NewPathVR spends the major portion of its time conducting research and development. We read and follow as much research as we can about the psychological, neurological, psychoacoustic, and affective scientific behavioral changes that can be made using immersive technologies. Simon Chandler at Wired recently wrote in an article titled “Virtual Reality’s Latest Use? Diagnosing Mental Illness” that VR is a promising diagnostic tool, researchers say, because it generates scenarios and experiences that can’t easily be produced in a traditional clinical setting. The question the article asks “What is it about VR that makes it a promising technology for detecting neurological and psychiatric conditions?”
Early applications of the technology were in designing vehicle simulators. The technology was mainly used for training military personnel, pilots, and astronauts; but largely remained out of the public eye. The first applications of VR in medical teaching occurred in the 1990s with colonoscopy and upper gastrointestinal tract endoscopy simulation. Today, VR is being used to detect and treat psychological and neurological conditions and the questions are why and is it better than current methods. The answer is yes, and here’s why.
First, VR simulates real life very “convincingly”, so convincingly that your brain remembers VR as if it were real life. A notable 2009 Stanford study showed that preschool students surveyed 5 days after a VR experience of them swimming with whales believed that the experience was a real memory. They believed they actually swam with whales. Younger minds tend to be more impressionable but this begins to show you how powerful VR is.
Jeremy Bailenson’s Four Reasons to Test in VR
Jeremy Bailenson, founder of Stanford’s Virtual Human Interaction Lab and author of “Experience on Demand”, states four reasons for testing something in virtual reality. He says you should build something in VR if otherwise, it would be:
If something were dangerous like spiders or the plank experience, VR would make sense. To address the fear of flying, or reproducing an auditorium of people to practice speaking in front of would be quite expensive compared to a VR experience you could do again and again. To create a game where you shoot frogs in space would be impossible. Finally, it may be counterproductive to recreate role-playing between domestic abuse partners.
However, there are many other reasons to build in the immersive environment and many reasons why you would diagnose psychological and neurological conditions using VR.
VR for Real-Time Observation and Modification
One of the benefits of virtual technologies is that of the therapist’s ability to monitor the patient’s activity. Some systems can be used to identify emotional facial expressions in patients with psychosis, or how to pick up other visual cues by watching the user or using heat mapping software. In this way, the therapist can be responsive to the patient and adjust the therapy in real-time in some cases.
VR for Testing Consistency
Virtual reality allows one to create a consistent, error-free environment or environments that can be customized for your assessment conditions. In the VR environment, you have complete control and can repeat simulations with finite accuracy and consistency. This combined with the real-life likeness of surroundings and objects provides control in order to make assessments.
VR for Privacy and Removing Fear of Personal Judgment
There is some evidence to show that people will divulge more information to an AI or scripted avatar than they will to one embodied by a person or to a person directly. They also prefer to interact with an avatar of their own sex. This has to do with the feeling of being judged, which patients feel less of when dealing with an AI avatar.
VR for Gamification During Research
VR can provide patients with added motivation by adding gaming factors. This motivational aspect can lead to more accurate results and deeper engagement by participants. Gamification in VR is especially compelling, again because of the realism. For generations, game theory has been developed and refined and this psychology can transfer to VR, particularly in the dynamics surrounding how to keep the user engaged through each step or stage and for gathering emotional feedback.
VR for Safe Psychological Activation
There are other reasons, too, ie many therapeutic methods in vivo encourage you to put yourself in a state of stress, anxiety or PTSD, such as exposure therapy for agoraphobia or fear of crowds which include actually exposing yourself to crowds of people, perhaps activating a panic or anxiety attack you can’t escape easily. If you were doing this therapy in VR, you could immediately remove the headset and address the emotions.
Creating Specialized Scenarios in VR to Detect Psychological or Neurological Conditions
To answer more on detection, Greek researchers in 2015 built a cognitive training game for patients with mild cognitive impairment, something that comes before Alzheimer’s. This can detect memory loss by presenting scenarios that are increasingly complex such as financial planning.
When compared with existing cognitive tests, VR is showing great promise in helping to diagnose and help with memory. Cambridge University’s Dr. Dennis Chan tested participants’ spatial navigation and memory by having them don an HTC Vive headset, follow an L-shaped path in a virtual environment (initially mapped out by cones), and then trace their footsteps back to their starting point without the help of any markers. Chan’s team reported that the VR-based navigation test was more accurate in diagnosing mild Alzheimer’s-related impairment than traditional “gold-standard” cognitive tests, such as figure recall and symbol tests.
Here at NewPath we are also inspired by Adam Gazzaley’s work at UCSF’s Sandler Neuroscience Center. Some of this research says that essentially as we get older, we lose the ability to ignore distractions. Adam’s research has shown that you can train the elderly brains to concentrate and focus, through gaming mechanics, improving memory. His research has also shown that video games can increase cognitive ability.
VR and Biometrics to Determine Psychological and Neurological Conditions
Both neurological and psychological conditions may present themselves physically, hence the warranted excitement about biometrics and certainly those are being utilized for detection, but there are many issues to consider in this area.
Cubicle Ninjas used the heart rate tracking in concert with their VR meditation application called Guided Meditation VR. Users would attempt to lower their heart rate while using their app and a biometric headband. Some of the issues with using these devices together become evident right away — privacy, user education, sizing, consistent results, and shared data across both apps. Well, it’s not a closed loop, right? The VR application is not integrated, not HIPAA-compliant. Companies need to think these things through. Cubicle Ninjas removed this feature in 2018 due to “increased regulation around biometric data.” they said. Another problem is the specificity to the hardware. An app that is specific to a headset, specific to a biometric device for the app? That’s like a spoon that only works for hot carrots.
Detection of Psychological Conditions Through AI
NewPathVR is working on an AI-enabled AR/VR product that assesses your depression level upon intake of your therapy session. Currently a cold, numeric assessment, we’ve taken an avatar, meant to be one of many you could choose from, who asks you questions using natural language and a more personable interaction that we believe will generate more accurate answers and engaged patients, helping patients and clinicians and decreasing healthcare costs.
We also just held our 2nd Annual VR Wellness Hackathon, and one team created a prototype for an app that allows you to externalize and identify visually your anxiety or depression or the emotion you are experiencing with colored and textured brushes in VR and then interact with it by lighting it on fire, pushing it far away, erasing it, or just giving it a hug. By seeing your emotions as external notions rather than as ourselves, as we sometimes say “I am anxious”, and that is an identifier, but by seeing the emotion outside of ourselves, we are better able to act upon feelings.
Many people are excited about facial recognition. The problem with facial recognition at this time is that the VR headsets inhibit recognition of the full face. Eye tracking is something that you might see come out now incorporated into some of the headsets, but again, we’re edging into the business of your bodily health information. Pupillary dilation, for example, says a lot about people and we are definitely headed into Minority Report territory — it’s the merging of these two that is a delicate weaving we’re seeing.
VR Compared to Other Methods of Research Recording Methods
VR is certainly more accurate than human recording methods, because of pilots errors and more. But beyond that, beyond say a computer program, why is a VR environment better at diagnosing than a mobile app, for instance? It’s because of the touch points. It has the potential to be a better diagnostic tool because of this, a better education tool, a better change tool.
Put it this way. If TV was a seal, and computers were maybe an octopus, VR is a jellyfish. It can touch you everywhere!
Because you are PART of the experience of VR, VR can connect to you in so many more ways. You are IN it. VR is experiential.
The reason we believe that VR is such a powerful tool for psychology is that memories and behaviors are formed from experiences. And VR is the first “experiential” medium. We can present experiential environments and present experiences for people and form memories, writing neural networks to change behaviors once people remove the headset. That’s a major driving principle and theory for us at NewPathVR.
Our team built an app here for role-playing in which you choose actors and scenes and role-play past memories to do just this. Users record dialog and then role-play conversations from those memories to reform memories and change narratives in their lives to which they may have formed maladapted behaviors and coping mechanisms that don’t suit their present-day relationships and healthy behaviors.
Dr. Brian Chau, a physician who writes about new medical technology, says, “The key here is data — we need validated measurements” to show VR is comparable to or better than traditional methods, he says. Continued partnerships between clinicians and VR developers are needed to move the technology” from the lab bench to the clinical bedside. NewPathVR agrees.
Why Psychological and Neurological Conditions Go Undiagnosed
Mental Health is a silent epidemic. For example,1 in 5 people have depression, 70% of these are between the ages 18–25 per the CDC in 2018. Eight (8) million people die each year due to mental illness. Mental health is not spoken about or given as much funding as physical illness, so it is harder to find research and support and find new more effective, ways to solve problems for this area.
Traditional techniques do not always work. It is difficult to diagnose mental illness due to issues of stigma, lack of mental healthcare workers, expense, and the nature of the illnesses themselves which pose inconsistencies and challenges. Individuals vary in responses to traditional treatments and for some people it is a lifelong commitment (e.g. there are many patients who cannot afford to keep up long term therapy, especially people who are more disadvantaged, most at risk and most in need, and government counseling services cannot possibly reach everyone) and although through community outreach programs it is possible to deliver these services to many more people, some people tend to be more closed off and find it difficult to connect with traditional processes or it can take them a while to do it.) In these situations, VR could offer a better solution as it addresses issues such as expense, accessibility, and stigma.
The Psychological Dangers of VR
Yes, there are dangers to consider. As one example, I mentioned the strategy of “activation” in order to practice skills during your stress state so you will readily be able to call up those skills during your next stress state. This is often done under the supervision of a therapist. Developers need to consider how to contain a user’s experience in this regard when a therapist is not present.
When subjecting individuals to tests intended to bring out symptoms associated with panic or psychosis, there is a danger that VR could provoke or cause these symptoms in people who would have otherwise never exhibited them. In other words, there is, in fact, the risk that VR could cause psychiatric symptoms, such as PTSD, in healthy individuals.
There are several other important things to consider when adding VR to a clinician’s toolkit. Practicality, privacy, safety and more. NewPathVR teaches courses on these topics precisely. We are the only company approved to teach accredited courses on VR Psychology for the practical and clinical use of VR with patients. We teach practitioners about the guidelines for the different headsets, the research behind conditions being treated with VR successfully and areas that are still gray. VR applications available for each headset, pricing and options and solutions that suit individual or organizational scenarios are also covered. We teach safety, what population will be using the technology, app insurability, sanitization, we cover all of this. Importantly, which applications are for use with a clinician and which apps people can use at home on your own.
We also believe that standards and guidelines need to be developed for XR across the board, usability, and ratings, for example, and we are familiar with some associations working on this.
I wrote an article about the responsibility of VR developers in 2016 to try to shed light on this topic. This indicates that the tool has to be used with care and caution, particularly with the entering and exiting of an application (the “handling”, I call it, or “containing” some people say) however, the fortitude of the platform also translates to its positive effects, and when using it to treat and enhance mental health, it can have enormous benefits for an individual.
In summary, VR provides an excellent opportunity for optimized testing and detection of psychological and neurological conditions. There are important things researchers and clinicians must keep in mind with this incredibly powerful technology when doing so, and working with experienced professionals is a good way to avoid some of the pitfalls inherent in this newly emerging, but very promising, technology.