Virtual Reality for Mental Health
Recently I was invited by Zinc.vc to give a talk on how VR can be useful for mental health. I discussed many things, such as treating phobias and PTSD, using VR for affecting cognitive biases, improving mindfulness, and expanding consciousness using immersive tech. Here’s a short recap of it.
Intro
The research into effects of VR on our psychology started in the 1990s with the first commercial VR devices, such as SEGA VR-1. Prof Anthony Steed of Immersive Lab at UCL once told me, that ever since he saw people in VR headsets crawling on the floor terrified of the height, even with the very low quality visuals of simple lines and cubes, he understood that VR brought something totally revolutionary. VR creates a feeling of presence and embodiment, or so called “supsension of disbelief” — your body thinks it is actually somewhere else. Equipped with these instruments, researchers can study and affect psychology, psychophysics and physiology of humans, in essence the connection between mind, body and environment.
“The virtual embodiment can lead to changes in perception, implicit attitudes and behaviour based on attributes of virtual body” (Mel Slater)
How can we use these advantages of VR for something useful?
Mental health and VR
The heart of mental health disorders lies in a difficulty interacting with the world, and thus mental health problems are inseparable from the environment. The most successful interventions are those that enable people to make positive changes in real world situations. VR enables creation of controlled environments, and can be used to make those changes. For example, the user’s virtual body can change embodied perspective and can affect cognitive changes.
VR has been used for Assessment, Study and Treatment of mental health disorders. Below are many disorders that VR can be useful for:
- Anxiety Disorders
- Phobias: Claustrophobia, Fear of heights, Flying, Driving, Spiders/snakes, Public speaking, Social phobia
- Panic disorder
- PTSD
- OCD
- Depression
- Psychosis
- Schizophrenia
- Paranoia (VR is good for accessing this)
- Substance / Eating disorders: VR can induce craving. Improving body image / reducing food cravings. Body ownership
Phobias
Usually phobias are difficult to treat, because patients avoid them at all cost, specifically since the main treatment is exposure therapy. The aim of the exposure therapy is to help patients to confront the feared stimulus in order to correct the established dysfunctional associations. In VR, problematic situations of varied intensity can be programmed very easily. In addition, it is easier to overcome the above-mentioned avoidance — the patient knows in advance that it’s not real, and the intensity of the feared stimulus can be very well controlled. VR therapy can eradicate the need of a therapist or reduce the time of their input. VR phobias therapy is surprisingly persistent over years (that is why some of the first commercial VR psychology companies focused on phobia treatment)
In addition to exposure therapy, VR cognitive therapy (e.g. changing the patient’s perception of their height and thus self-esteem) can be used for treating anxiety disorders or persecutory delusions.
Below I will describe the work of the three fathers of VR psychology research and show some examples of their work.
Prof Albert “Skip” Rizzo
Skip Rizzo works at University of Southern California, mainly focusing on treating PTSD since the 90s. The main thesis of his work is that people automatically react to fear cues, even in an environment they consciously know isn’t real. That happens because the brain’s emotional command center, or limbic system, responds to stressors in a matter of milliseconds — way faster than logic can kick in.
Prof Mel Slater
Mel Slater is a father of VR empathy studies, currently teaches at University of Barcelona. He pioneered research into how VR can change intrinsic biases. For example, if white people see themselves in a black virtual body, it can lead to a reduction in their implicit racial bias (implicit bias is the one that the individual can even not know they hold).
Another seminal (and ingenious) work by Mel Slater: Conversations between self and self as Sigmund Freud. First, you tell an emotional story to a virtual Sigmund Freud. Then, you become a Sigmund Freud and listen to yourself telling yourself a story you just told Sigmund Freud. After that, you come back to your body, and Sigmund Freud gives you very good advice (that you just gave yourself, with a lowered voice). It actually helps.
Prof Daniel Freeman
Prof Daniel Freeman works in Oxford on a variety of psychological VR stuff, with a focus on persecutory delusions (paranoia) treatment. Imagine how great it would be if you could use an automated treatment system with proven efficiency that doesn’t require you to see/pay a therapist every week? During the project named gameChange VR, his group created an automated treatment of social anxiety & psychosis, it dealt with anxious avoidance of everyday social situations, such as a street, a bus, a café, a pub, a doctor’s waiting room, and a shop. With 5 levels of difficulty, a patient could run the treatment routine at home.
Devices to study psychological response
Most psychological studies include pre- and post-intervention questionnaires, however it is always more preferable from a scientific point of view to measure actual physiological parameters, such as heart rate, skin conductance, body temperature, electroencephalogram, pupil dilation etc. Some of the modern devices combine VR and those parameters:
- OpenBCI — combination of VR Headset and EEG https://openbci.com/
- EMTEQ — combination of VR headset and EMG for emotional analysis: high/low arousal & positive/negative valence https://www.emteqlabs.com/
- Tobii — eye-tracking
Companies using VR
In the last 5 years, since the release of Oculus Rift and HTC Vive, many companies have popped up bringing all the prior VR research into the commercial domain. Here are the most prominent ones (ones I know and respect):
- https://bodyswaps.co/ — deals with soft skills: communication, leadership and teamwork. Bodyswap VR experiences can prepare you for job interviews, teach gender inclusion, career mindset development etc.
- https://ovrhealth.com/ — Oxford VR, founded by Daniel Freeman. VR provides a safe space to try new behaviour, and is used for treating phobias.
- www.xr.health — physiotherapy “drug-free treatment”.
- https://vr4rehab.org/ — Open Innovation Network for European VR health startups
VR for mindfulness
The audio-visual quality of VR can be used to remove the user from the hassle of everyday life and into a calm and peaceful environment. This is used for mindfulness and meditation.
- https://www.exploredeep.com/ — breathing game for anxiety regulation
- https://www.discoverneon.com/ — AR/VR for health, disability, breathing
- https://www.tripp.com/ — meditative “psychedelic”-like experience on Oculus Quest
- Marshmallow Laser Feast — “We live in an ocean of air” — immersive meditative experience for environmental emotional connection
Expanding consciousness
Extrapolating from meditation, people started exploring consciousness expansion using VR and technology. The term “cyberdelics” that appeared in modern counterculture in 80s/90s, was boosted by VR:
“Cyberdelics“ — targeted application of ancient and modern technologies to generate altered states leading to altered traits. Also “techno-shamanism“ — combination of technology and spiritual practices.
Here is a very comprehensive list of psychedelic VR games and experiences collated by RepeatUser on reddit. How can you improve the psychedelic experience even further? People combine VR and sensory deprivation tanks, people pair VR and drugs. You might think it’s either a gimmick or just a weird fantasy, but no! The previously mentioned Skip Rizzo has co-founded a startup combining VR and psychedelics for treating PTSD — https://www.virtualpsychedelics.com
Multi-sensory VR and consciousness
Immersive technology is not only limited to audio and visual virtual reality. Researchers and entrepreneurs are constantly trying to enhance virtual experiences. For example, feeling of smells affects your brain in a very unique subconscious way, making experiences much more emotional.
Touch and haptics can create a variety of feelings on different parts of your skin. They can be anything from realistic (very expensive) to uncanny or gimmicky unpleasant (still very expensive). The recent research example creates ultrasonic haptic sensations on the skin of your mouth and lips (dubbed by journalists “kiss simulation”).
Although a lot of haptic companies are using haptic devices for training, passing information, research or marketing, haptics actually points out a lot of really interesting psychological oddities. Consider, for example, a famous rubber hand illusion (see image below). While the user looks at the rubber hand lying in front of him (without seeing his real hand), the experimenter synchronously touches the rubber hand’s finger and a corresponding real user’s finger with a brush. After 2–5 minutes, the user starts believing that the rubber hand is actually his hand. This is a very weird feeling, and you can try it with your friends.
Expanding a hand to the whole body, Prof Olaf Blanke creates out-of-body experiences using VR and robotics. The multisensory conflicts created by seeing yourself in front being touched on the back, and simultaneously feeling someone touching your real back can induce perceiving your body not where it actually is (link & link).
This is Olaf Blanke touched by a robot:
Outro
Virtual reality is an amazing tool that can dramatically affect our feeling of perceptual and emotional presence. It can be used to study and improve our mental health, develop our soft skills and make us mindful.
To conclude this article, I, together with Mel Slater and Maria Sanchez-Vives, would like to claim, that multi-sensory immersive virtual reality can affect, enhance or break our “feeling of presence, and thus can improve our understanding of perception and consciousness”.
