Posted by Dr Charles Nduka.

Virtually drug free treatments of mental heath conditions you didn't know about

Cancer and heart disease are well recognised causes of ill health, however a recent report by the Institute of Global Health reveals that in terms of the impact on quality of life (measured by Daily Adjusted Life Years, DALYs), mental health conditions affect more people than cancer and heart disease combined.

Furthermore, according to the World Health Organisation, approximately one in four of us will suffer from some kind of mental disorder. Those who don’t might still experience substantial anxiety and stress levels. Mental health disorders and psychological conditions influence our day-to-day activities, and in the U.S., it costs taxpayers about $467 billion in medical expenses ($2.5 trillion globally).

Alternative drug-free techniques like exposure therapy (ET) and cognitive behavioural therapy (CBT) have been shown to be very effective in overcoming conditions like phobias, anxiety disorders, panic disorders, obsessive compulsive disorders (OCD) and PTSD amongst others. However, for many healthcare providers, drug based treatments are the mainstay in spite of the potential side effects and marginal benefits. 

Virtual Reality and Mental Health

An exciting opportunity to minimise reliance on pharmacological garments for mental health lies in Virtual Reality.  Advances in Virtual Reality technology allow you to enter a world that is authentic enough to trigger your mind and body to behave as if it’s the real world. 

Exposure Therapy (ET) using Virtual Reality (VR) is an increasingly popular alternative method amongst some practitioners to administer safe and regulated therapy for patients suffering from mental health. Previously, technological and cost barriers have limited the use of Virtual Reality Exposure Therapy (VRET) to the private sector. The introduction of mobile VR headsets, including the Gear VR, presents an opportunity to use telemedicine for mental health treatment.

The use of VRET could lead to mobile tele-therapy that can work in collaboration with in-clinic VR therapy. Further still, patient-directed VR therapeutic approaches are currently operating that don’t require the therapist to be physically present. 

As a relatively new form of treatment, more data from well-designed large trials and clinical evidence is needed to support VR as an effective tool for therapy. Organisations who want to target this market must conduct randomised controlled clinical trials to prove the efficacy of VRET. Once the technology’s effectiveness has been established, there will inevitably be an influx of VR apps attempting to digitally treat mental health issues.

 Exposure therapy and cognitive behavioural therapy (CBT)

CBT is a psychotherapeutic treatment provided by a therapist specialised in mental health disorders. It involves patients participating in a number of sessions that concentrate on an isolated issue, helping the patient recognise and modify troublesome thoughts, feelings, and patterns that produce negative behaviours and beliefs. 

CBT can compliment exposure therapy (ET) well, which over time, gives patients the confidence to confront their disturbing fears and thoughts, head-on. This reduces the peak anxiety an individual goes through when faced with anxiety triggers.

Virtual reality is capable of isolating anxiety-related stimuli with a controlled and safe approach. Even though ET goes hand-in-hand with VR, there are several other psychiatric conditions, including autism (see below) and childhood developmental disorders, where VR might have a more active role in the coming years.

Using virtual reality to treat PTSD

There are approximately 8 million adults in America who suffer from PTSD.

Virtual reality has been used to deliver prolonged exposure therapy for PTSD patients since the early 90s, mostly for war veterans and soldiers. This is particularly the case in America, where approximately 8 million adults suffer from PTSD. Dr. Albert “Skip” Rizzo is a pioneer in this field. His software, named “Bravemind”, was created in partnership with globally renowned programmers Virtually Better.

The system is comprised of a customisable and controllable VR environment, a vibro-tactile platform that provides sensations relevant to explosions and firefights, and a scent machine that emits smells like garbage, diesel fuel and gunpowder. All of these simulated sensory components are released at precise times to enhance the digital scenario. There have been multiple clinical studies examining the effectiveness and safety of Bravemind. Current ongoing clinical trials are looking into the use of Bravemind VR therapy for sexual trauma in the military. 

Recent research discovered that using VR therapy treatment alone was as effective as a mix of medication and VR therapy. In a direct comparison, prescriptions received greater negative results for patients than the VR therapy.  

Privates and smaller organisations producing VR therapy software on tight budgets will still have to prove clinical effectiveness if they intend to make an impact on this market.

Severe paranoia treatment using virtual reality

In Britain today 1-2% of the population suffers from paranoia, showing significant mistrust in others to the extent of feeling threatened. Sufferers of paranoia when in social situations may use defensive mechanisms such as reduce eye contact or shortening social interactions. At its most severe, avoiding social interactions all together. These only reinforce the paranoia. 

Oxford researchers are trialling treatments of hallucinations using VR. Professor Daniel Freeman and colleagues from Oxford University used VR to test if patients can ‘re-learn’ that social situations were safe, and to reduce the use of defence mechanisms when feeling threatened. Projecting images of train rides, a lift or an airplane where one must encounter several people, and gradually making them busier. Using virtual reality to do this allows the patient to come face to face with their fears, and attempt to overcome them. The patients then transfer the techniques used in VR and presented a significant reduction is paranoid feelings, with 20% no longer presenting severe paranoia symptoms. 

Treating anxiety disorders and phobias with virtual reality

Approximately 40% of disability worldwide is due to anxiety and depression, and in the US costs the country an estimated $42 billion annually. With so many people affected and the significant cost this represents, technology provides an opportunity for treatment decentralisation. Alternatives such as self-guided therapy or telemedicine present low cost and potentially equally effective results. 

Phobias influence the behaviour of approximately 19 million Americans. A recent study from 14 clinical trials suggested that Virtual Reality Exposure Treatment (VRET) was effective in treating phobias. Outlined below are some instances of organizations using VR to treat anxiety disorders.

•    The Virtual Reality Medical Center has a procedure to treat those afraid of being on an airplane. The system consists of hardware and software, as well mock airplane seats, and even a subwoofer system to imitate the sounds, sights, and experience of flying.

•    Virtually Better developed a program that treats public speaking, heights and thunderstorm phobias. The business is working with top-name schools and research facilities to take on research and development projects about childhood social phobias and anxiety.

•    CleVR is a Netherlands-based business constructing VR systems to treat the fear of heights, flights and social phobias, all based on scientific research. The organization is conducting experiments to examine the effectiveness of VR as a therapeutic approach to treating social phobias and psychosis. Using dynamic virtual emotion technology, the general environment of such simulated social scenarios can be regulated.

•    Psious is a business in Spain that provides a toolkit therapists can use to control and administer VRET, in order to treat patients with phobias. The software consists of VR hardware, a programmable software platform, and devices for biofeedback.

•    VirtualRet is a tool therapists and psychologists can use to treat and evaluate phobias, including flying, public speaking, the sight of blood, heights, and public places. The developers offer a variety of hardware, virtual environments and parallel services.

•    A business from Sweden named Mimerse is creating psychological tools for VR treatment, and hopes to partner with Stockholm University and the Swedish Government for mass-market use. Their initial program, “Itsy,” is a game concentrating on treating arachnophobia through a digital therapist. In conjunction with the game’s release on the Gear VR app store, a regulated study is currently being administered that compares VRET with Itsy versus actual exposure therapy. Since most people with phobias don’t obtain professional treatment, mass-market games, such as Itsy, may provide tremendous value for people all over the world.

High Functioning Autism and Virtual Reality

Autism can be classified in many ways. At one end of the spectrum there is high functioning autism that has Asperger’s type symptoms. The symptoms include delayed motor skills, limited understanding of abstract language and obsessive interest in specific items or information. Virtual Reality has the ability to provide a platform where children can safely practice and enhance these social skills. 

Virtual Reality Social Cognition Training (VR-SCT) is able to support children and adults at different ages, adjusting the scenarios depending on the stage of development. For children with autism this could include confronting a bully for the first time, or meeting a new peer. Contexts may remain the same, but the content and complexity may differ depending on age. 

Recent studies have suggested using VR-SCT can benefit a child’s emotion recognition, social attribution and executive function of analogical reasoning. Patients were able to practice a dynamic range of social encounters with outcomes dependent on their responses. Therefore VR-SCT has the ability to allow for meaningful close-to-life scenarios with immediate feedback, enhancing the child’s development

Virtual reality for meditation and stress relief

Whether or not an individual suffers from a mental health condition, many of us go through varying levels of anxiety and stress at some point. Meditation is a long-established approach to improve one’s mood and bring about a more relaxed state of mind. Though relaxation and meditation might not be the sole treatment for any specific condition, their health benefits can be positive.

Besides their work on phobias, VirtualRet and Psious also have solutions for relaxation and generalised anxiety. Another tech start up created DEEP, a special meditative VR game where the player walks through a beautiful underwater environment. The character’s movement is operated through the player’s breath. Proper breathing techniques are at the heart of relaxation and meditation, so the customized DEEP controller allows the user’s breathing to correspond with what is shown in the digital environment, and determines how the player navigates through it.

Unello Design have developed several relaxation and meditation apps for Oculus Rift and Google Cardboard. Examples of these are Eden River, a nature adventure, and Zen Zone, a supervised meditation journey. Players can also check out “sound sculptures” with their 3D music apps.

One of the most famous relaxation apps is Cubicle Ninja’s Guided Meditation VR, which provides a quartet of soothing, deeply engaging environments to experience.

Depression and Virtual Reality

For those with depression it is often a case of lacking compassion for themselves, and being highly self-critical. Using VR to place patients in situations whereby they can indirectly provide themselves with self-compassion is one method used with promising results. The method asks the patient to provide a child who is sad with support. As the patient does this, the child ceases to cry, and begins responding positively to the compassion. The patient then takes the role of the child, and receives their own compassionate words back to them, reversing the role and effectively practicing self-compassion.

Feedback from the use of VR for treating depression has been very promising, with patients responding with how they transferred their virtual experiences into real-life scenarios. Virtual Reality presents a low cost alternative therapy, thus increasing the accessibility to depression treatment and support.  

 Shining a light on mental darkness

The demand for improved mental health via VR use as been well documented based on years of scientific research. That said, this market remains in its early stages, since the technology, at least so far, as not been perfected. Measuring emotional responses through facial EMG is a well-established research method. With advances in sensor technologies, machine learning and artificial intelligence, Emteq are launching a low cost platform for researchers in 2017, with consumer versions shortly thereafter. If you’re interested in learning more, do get in touch.