Not a Freudian Slip: Virtual Reality for Mental Health [Virtual Reality for a New Reality?]

Contributor: Connie Mester, MPH
To learn more about Connie, click here.

 

For over fourteen months, during the pandemic, I have been working in my home office while my teenage daughter attends school virtually in another room in our house.  This situation has been challenging to say the least, and I know every other parent echoes the same sentiment.  To make matters more daunting, my daughter has ADHD, visual sensory processing difficulties, and dyslexia. All of these conditions make digital learning a nightmare! 

What has worried me the most during this extremely unusual time, however, is her mental health. The social isolation and complete shutdown of normalcy have had a tremendous impact on everyone. Furthermore, many families have even heavier hardships to face (e.g., food insecurity, job loss, and a lack of the technology required for virtual learning), which can significantly impact mental health.  What I have seemed to notice most in our situation is that my daughter's once confident disposition and positive outlook have completely transformed into feelings of “not being smart” or “capable of being successful” in school.

I imagine many are struggling with similar scenarios, whether those thoughts are about work, school, life, relationships, etc. This negative thought-loop isn’t just for teens. Our brains have a negativity bias. In fact, according to the National Science Foundation, people have 12,000 to 60,000 thoughts each day and 80% of those thoughts are negative.  These thoughts of not being good enough, or smart enough, or (__fill in the blank) flood our minds daily.  In many cases, people are able to overcome these negative thought patterns by realizing those thoughts aren’t reality—some through self-growth and others through sessions with a therapist or online support groups. 

As an educator and behavioral scientist by training, I started thinking….could there be an exercise that could transport her out of her negative thought-loop into a three-dimensional world that boosted her confidence by allowing her to see herself being successful in different scenarios?  Could a Virtual Reality (VR) session help her develop new skills, then practice those skills in a simulated environment where she sees herself accomplishing her goals?  Similar to how athletes visualize winning, could the same virtual scenario be visually displayed to allow a person to see themselves succeed in their endeavors?

When people think about VR, most think of its use in gaming and entertainment.  As technology has advanced, so has the ability to mirror real-world situations more authentically. This is certainly “cool” for the gaming world, but even more so for VR's impressive application in the mental health space.


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VR has been successful in helping to treat many disorders such as PTSD,1 panic attacks,2 social anxiety,3 chronic pain,4 and phobias for issues such as fear of spiders,5 small spaces,6 or flying on an airplane.7

Research has demonstrated positive treatment outcomes in these carefully controlled environments led by a trained therapist. 

Could similar methodologies be applied to create VR programs that people use for the self-management of one’s emotional health? Just as people read self-help books and use apps to help them form new habits, infuse more gratitude into their day, and practice mindfulness, could these same self-led interventions become magnified as a person is transported into an immersive VR environment?  

This year there’s been significant funding for innovation in the digital mental health space.  This isn’t surprising as the pandemic has elevated the mental health crisis beyond the critical level it had already reached.  In 2020, research reported elevated adverse mental health conditions, with 1 in 3 adults suffering from anxiety or depression related to COVID-19.8-10 Perhaps research and development of a virtual self-led program, which individuals could access early on before things spiral to a level where there is a need to seek therapy, becomes a new area of disruptive innovation for the greater good.

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One of the best, most proven methods for helping people work through mental health challenges is by partnering with a therapist and using cognitive behavioral therapy. In fact, CBT has shown to be more effective than Rx treatment.11 CBT helps people understand their thoughts, feelings, and behaviors and learn and practice coping mechanisms that can be used in the future when a person is facing a challenging mental health situation. These same learning methodologies can be applied, and the user can reinforce skill-development through practice in a safe virtual environment. 

Allowing one to become aware of and confront their inner critic - and then work through exercises that help the individual change the internal narrative and break the cycle of negative self-talk - could have a tremendous impact on their well-being, self-confidence, and overall outlook on life.  Not to mention the possibility that this type of skill development could be preventive in nature against future anxiety or depression diagnoses.

In many cases, our internal dialogue can be exacerbated, or sadly reinforced, on social media.  Could VR programs be built to not only boost a person’s confidence through reinforcement of skill-development, but also created to combat the feelings of isolation many have when using social media?

I recall a human relationship course in the educational psychology department during my undergrad studies at the University of Florida. This course was like no other. A particular exercise - mirroring, a technique used in movement therapy where a person imitates (mirrors) the other person’s movement and actions - was used during several class sessions.  Research has shown this type of play and dance activity has influenced feelings of togetherness.12 This seems like a perfect place to investigate the efficacy of VR in helping teens and adults alike to develop self-appreciation - along with social skills - that supports a positive well-being.

With any self-led program that individuals access directly, there must be safety measures in place to activate a deeper level of support if necessary, through a link to teletherapy scheduling service, or in more severe cases to a direct line for a suicide prevention 24-hour hotline.  These program enhancements are simple additions to a holistic program and can be more purposeful and timely than one might come across in a self-help book or a mental health support number. 

I am hopeful the new investments in digital mental health continue to bring support to the many people suffering from mental illness.  With the addition of VR technology combined with traditional CBT methods, the possibilities of preventing extreme emotional distress or advanced mental illness with early skill-development in a virtual world could prepare people for future emotional well-being challenges they may encounter.

If you’re a person who’s ever bought a self-help book or downloaded an app that delivers calming tips, stress management, or positive psychology techniques, would an evidence-based VR platform be a consideration for you?


Contact Connie at: [email protected]

 

References 

  1. Rizzo A and Shilling R (2017). Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology, 8(sup5), 1414560. https://doi.org/10.1080/20008198.2017.1414560
  2. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, Carlbring P, and Powers MB (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorder; 61:27-36. doi: 10.1016/j.janxdis.2018.08.003. PMID: 30287083.
  3. Kim HJ, Lee S, Jung D, Hur JW, Lee HJ, Lee S, Kim GJ, Cho CY, Choi S, Lee SM, and Cho CH (2020). Effectiveness of a Participatory and Interactive Virtual Reality Intervention in Patients with Social Anxiety Disorder: Longitudinal Questionnaire Study. Journal of Medical Internet Research, 22(10), e23024. https://doi.org/10.2196/23024
  4. Darnall BD, Krishnamurthy P, Tsuei J, and Minor JD (2020). Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study. JMIR Form Res. 4(7):e17293. doi: 10.2196/17293. PMID: 32374272.
  5. Miloff A, Lindner P, Dafgård P, Deak S, Garke M, Hamilton W, Heinsoo J, Kristoffersson G, Rafi J, Sindemark K, Sjölund J, Zenger M, Reuterskiöld L, Andersson G, and Carlbring P (2019). Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial. Behav Res Ther. 118:130-140. doi: 10.1016/j.brat.2019.04.004. PMID: 31075675.
  6. Maples-Keller JL, Yasinski C, Manjin N, and Rothbaum BO (2017). Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress. Neurotherapeutics : The Journal of the American Society for Experimental NeuroTherapeutics, 14(3), 554–563. https://doi.org/10.1007/s13311-017-0534-y
  7. Rus-Calafell M, Gutiérrez-Maldonado J, Botella C, and Baños RM (2013). Virtual reality exposure and imaginal exposure in the treatment of fear of flying: a pilot study. Behav Modif. 37(4):568-90. doi: 10.1177/0145445513482969. Epub 2013 Apr 12. PMID: 23585557.
  8. CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
  9. CDC, National Center for Health Statistics. Early release of selected mental health estimates based on data from the January–June 2019 National Health Interview Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealth-508.pdf
  10. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2018 National Survey on Drug Use and Health. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  11. Hofmann, SG, Asnaani, A, Vonk, IJ, Sawyer, AT, and Fang, A (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
  12. Rinat FS, Yuval H, Nava L, Nina KK, and Lior N (2018).  The Body Speaks: Using the Mirror Game to Link Attachment and Non-verbal Behavior. Frontiers in Psychology, 9. DOI=10.3389/fpsyg.2018.01560