One in four adults and one in ten children experience mental illness in the UK, and many more of us know and care for people who do. But recently the NHS has faced a backlash as it was revealed that in extreme cases, some people with mental health problems were waiting so long for care (up to 13 years), they ended up jobless, divorced or in financial distress because of the delay.
Addressing mental health in most cases, requires a range of treatment methods including medication, therapy, exercise and in the most extreme cases, hospitalisation. But virtual reality could be about to change the speed and the way in which patients receive help.
Virtual reality was first developed in the mid-1960s. The essential elements haven’t changed much over the years but what has changed is the sophistication and affordability of the technology. Despite the massive investment in VR from organisations such as Facebook, Sony and HTC, the technology has so far struggled to gain a foothold beyond the gaming market. So what could it bring to the world of mental health?
The answer lies in VR’s extraordinary ability to create powerful simulations of the scenarios in which psychological difficulties occur. With the introduction of VR, there’s no need for a therapist to accompany a patient on a trip to a crowded shopping centre, for example, or up a tall building. Situations that are more or less impossible to build into a course of therapy such as flying, for example, or the shocking events that often lie behind PTSD — can be conjured at the click of a mouse. The in-situ coaching that’s so effective for so many disorders can now be delivered in the consulting room, with the simulations graded in difficulty and repeated as often as necessary. So let’s take a look at just a handful of the health disorders being tackled with the help of VR.
For those who are reluctant to engage in recollection of feared memories, VR provides a sensory-rich and evocative therapeutic environment, allowing patients to experience a “sense of presence” in the virtual setting. VR technology allows for gradual exposure to increasingly feared situations that can be carefully monitored and tailored to the individual patient’s needs. VR environments can be manipulated above and beyond the constraints of the everyday world, creating new possibilities for therapeutic action. As a result, VR therapy can increase a person’s feelings of self-efficacy and of being active agents of their own experience. Patients have often been found to be more willing to consider VR treatment than other forms of exposure therapy. The VR world does not include the same risks as returning to the actual feared environment, and patients can feel supported in knowing that the therapist viewing the virtual environment is sharing in their experience.
Persecutory delusions is one of the most common types of delusions, centering around a person’s fixed, false belief that others aim to obstruct, harm, or kill them. Delusions are notoriously difficult to treat, so there’s a pressing need for new ways of tackling the problem – which is where VR comes in.
The UK Medical Research Council recently funded a study at the University of Oxford designed to tackle the fundamental fear thought to underlie paranoia: the sense of danger from other people. The most effective way to do that is to help the individual learn from experience that the situations they dread are actually safe. As the feeling of safety increases, the delusion, in turn, diminishes.
Understandably, it can be very difficult for patients with severe paranoia to face feared situations. But it’s easier with VR. Knowing that the scenario isn’t real helps with confidence, and it’s simple for therapists to present the least difficult situations first. VR also offers other practical advantages – patients can experience the same situation as many times as they like and be instantly transported from one challenging situation (say, a shop) to another (such as a train), meaning that progress may well be much faster than it would be if they were facing real-life scenarios. Some patients in psychiatric wards usually have very limited access to real-world situations, making VR an invaluable treatment option.
Post-traumatic stress disorder (PTSD)
One in three people who experience an extremely traumatic event- anything from a car accident to a natural disaster to a violent mugging, may suffer from PTSD. The symptoms are often persistent and life wrecking with symptoms ranging from nightmares, insomnia, feelings of isolation, irritability, and guilt.
Treatment for PTSD has varied over the years, from medication to psychotherapy to simple exercise. Most now agree that exposure therapy, a treatment pioneered in the 1950s that seeks to relive a sufferer’s trauma in a controlled, often imaginary environment, is usually the most effective prescription. The idea is to take a patient back to the memory of their trauma over and over again until their triggers no longer produce anxiety.
Simply discussing such a charged scenario is a tall order for most trauma survivors but VR-based exposure therapy goes one step further by making the patient an active participant in the scene and therefore completely immersed in the traumatic incident. And by confronting the traumatic incident in a safe environment, the patient is able to create new memories associated with the cues. In short, it’s giving the cues that trigger the memory of the traumatic event something new to wire with: a safe experience.
Until recently, eating disorders have been treated mainly through cognitive behavioural therapy (CBT). New advances in the emerging field of virtual reality therapy, however, are being combined with traditional therapy and show promise for more effective treatment.
The therapist plays a simulation program that displays avatars in a variety of anxiety-provoking settings, such as in a restaurant or a store dressing room for those with an eating disorder. These settings are low stress to begin with, then stress levels are increased as you become more desensitised to the troublesome scenario.
During VR experiences patients are placed in a virtual body. Although this avatar isn’t really the patient, studies show that people feel a close enough association to the avatar that they emotionally respond as if they were in the actual setting. In this way, they can address their eating disorder and work through their body-image issues in a safe, controlled environment. The psychologist listens in during the session to coach, help with relaxation techniques and provide coping skills. They can also control the environment by placing the patient in a restaurant, kitchen, before eating, after eating and either stop the program or lower the stress level if patients become too upset.
It’s still early days for virtual reality and mental health. But what we’ve already seen is that the potential is huge, not only for therapy but also for assessment: rather than relying on what people can remember of their thoughts and feelings, VR will allow clinicians to run powerful situational tests. We may not be far off the time when we can all use VR whenever we feel we need to, in order to improve our psychological well-being from the comfort and security of our own homes. Current VR treatments require a trained therapist to be present; but future versions could be delivered by a virtual therapist, making the best psychological science available to far greater numbers of us than ever before.