From depression, anxiety and Post Traumatic Stress Disorder (PTSD) to migraines, chronic pain management and Alzheimer’s disease, virtual reality (VR) is really starting to show great promise as a potential treatment for a range of mental health issues. Healthcare professionals have also been looking to VR to calm young patients during dental procedures, treat burn patients and ease the pain of the birthing process to name just a few. In fact, we’re just starting to grasp the potential as new applications keep pouring in.
It’s become an area of intense research. There have been numerous recent mental health studies conducted across the gamut that show promise to treat a wide range of conditions without the use of drugs.
Here we take a deep dive into some the research that’s going on.
The Anxiety and Depression Association of America cites data from Our World Data that indicates that 322 million people worldwide live with depression. In fact, the World Health Organization (WHO) found that depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. This epidemic has hampered our personal lives and our ability to participate in society at large and is costing the U.S. on average of $210 billion per year according to the newest data available from Analysis Group.
In September researchers at The University of Sheffield unveiled their latest research into a new VR tool called LifePathVR – a pioneering project that moves away from a cookie cutter approach to treating depression and other mental health conditions to a much more engaging and personalized type of care that offers higher recovery rates and fewer side effects. The tool allows people to capture life events, upload relevant digital content and reflect on their thoughts and feelings with greater detail. By creating an immersive version of their journey through life, this new form of self-reflection could help improve and maintain positive mental health. Upcoming workshops at the university this October will allow for the development of a full-scale prototype.
Anxiety and PTSD
Anxiety-related disorders are plaguing our society with millions of people struggling to cope on a day-to-day basis with no relief other than pharmaceuticals. Virtual Reality Graded Exposure Therapy (VRGET) is quickly gaining ground as a complimentary healing aid for specific phobias, generalized anxiety, panic disorder and agoraphobia.
Exposure therapy has been around since the 1990s used to treat anything from agoraphobia, fears and phobias as well as PTSD with great results. Patients are exposed to anxiety-inducing stimuli in a safe, controlled environment, eventually learning that the “threats” they’re worried about are not actually very dangerous. Having VR as a medium for this demonstrates the benefit of what immersion can provide.
A fear of flying can make air travel a highly stressful event, especially if you have autism. Boise Airport in Boise, Idaho has responded to this by implementing their Airport Tour – a VR experience designed to ease and reassure travelers prior to flying in order to improve their flying experience.
According to a Sept. 5 Idaho News report passengers can have a kind of dress rehearsal beforehand – navigating the airport itself and experiencing some of the stressful check-in procedures before heading to the airport.
Having any sort of medical procedure can be a source of anxiety and stress for anyone, especially children. Using VR as a remedy to ease the discomfort seems like a no-brainer. In a September 2019 clinical trial by Sung-Hee Han, MD, PhD, 99 children aged 4-8 years were assigned to receive virtual reality education with cartoon characters before chest radiography. The children showed lower anxiety and distress scores, slightly lower procedure scores and high parental satisfaction in favor of the VR group versus the control group.
According a March 30 2019 Colorado Public Radio report, The University of Central Florida (UCF) offers a program called UCF Restores that uses VRGET to treat veterans suffering from PTSD. Clinic director Deborah Beidel said patients often have trouble with the simplest of errands like shopping or getting gas and states that “what we want to do is dislocate those triggers from the anxiety, so that from now on, a person could smell diesel fuel and not worry an IED is going to explode and their best friend is going to be killed."
38-year-old National Guard veteran Kevin Tergliafera, who served in Afghanistan has battled both anger and manic depression, is one such patient who participated in the UCF Restores’ three week intensive program. He says that it is an uncomfortable process at times being submersed in personal scenes relevant to his trauma, not just with visuals but also sounds and smells such as fuel and a vibrating chair that simulates being in an explosion. Therapist Keith Smith says that patients get calmer with each session and reveal more details about their trauma and, as a recipient, Tergliafera states that "The layers they just peel back and they just get you to your core. At first you don't want to, but you break down and do it, and it's absolutely amazing."
Beidel and her colleagues published a study that involved about 100 patients in the program and found two-thirds of them no longer met the diagnostic criteria for PTSD once they completed the program. And those results held up six months later.
Even better news is that the program is expanding thanks to the two new grants issued by the Department of Defense. The injection of $3 million into the program will allow for updated software which means UCF Restore’s VR tool can supply even more detail to better address the trauma. As a result, the program is now able to expand – developing VR experiences for more branches of the military and creating scenarios that could be used to treat first responders, survivors of mass shootings and survivors of military sexual assault.
Researchers say that environmental context is a major factor in the treatment of chronic migraines and the distraction feature of virtual reality offers hope in managing this condition. The immersive quality of VR “hijacks” the user’s auditory, visual and proprioception senses, acting as a distraction that limits the ability to process stimuli from the real world according to a research paper by C Lee Ventola.
As humans have a finite attention capacity, a task that involves distraction such as immersing the patient in a VR environment is believed to leave less cognitive capacity available for processing pain. (Bernie Garrett, RN, PhD Garrett et al). In this sense, the patient gets ‘lost in time’ having less time to focus on the pain. The pleasant, immersive experience is thought to block the "gates" in the spinal cord from receiving pain signals according to Dr. Brennan Spiegel, director of health services research for Cedars-Sinai in Los Angeles. He is listed in the 2016 Onalytica "Top 100 Influencer" lists for digital health (No. 13) and virtual reality (No. 14) and considered to be an imminent authority on virtual reality within the medical sphere.
Chronic Pain Management
Although the allopathic medical tradition relies heavily on pharmaceuticals as a remedy for chronic pain management, given the staggering opioid crisis that we face, researchers are taking a serious look at VR as a potential drug-free way to address and manage pain. According to The National Institute of Drug Prevention in an updated January 2019 article, The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addition treatment and criminal justice involvement. And here’s an even more alarming number: chronic pain management has cost up to $635 billion each year in medical treatment costs and lost productivity in the United States (Florence CS et al).
Researchers have embraced this challenge and the results are encouraging. In an interesting article published June 2014 in PubMed Central (US National Library of Medicine’s digital archive) Dr. Brenda Wiederhold co-founder of the Virtual Reality Medical Institute in Brussels, Belgium, reports that VR intervention is being used in combination with other analgesic strategies such as training to attack pain symptoms with an omnidirectional approach.
For instance, it is known that the ingestion of pharmaceutical drugs can activate primary physiological systems and VR treatment acknowledges these changes and offers methods for promoting activation of systems otherwise unacknowledged by drug treatment. Within this study, Dr Wiederhold cites an October 2013 study by Villager M. et al about the efficiency of VR in the treatment of neuropathic pain that was investigated in 14 patients suffering from iSCI (incomplete spinal cord injury) who were treated over four weeks in 16-20 sessions for 45 minutes.
The results indicated positive changes reported by patients, improvements in lower limb function, reduced intensity and unpleasantness scores on the Neuropathic Pain Scale (NPS) and stability of this finding even after 12-to-16 weeks of training.
Dr. Wiederhold concluded that VR distraction is a safe and effective treatment to treat pain and manage patients with a variety of medical conditions, (Wiederhold et al).
In the latest study () published in August in the PLOS|ONE, Public Library of Science led by Dr. Spiegel MD, MSHS, director of Cedars-Sinai's Health Service Research, 120 patients participated in a randomized comparative effectiveness trial whereby one group used VR and the other watch wellness programs on TV. Results showed a significant difference in pain scores in favor of VR and it seems to be the most effective for severe pain. The conclusion drawn was that future trials should evaluate standardized order sets that interpose VR as an early non-drug option for analgesia.
"Virtual reality is a mind-body treatment that is based in real science," Spiegel said. "It does more than just distract the mind from pain, but also helps to block pain signals from reaching the brain, offering a drug-free supplement to traditional pain management." (Source: Cedars-Sinai Newsroom)
According to Dr. David Howett with the Department of Clinical Neurosciences at the University of Cambridge in a May 2019 research study, VR can identify early Alzheimer’s disease more accurately than ‘gold standard’ cognitive tests currently in use. The entorhinal cortex, the region of the brain responsible for navigation is typically the first to show signs of degeneration in the early stages of the disease. Participants who are at risk of developing dementia navigate by real-world walking within simulated environments, which eliminates rotational and distance errors that occur with 2D desktop cognition tests. It is this real life, self-motion testing that can provide a much more accurate analysis in diagnosis.
Researchers are exploring the role VR plays in Alzheimer’s and dementia care with applications like Sea Hero Quest (http://www.seaheroquest.com/site/en/game-story) – a free video game, available in mobile and VR versions that is both fun and ground-breaking. Players are helping researchers collect data about spatial navigational skills while playing the game.
Another application is BikeAround which is a VR-inspired experience that combines a computer, a screen and Google Street View with an exercise bike. As users pedal, they tour through different locations – including places from their past, such as their childhood neighbourhood.
BikeAround’s makers say it’s suitable for people with memory problems, cognitive disabilities and physical disabilities.
Going to the dentist can illicit fear anxiety for many of us, especially children. Given that local analgesics are the typical go-to to reduce pain during procedures, children often experience pain and anxiety that can result in dental fear, uncooperative behaviors and an overall dissatisfaction with dental care. (Guelman, 2005)
Through the use of VR, this can be a less traumatic experience and even considered enjoyable according to a November 2018 study by Dr. Hoffman who found that patients reported significantly lower “worst pain” and “pain unpleasantness,” and had significantly more fun during dental procedures, compared to a comparable procedure without VR. Using Oculus Rift VR goggles, patients reported a “strong sense of going inside the computer-generated world,” without side effects. The dentist preferred having the patients in VR. (Hoffman, 2018)
Treatment of Burn Patients
Clearly, virtual reality is rapidly growing in its applications particularly in the mainstream medical community as a powerful aid in transforming our healthcare experience and the treatment of burn patients is no exception.
A recent August 2019 research article cites a pilot study that uses VR as an adjunctive treatment for adult burn victims. Psychologist Hunter Hoffman created Snow World, an experimental therapy game to divert a patient’s attention from the pain they were experiencing and into a magical world that saw them flying through a virtual canyon while throwing snowballs at penguins and snowmen.
Results indicated that all patients reported less pain when distracted by VR and the magnitude of pain reduction by VR was statistically significant. This provides preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique, (Hoffman et al).
Imagine being in the throes of labor pain and instead be virtually teleported to a relaxing beach complete with soothing background sounds instead. VR technology is being used across the U.S. and U.K. and the results suggest a promising drug-free alternative to the birthing process.
In a June 2019 pilot study from The University of Michigan into Virtual Reality Analgesia in Labor (VRAIL), 27 women were observed for equivalent time during unmedicated contractions in the first stage of labor, both with and without VR. Results suggest that VR is a potentially effective technique for improving pain and anxiety during labor.
In a pilot study initiated in January 2018 by Dr. Michael Foley and OB/GYN Resident Steven Cowles, MD at the University of Arizona College of Medicine-Phoenix and Banner-University Medical Center Phoenix sought to confirm association between immersive virtual reality and an improved childbirth experience. Out of the 20 participants, the test group of 10 who used VR during childbirth used half the amount of stadol – a narcotic pain reliever used in early labor – compared to the control group of 10 who did not use VR. In addition, 77% of the women who used VR said that they would use it again.
According to Dr. Cowles, “In today’s world, people are looking for improved experiences with childbirth-whether that’s with less medical intervention, less medicines or less interruption of the natural process.”
“New technology is creating a revolution,” Dr. Foley said. “From our perspective, we have a new group of patients and physicians by these young and technology-savvy users who are thinking outside the box and applying it to medicine to improve patient care.” (Source: University of Arizona Newsroom.
The headsets, headphones and simulations used in the study were donated by Samsung and Applied VR.
Matthew Stoudt, the CEO of AppliedVR said that more than 130 hospitals were using his company’s VR platform in regular medical practice.
Exploring The Ramifications
It is becoming increasingly clear that virtual reality is making huge advancements in healthcare ushering us into a new paradigm. And this is only the tip of the proverbial iceberg. The ramifications of VR in the healthcare sector is far reaching as this technology continues to develop at an exponential rate.
This new therapeutic tool and other fascinating technical developments will be explored at the 5th annual Transformative Technology Conference, in Palo Alto, Calif. from Nov. 15-16 2019.
Their mission is to “permanently move a billion people into a state of wellbeing and flourishing by 2030.” The Transformative Technology Conference focuses on technology for mental health, emotional wellbeing and human flourishing, sitting at the intersection of neuroscience, psychology, technology, entrepreneurship and innovation.
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