Virtual Reality for Mammograms and Annual Exam Anxiety

Virtual Reality for Mammograms and Annual Exam Anxiety

Kaiser Permanente has retrieved its poor reputation from the clenches of the 80’s and now boasts many accolades and awards of recognition for its leadership in healthcare and programs, leaders, and in places to work. Patients no longer complain regularly about mishaps, insurance nightmares and long office waits. Kaiser ranks top in member satisfaction and has invested billions in electronic records and modernizing medical department and administrative equipment for the benefit of practitioners and patients alike. I, myself, am a Kaiser patient, and credit the payer-provider organization for saving the life of both myself and my husband when we were each faced with life-threatening diseases — him with a heart attack in 2009 and me with breast cancer, 5 years ago in 2013.

I found out about my breast cancer on my 43rd birthday at 8 am. The phone call woke me up. I thought it may have been my dad, calling to sing me happy birthday. “This is Kaiser. We’re calling to tell you that your test showed that you are positive for cancer in your left breast. We recommend a mastectomy We have an opening on Thursday. Would you like to schedule it?”

Um, can I get a second opinion?

“You can,” she responded, “but you don’t want to wait long, it’s very aggressive.”

After a second and third opinion, I took the Thursday appointment and had a mastectomy. I would love to tell you how brave I was, how quickly I recovered, and what a poster child I am for how to approach breast cancer as a patient. But the story is the exact opposite. I went in totally uninformed. I went in with cringed eyes and phenomenal stress. There was no time, and no one there to explain it adequately. It was terrifying. I had barely enough time to search Google to determine which kind of breast cancer it was and what my chances were for surviving. I didn’t know how to find information about what the process was going to be, what my options were, what recovery would be like, or how this would impact me or my family. I was completely in the dark.

The whole process was so quick, there was no time to think about the decisions I was making. We were given pamphlets and a page with checkboxes and if we needed more time to decide, we were left alone in a room to discuss it (and look things up on Google), but I mean, Jesus. Both breasts, just one? Reconstruction or not? Saline or silicone? Tummy tuck add-on (for real, yes, no charge)? Is 11 am good for you?

“You’re so brave,”

“You’re so brave,” people kept saying. That’s a nice thought. I want to be someone that others can look up to, someone who weathered the storm with a stiff upper lip, but I’m afraid I let everyone down on that count. I was in a panic most of the time, I cried after sometimes in confusion about what was happening to my body, sometimes just out of fear of what would happen next. I was a total nuisance to the nurses and doctors, calling on them constantly with questions and concerns and escalating my issues to their supervisors when I didn’t like the answers or treatment I received.

When I got home, I couldn’t stand to look at the scars so I showered in the dark for months. The PTSD from the surgery and procedures afterward did not fade really. I didn’t want to be touched. My self-confidence started to suffer. My very understanding husband was doing whatever he could to support me in my healing, but I kept falling into despair and self-loathing, I didn’t feel whole anymore. Year after year I would watch the breast cancer walk on TV and wonder why I hadn’t bounced back so effortlessly they way the spokeswomen had, in their bright pink t-shirts with ribbons pinned to them. I looked for breast cancer survivor support groups and found two within an hour’s drive. One was for young women under 40. I was 43. The other required that you leave a voice message so I did and no one called me back.

3%

Statistically speaking, there is a 3% chance that I will have cancer in my right breast in the future. Doesn’t seem like a lot but….the chances of winning the National Lottery are 1 in 45,057,474. And I’ve played that, probably, 20 times in my lifetime. Every year since the surgery, when I receive a call from my Kaiser nurse telling me it is time for my annual mammogram and women’s exam, an anvil drops into my stomach. Time to play again.

I schedule a day that I have no meetings because I know that I will be so psychologically and physically triggered that I shouldn’t plan anything else. I usually plan to get cupcakes or ice cream afterward so I have something to look forward to and reward myself (something leftover that my mother used to do for me, I still do for myself).

When cupcakes aren’t enough

We promised you the technology is evolving and this year Oculus came out with a phone-free, tether-free headset with a nice resolution that runs apps that ran on the Samsung Gear VR, which required an expensive phone. I’ve been singing its praises for months, suggesting patients use it in hospital beds, waiting rooms, and doctor’s offices. We even built an Oculus Go application called the Prostate Procedure Guide for patient education and anxiety reduction. I imagine you’re beginning to see some of the origins of our motivations.

At previous exams, I premedicated with anti-anxiety medications and/or recreational drugs. Yes, I’m (not) the portrait of strength and fearlessness, as mentioned. Yet these solutions somehow made me more sensitive to the experience in many ways and that wasn’t productive. This year I am convinced by the extensive research and people I have witnessed and their healing experiences with VR. I have seen and reviewed hundreds of wellness applications on RenewVR and have read hundreds of articles and research papers on the mental health benefits of VR. So I decided to load up my Oculus Go and take it to my appointment.

First was my mammogram. I sat in the waiting room and started an app called Kaleidorium.

I paired the app with my Spotify playlist I use while I make art made up of some current favorite songs (Hearts and Bones, Paul Simon; Let You Love Me, Rita Ora; Wild Things, Alessia Cara; What About Us, Pink) and I watch the beautiful colors change and fly by.

I hear the nurse call my name and forget that I was supposed to be worrying about this procedure. I quickly disrobe and step into the room with the radiologist to perform the mammogram. She does her thing. I resist the urge to look at the screen but wait for her response. She sees these all day, she knows what’s up. She says it looks good but they’ll contact me in a few days to confirm. I notice that overall I am not so freaked out. Now it’s time for my pelvic exam.

Ladies. Let us speak frankly. One really can’t equally compare a prostate exam to a pelvic exam. I’ll take one of those any day of the week, in fact, well nevermind. Could we more fairly compare it to an alien abduction with a non-consensual probe? Yes, see, several hands just went up in agreement. In a prostate exam, the doctor uses a finger. In a pelvic exam, they start with this.

Wait, you are wondering, are we not past the 1700’s? Why yes, that’s true, but we still use steam-punk, friggin’ ice-cold, torture-looking devices and this is just so the doctor can get inside our lady bits, I’m not going to go into what they do once they get in there.

Think cupcakes. Think cupcakes. Think cupcakes.

So, you still get to lie in the same cold slab of weird, paper-covered, stirrup-equipped bench of the 1920’s, thank GOD, thank you SO much! I was left alone to undress and my anxiety started to rise. This procedure can be as brief as 5–15 minutes, but my knees are often times left shaking afterward for hours. This time, when the doctor came in with her assistant, I said, “Give me a moment,”

“I brought my VR headset to help me relax,”

This time I put on an app called Azul. It’s a meditation and mindfulness app that helps you focus.

Instead of looking at the foam panels in the office ceiling and fluorescent light bulbs, I selected a scene, a field with birds in the sky, and I selected the music and laid back. I watched the birds fly in circles.

Before I knew it, she was done. It was that fast. Time flies when you are in VR, people often recount that they thought less time had gone by while they were using it. But in this case, shorter perceived time, no pain, very little discomfort, and no PTSD as I usually have had after this procedure.

As the CEO of NewPathVR, I spend my days evangelizing the psychological benefits of virtual reality. Taking it into my own life is a natural step but one that surpassed my expectations still. I didn’t actually need those cupcakes or meds after all. Virtual reality is a powerful state change tool and remains the most evolutionary force to meet so many industries in years, particularly emotional wellness.

The great news is that I received a clean bill of health. 5 years cancer free!

I recommend the Oculus Go this winter for you, your kids, your friends, and family, believe me, you’ll find uses for it. This spring, you’ll want to grab the Oculus Quest too, for full room-scale VR and higher resolution apps. Here are links to the apps I used but there are hundreds more on renewvr.com.

Kaleidorium: https://www.oculus.com/experiences/go/1700720009953361/

Azul: https://www.oculus.com/experiences/go/1274880599305742/

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Analysis of a Scene: Building Our First VR Prototype

by Guest Author Eiran Shalev, CTO, NewPathVR

When Lisa Padilla first approached me with her vision for NewPathVR, I was immediately inspired by what we could achieve. Imagine the possibilities to not only unlock the hidden power of the brain but to empower our users to look inside themselves and find a way to improve. To feel better. Gain the strength to refine, and then to share that with others. While VR may be many things, to the folks at NewPath, it is the best tool to reprogram the brain for success. We huddled around and researched hundreds of papers where studies demonstrated how positive reinforcement, perception, and sensory filters can influence our behavior, as well as our memories.

Research and Design Phase
We knew we needed a prototype to prove VR as the right medium for spiritual growth, but what platform could serve us best?. Was this going to be a seated experience? How much interaction should it have? And what to build? For instance, did you know that if you perceive yourself as taller in VR, it actually makes you feel more confident during and after you remove your head-mounted display (HMD)? As it turns out, this is very true. Our discussions turned towards identity, and how to connect our users with their VR self. In gaming, this is called your “player self”. You have three “selves” actually. The first self, the real you, is what you do outside of games or VR experiences – ie your life: work, job, family, etc. The second self is the you that plays the game using peripherals, and experiences the content through the point of view of one or several characters in the game. You become a “player self” and share characteristics with the “game self”, but you are not the character. The third self, the “game self”, is the content’s avatar that represents you, and has a role to play in the content’s story or scenarios that your avatar experiences. By witnessing the story, and in some cases, by making choices for your avatar “game self”, your “player self” gets to experience those same emotions, and thus, share those same experiences. The cool thing about VR is that the player and the game self boundaries become blurred, such that you feel as if you are literally inside the content, and you feel much closer emotionally to the experience then you would be if you were observing the content through a monitor or TV screen. Keep in mind that taking an experience designed for a flat screen does not merit porting it to VR. All content in VR should be unique and specifically designed to transform and empower the user.

When building a VR experience, game mechanics that are based on challenge-reward systems create much more value for the user if they incorporate your senses. Adding a 360 visual experience may not be enough to trigger personal, real-world change. Adding 360 audio to that experience brings us closer, but is still not enough. By adding the ability to use your body, such as walking around and touching virtual objects, to influence the content, our team realized that we could create a world where consequences could have just as much impact on the “player self” as incentives. What’s more, if we incorporate at least 3 senses, this combination activates the memory centers or the brain. With the right experience, a player may create an association between something he/she experiences in VR, and a similar experience in his/her real life.

So, we knew we had to make a room-scale experience, and we knew we wanted it to leverage game mechanics that could change a player’s mood. The obvious choice for platform was the HTC Vive. But what about the content? I volunteered that for a prototype, we should keep things simple and demonstrate that we could achieve a basic goal. We wanted to transform a user’s mood from a negative or an indifferent position into a positive one. However, going through a sequential experience in VR, will usually not improve your life on exposure alone. In the real-world (or what we perceive to be our reality), we can usually learn any skill and master it, by practicing it over and over again. In our VR prototype, we needed to do the same. We decided that if we could create content that would teach our players some moral or zen-like lesson. A takeaway. But then also provided an opportunity to apply it, then we could create real personal growth.

Our “Self-Compassion Buddy” vision was born. In our prototype, we essentially introduced our users to their avatar self by literally creating a virtual mirror. The system tracked each of the user’s arms and mimicked his/her movement through the avatar that was reflected in the mirror. Our research showed that in order to strengthen the bond between the player-self and the avatar game-self, our users would need to interact with their mirrored reflection for approximately 70 seconds. This seems like a long time for a prototype, but in a future, commercial version of our product, the interaction could involve a game mechanic with a reward incentive. Next, we focused on the story ingredient. We did not require an elaborate story to demonstrate our vision; only a simple scene based on some narrative context. I believe that in order to create positive change or at least to invoke positive feelings, you need to have contrast, and that means placing the user into a negative situation – for a very short time of course. Then, follow it up with a positive environment filled with good energy. By placing the user into a slightly distressed state, and then moving him/her into a comfort zone, you can generate a sensation of emotional gratification. Games also apply a similar approach when they create a difficult challenge, in which a player must learn a new skill to overcome it. Once the skill is learned, the obstacle is easily navigated, and the player moves on to claim his/her reward. But more importantly, in your own life, when you undergo challenging times, and not only survive them, but learn to be stronger as a result of them, you then undergo positive change within yourself. Through overcoming these challenges, you may either improve your level of independence and self-sufficiency, or you may grow more carefree by successfully navigating stress and becoming familiar with it.

The Prototype Phase
We applied this to our “self-compassion” prototype. Imagine being immersed in a dirty, poorly-lit, virtual environment that exhumed negativity. You find yourself staring at your reflection in a mirror. You move, it moves. After a lengthy exposure to your reflected avatar, your avatar aka “buddy”, starts moving independently of you. It steps out of the mirror. Charges at you, invading your personal space. The result. You start feeling threatened. Your “inner bully” points his red finger at you and verbally abuses you, calling you “a loser…and a failure in life”. After a few moments of this, your brain switches to panic mode – a sort of fight-or-flight response. We kept the user in this state for about 7-10 seconds before interrupting the experience with another friendlier avatar. Any longer than that and we would have risked spoiling the whole experience and alienating our user.

buddy1

The friendlier avatar, a nurturing female guide appears and rushes to your rescue. Freezing the bully in action, she explains to you that the bully is you. Recap: by belittling yourself, you lose confidence in yourself. The female guide then offers words of encouragement to rebuild your confidence. Her words manifest in a new scene in which soap bubbles shower from the sky. Some of the bubbles contain cute gifts such as adorable stuffed animals and pets. We introduced a bit of the fun factor in this scene. When the user pops one of these soap bubbles containing a gift, the female avatar aka your “guide” offers words of encouragement with a positive message, ie: “Lots of people care about you.” Each time you pop a bubble, the gift item inside goes into your collection, and new positive words materialize. In the next scene, you have an opportunity to apply these gifts and redeem yourself. We call this the “pay-it-forward phase.” You observe three couples, standing at surrounding points around you. These couples each reveal a virtual buddy figure matched with his respective inner-bully avatar. Similar to your initial case, the bully verbally terrorizes his victim. This continues in an endless cycle, until you interrupt the buddy, and hand out gifts from your previous scene’s collection. Each time your gifts are received, the words that were initially associated with the gift, retrigger audio playback again. The buddy’s inner-bully vanishes and the buddy then begins playing the ukulele. When all three avatar buddies receive their gifts and play the ukulele, a well-known song begins playing, lifting the mood even more and embracing a sense of relief and closure. The three playing buddies merge into one buddy enclosed behind a giant mirror. And you are once again faced with your own buddy reflection. The simulation ends when the environment cross-fades into a sunny sky, and you find yourself standing on Cloud Nine. Literally.

Post-Analysis Phase
We quickly discovered that when a user goes through this VR experience, they feel better coming out, then going in. Our research also suggests that if we had ended simulation after the initial soap bubbles were popped, gifts received, and words of encouragement heard, then the effect would have been short-lived. By adding the “pay it forward” scene, where the user returns the favor and gives a gift to his surrounding buddies, we essentially teach our users to apply their acquired skills and pay them forward. To share. Therefore, our users resolve to help themselves, feeling a sense of contribution and meaningful value. Generosity in VR impacts our users in the real world and has longer lasting effects on their mood. It builds confidence and self-love.

buddy3

Our biggest challenge in building this first prototype was testing it. I relied on using Unity as our main game engine development tool. Unity not only has established partnerships all over the world, and is compatible with 27 target platforms, but it is also free to use for development. Due to our limited resources and limited access to the HTC Vive, I ended up building our prototype using game object placeholders to represent both the HMD and the two game controllers. I then parented OpenVR’s game controller objects under these placeholders. When I repositioned the placeholder game objects in Unity’s simulator, I was able to estimate fairly accurately how the HTC Vive’s game controllers’ movement would impact the VR environment around them. On a weekly basis, under limited time and limited test access to the shared hardware, I methodically validated and tested our experience on the Vive hardware, tweaking and improving our prototype step by step. Unity is not quite WYSIWYG (What You See Is What You Get) when it comes to the built-in development simulator. That’s why end-to-end testing is so important, especially in VR. I set up a mode that would allow me to switch between my mocked game objects and the hardware game objects in the scene project. Doing so, allowed me to execute a series of tests on our shared hardware device while continuing development in our mocked Unity environment.

Our second challenge was getting our 3D buddy avatar to move correctly in our initial mirror reflection scene, used to build an identity association with your inner buddy. I solved this by building a mimic-engine that tracked the delta positions of the mocked, game-controller-object placeholders. The engine then inverted these vectors and applied the new deltas to a basic, rigged stickman model. I added constraints on the limbs of the stickman and locked the lower limbs so that only the upper body would be affected to move freely. And it worked. Additionally, since the Vive is a room-scale experience, the position and orientation of the stickman (aka our buddy reflection) needed to map to my HMD game object’s position, such that when I moved left or right, my reflection (facing me) would move in the opposite direction. And because the mirror image itself has borders all around, our 3D stickman was piped through a render-texture camera, that projected the image onto a 3D mirror game object as a texture. The mirror game object itself had no reflection, but projecting the stickman as a texture on top of it, gave the illusion of a mirror reflection.

No matter how you choose to implement your own VR project, remember that VR is highly immersive. Due to VR’s transformative nature, the underlying purpose of your content should support a key responsibility for contributing to social goodness, and hopefully, empower our users to live more fulfilling lives.

Eiran Shalev is an experienced technical, hands-on leader with 18 years of professional expertise overseeing top teams on mobile, social, and web technologies for products ranging from multi-player mobile & social games, to streaming video ads to interactive television and more. He comes from Disney Interactive, where he established the technical vision, and helped to scale and deliver Disney’s mobile technology platform to all game studios. Before that, he spent time at Koolbit, Kabam, and RockYou! He has built more than 50 games. He joins NewPathVR as CTO.

Can Virtual Reality Sidestep The Time Travel Paradox?

tree-bubble
There are two technologies that humanity has been looking forward to for decades. One of these technologies is time travel. The other is virtual reality. You may want to throw ‘flying cars’ up there somewhere as well, but some people haven’t seemed to realize that planes essentially are just that. Regardless, of all of these technologies that humanity has wished for, only one of them has come to pass so far: virtual reality. The thing is, with virtual reality, it may be possible to experience the other technologies through it.
Granted, virtual reality will never be able to truly, physically send you through time and space to exist in a different era. But, with the power of virtual reality, it may be possible to experience the past and future in every sense besides the legitimate physical.

Imagine, for instance, virtual reality that lets you experience the American Revolution firsthand. As a soldier perhaps, or even one of the commanders. Or perhaps you would just be present in an ethereal sense, watching everything from the safety of virtual reality. Or consider the opposite. What if you could go into virtual reality, and experience a programmer’s idea of the world in the year 3000? While you can’t claim any accuracy to what people think is the future (though Back to the Future did an uncannily good job with their Cubs World Series prediction), you could still experience what people believe the future will be like, from flying DeLorean’s to those hover boards we never got when we were supposed to.

Obviously, none of this will truly take you to the past or the future. You will still physically be present in the world of 2017, but, the real question is, does it make a difference? If you experience something that is so real to your senses that it may as well have been, does it really matter if it actually happened? To some people it might, but to many others it does not.

If you could use virtual reality to experience say, sky-diving, would it not be the same as actually sky diving so long as it was realistic? The same notion can be held to the idea of pseudo-time travel through virtual reality. Maybe you didn’t really travel in time back to the Crusades, the American Revolution, or one of the World Wars. Maybe you didn’t really travel to the year 3000 and witness the future. But if the experience is real enough, is it not the same as though you actually did?

It is something that is yet to be seen, but highly anticipated by all. Moreover, the potential is nearly limitless. With this kind of virtual reality, will the way history is taught change? Will students be able to experience renditions of the history they are learning first hand? And what of religion? Rather than read the Bible or the Quran, will you be able to experience every part of it from the perspective of someone who was actually there? You very well could, provided that a programmer desires to make it so.

In the end, virtual reality is one of the most exciting things to happen to humanity in decades. And though we may never truly travel through time, who knows what we could one day experience through the power of the technology we now have. I’ll meet you there or, rather, then.

Original post on SpiritualVR.com

Mindfulness and Technology

newpath

Originating in Buddhist philosophy, mindfulness is becoming increasingly popular in the West as the incidence of anxiety, depression, and stress-related disorders plague the undercurrent of our fast-paced industrialized way of life. Recent scientific research on mindfulness has demonstrated beneficial effects on several holistic aspects of personal health, including the mind, the body, and behavior.

Mindfulness meditation has been proven medically effective to decrease stress and improve well-being when practiced consistently. Yet many people still struggle with the concept or application of mindfulness-based therapy. A new wave of delivery is emerging which is combining this ancient practice with modern technology to bridge the gap and appeal to a modern generation of meditators. Studies show not only relaxation, but important shifts in cognition, emotion, biology, and behavior that may work synergistically to improve health. There is also emerging evidence that mindfulness training is associated with greater meaning and peace in one’s life (spirituality), as well as enhanced relationships with others (Carmody et al., 2008Carson et al., 2004)

Imagine you are sitting peacefully on a beautiful beach. You can hear seagulls against a backdrop of pebbles clinking together with each breaking wave. You take deep belly breaths and listen to your meditation teacher as she sits beside you and guides you through the film roll of anxiety and consciousness unfolding behind your eyes. Now imagine that you take off your virtual reality headset to discover you in fact never left your own living room (and saved hundreds of dollars on a flight to a meditation retreat in India.) This is an example of one scenario that modern entrepreneurs are envisioning the marriage of mindfulness and technology to enhance the effectiveness of well-being and relaxation intervention. Virtual reality devices can be combined with health tracking technology such as Provada Health‘s iOS app; “…incorporated into (the) app (is) the ability to link health-tracking wearables, such as the Apple Watch, to quantify the effects of a meditation session on, for example, your resting heart rate. Or look at how your sleep is being affected by taking time out to meditate.”

Modern gaming technology is another avenue where it seems there is potential for mindfulness to be cultivated. Take for example one gaming app available via Play Store called ‘Pause,’ which was created through the principles of mindfulness meditation and Tai Chi. The creator Peng Cheng explains, “It started with my own severe experience of stress and depression. I gave myself 6 months, I practically didn’t do anything but I meditated and practiced Tai Chi with the goal to do nothing but staying in the here and now as much as possible.” The simple game involves a little blob which follows your finger across the screen and facilitates focused awareness by growing in size as you maintain a slow concentrated speed. “Most of our stress only exists in our head and absorbs all our attention. To break this pattern, I need to focus on what is physical and tangible and actively put my attention in the moment.”

Cultivating focused attention in the present moment is the core foundation of mindfulness practice preached hundreds of years ago, in ancient India, and today via a squiggly blob on a hand-held screen or through a high-tech headset. Proper use of technology has the capacity to transform the quality of our lives and the delivery of ancient therapies such as mindfulness which are being lost on a section of the modern generation unaccustomed or afraid of ‘spiritual mumbo jumbo.’ Many trials of research have found that people with higher levels of mindfulness – even without “formal” meditation training – report feeling less stressed, anxious and depressed, and more joyful, inspired, grateful, hopeful, content, vital, and satisfied with life (Baer et al., 2006; Brown & Ryan, 2003; Cardaciotto et al., 2008; Feldman et al., 2007; Walach et al., 2006).

Another benefit of mindfulness is the ability to recognize and accurately label emotions (Analayo, 2003). More mindful people appear to have a greater ability to control emotional reactions in the middle part of the brain (the amygdala and the dorsal anterior cingulate cortex [ACC]) by engaging the front part of the brain (the prefrontal cortex [PFC]), which is associated with attention, concentration, and emotion regulation. This means when you’re practicing mindfulness you’ll better be able to control your emotions and correct unpleasant mood states.

Believe it or not, there is increasing scientific evidence to support the therapeutic effect of mindfulness meditation training on stress-related medical conditions, including psoriasis, type 2 diabetes, fibromyalgia, rheumatoid arthritis, chronic low back pain, and attention-deficit hyperactivity disorder.

Several new technologies, including brain imaging, wearable tech. and virtual reality, are being used to look at and extend the potential health benefits of mindfulness. Finally, research is beginning to prove what mindfulness practitioners have known for centuries…that greater focus, awareness, acceptance, and empathy can make for more flexible, adaptive responses to stress, which, in turn, can help free us from suffering and realize greater well-being & happiness.

Original article