a few benefits that VR provides over video and even in-person learning. As with any other learning tool, the effectiveness of the instructional design and the instructor are fundamental to engagement and retention.

Expressive Avatars

Role play is uncomfortable in person and nearly impossible on Zoom. Trying to speak another language during role play adds another level of discomfort and distraction. By wearing the mask of an expressive avatar, language learners can focus on dialogue over how they act or appear. This was noted in the aforementioned study by students who described the “lower the stress when speaking in VR.”

Beyond reducing stress, avatar customization allows students the opportunity to take on different gender and identity roles during role play offering a broader range of interactions and scenarios. And, as noted below, combining personalized avatars with a library of interactive environments allows participants to play different roles while also interacting with other people, objects and media in the scene.

Interactive Environments

It is commonly accepted that immersion into a foreign language environment accelerates learning the language. By going to a farmers market in Barcelona on a daily basis, you will learn the names of fruits, vegetables, meats, cheeses, and pretty much every other staple quicker and with greater retention than by memorizing a set of flashcards.

Virtual Reality convincingly replicates real world environments including objects and people you would find in those settings. Instead of flipping through pictures in a book or watching a video animation, you can walk down an aisle filled with items that you would typically find in a drug store, clothing store, or grocery store. The experience can even be gamified. For example, receive 10 points for filling your shopping bag with five specified items and then interacting with the cashier in order to complete your purchase.

And populating these same environments with other students allows for conversational learning under the guidance of an instructor. For example, the role of the cashier above can be filled by a fellow language learner who now has the opportunity to practice interacting with a customer and with the local currency.

Tools for Instructors and Coaches

Virtual Reality offers new and unique ways not only to learn but also to teach a second language. Instructors can schedule sessions in different environments for specific groups of language learners or make spaces available for all levels of students to drop in and practice 24/7. They can participate in role play or observe from afar. Innovative features like direct audio channels allow instructors to speak into the ear of one student so as not to disrupt the scene being played out. And instructors can share audio clips, images, and video as well as lead guided 360 tours that provide insights into other cultures while reinforcing language learning.

Analytics and Playback

Language learning sessions in VR generate a variety of analytics that can be tracked over time. Interactions with objects, time spent speaking, and direction of gaze during role play and other exercises offer tangible feedback on progress and can be used to gamify the learning experience. For example, a student who advances to the next level of comprehension may receive a unique piece of avatar clothing denoting this achievement. This also indicates to other students what level their peers have achieved so they can practice with those at their level.

Additionally, instructors have the ability to record any session and play it back within the actual 3D environment. This allows students to listen to themselves and their peers without being self-consciousness of how they appear in a recorded video.

Access

The most popular VR headset on the market, the Meta Quest 2 had already shipped 10 million units by last November and that was before the holiday season where it was one of the most popular technology gifts. Though often marketed for gaming or exercise, Meta has recently placed an emphasis on supporting educational and training experiences. Additionally, other device manufacturers are rapidly entering the market creating more competition both from a price and capabilities perspective.

Just as the rise of the internet and mobile devices allowed millions of people to learn a second language online, the rapid adoption of VR by consumers offers an opportunity to take second language learning to another level, one that reduces stress, increases retention, and adds an element of engagement not possible through any other medium.

Foretell Reality is a VR platform that provides secure environments, customizable avatars, and instructor tools for interpersonal skills development including second language learning. Please contact us for a demo or with any questions.

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