With costs dropping, graphics improving, and an evidence base that is growing, virtual reality (VR) technology is positioned to play a bigger role in mental health care in the coming years.
At the 2020 virtual Psych Congress Elevate conference, Albert “Skip” Rizzo, III, PhD, director of the medical virtual reality lab at the University of Southern California in Los Angeles, used an example of a VR simulation that helps people with a fear of flying. “In this case, these environments are deliverables using low-cost VR headsets that don't even require a computer. All the processing is done on a headset that's about $400,” he said.
“The accessibility of this technology has dramatically changed in the last couple of years,” Dr. Rizzo explained. “You can pull a VR headset out of your desk drawer and hand it to a client, rather than having to use an exotic computer, and be able to deliver this type of treatment more effectively.”
Meta-analyses of VR interventions in people with anxiety disorders have documented its efficacy, Dr. Rizzo pointed out during his session. He cited meta-analyses that ran in the Journal of Anxiety Disorders and the Journal of Behavior Therapy and Experimental Psychiatry in 2008, the journal Depression and Anxiety in 2012, and the journal Behaviour Research and Therapy in 2015. Just last year, the Journal of Anxiety Disorders had a full issue dedicated to studies involving VR that, he noted, showed “a lot of positive findings for the use of this technology.”
“Under the guidance of a good clinician, this has been found to be as effective as in-session treatment for fear of heights,” Dr. Rizzo said.
Trauma, ADHD, and Training Applications
VR also has gained solid ground in helping military service members and veterans with post-traumatic stress disorder (PTSD). Clinicians use a standard clinical interface that allows for the creation of 14 different environments that can be customized to match a patient’s specific trauma narrative.
“The clinician can see what the user sees in the environment and help the patient go through the process of confronting and reprocessing difficult emotional memories,” Dr. Rizzo said.
As its PTSD applications move from military into civilian translations, Dr. Rizzo also sees opportunity to help first responders including police, firefighters, and emergency medical technicians train in de-escalation, coping, and resilience strategies. Physicians and nurses dealing with the psychological ramifications of COVID-19, too, could benefit from VR-assisted therapy, he reasoned.
“There's no shortage of trauma in the world,” he said, “and I think VR may be a solution for dealing with trauma.”
The speaker also shared VR applications designed to help people with high-functioning autism prepare for job interviews (users can choose from soft-touch, neutral, and cranky human simulators for practice on dealing with different types of personalities and moods) and to help children with attention-deficit/hyperactivity disorder practice focusing in distracting classroom simulations. Virtual patients also allow novice clinicians to practice therapeutic skills such as motivational interviewing, while virtual human agents are a nonintimidating vehicle for patient screening.
People tend to be more willing to disclose information honestly to a virtual character, Dr. Rizzo said, than on a symptom checklist that they know will be reviewed by a human clinician.
A Tool, Not a Substitute
In a poll of 70 psychotherapy experts published in the journal Professional Psychology: Research and Practice in 2013, VR ranked fourth out of 45 clinical care options clinicians predicted would increase in the next decade.
“Research has documented that clinicians are accepting of this work,” Dr. Rizzo said.
Still, he predicted growing worry in the coming years that VR is being put forth as an alternative to human clinicians. Several times throughout his talk, however, Dr. Rizzo mentioned to attendees that the technology is no replacement for living and breathing mental health care providers.
“We're not eliminating the need for well-trained clinicians,” he said. “In fact, what we're really doing is giving clinicians tools to extend their skills. Technology doesn't fix anyone. It's a tool in the hands of a well-trained clinician.”
— Jolynn Tumolo
“Virtual Reality: The New Frontier in Mental Health.” Presented at Psych Congress Elevate: Virtual; July 25, 2020.