AR & VR for Mental Health: Ready for Prime Time-The HSB Blog 7/19/21

Our Take:

For the past two decades, Virtual Reality (VR) and Augmented Reality (AR) have emerged as treatment protocols for mental health and are regularly studied in psychological research. Using an immersive experience, individuals feel as if they are in an environment other than the physical world they are actually in and experiencing sensations consistent with the artificial environment. The AR/VR industry has had a growing interest in medical applications over the past 20 years; however, the pandemic caused a boom in the usage of virtual reality in behavioral healthcare. For example, as reported in Scientific American, “a new wave of psychological research is pioneering VR to diagnose and treat medical conditions from social anxiety to chronic pain to Alzheimer’s disease.”. Although there is success with VR/AR therapies, additional research is necessary in order to ensure users are receiving cost-effective, high-quality care to cope with mental health issues.

Key Takeaways:

Recent studies indicate VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management.
Over 5,000 studies indicate that VR has the ability to diminish pain, steady nerves, and boost mental health.
In December 2020, 2 in 5 adults (42%) reported symptoms of either anxiety or depressive disorder, an increase from 36% when measured in August.
There are ways to blend VR and AR into the healthcare system, by incorporating VR treatments into psychiatric care and providing better directions for VR-based treatment and clinical research.

The Problem:

Following a dramatic increase in usage during the Pandemic, studies have revealed the benefits of using AR/VR technology in treating mental health and the need to increase the use of such technologies. AR/VR technologies have the unique characteristic of physically creating a sensation for patients that can be used to cause them to feel as if they are in stressful or uncomfortable situations to use in a therapeutic context.

Combining that with automated therapies or virtualized coaching would guide the individual to better cope with the stressful situation. The need for social distancing during the Pandemic led to increased treatment via AR and VR in conjunction with counseling and cognitive behavioral therapy to treat addictions, panic disorders, phobias, eating disorders, and post-traumatic stress disorders (PTSD). Successful use of AR/VR in treatment protocols during COVID underscores the need for greater focus to be placed on seamlessly blending VR and AR technologies into the treatment of mental health. This includes incorporating VR treatments into psychiatric care, and providing better direction for VR-based mental health treatment and clinical research.

The Backdrop:

AR and VR technologies have been used in the treatment of mental health since the late 1990’s. Within a safe and controlled environment AR/VR VR technologies can, through a controlled and deliberate process, increase levels of stimuli or exposure to situations that would provoke anxiety for a particular individual. Slowly as each level of exposure continues to reveal a lack of actual threat, the individual becomes less and less anxious around that stimuli. Virtual reality exposure therapy (VRET) and augmented reality exposure therapy (ARET) are most commonly used to treat PTSD. A study published in the Journal of Psychiatric Research carried out in accordance with PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses aimed to review the efficacy of VRET and ARET as PTSD treatment. The study included participants who have PTSD due to various traumas with a cut-off score on the Davidson Trauma Scale ranging from 40 to 65 points (the Davidson Trauma Scale, a common measure of PTSD ranges from 0-68, with 68 indicating extreme PTSD). The study concluded VRET might be an effective alternative to current psychiatric treatments for PTSD, especially among patients who have not responded to previous treatment. While it has not always been feasible to use exposure therapy for patients, these relatively new digitally assisted exposure therapies of ARET and VRET will broaden the ability to treat more patients. VRET creates the digital surroundings, and ARET adds digital fear stimuli to the user's physical world, aided by an interactive digital device such as a computer, smartphone, or tablet. ARET and VRET aim to increase the sensation of the presence of anxiety-provoking stimuli during exposure therapy, thus improving the efficacy of the treatment. In addition, these treatments are less dependent on the patient’s imagination and make it possible to reproduce the traumatic stimuli in a systematic, consistent and realistic way.

An article from JAMA reported that in December 2020, 2 in 5 adults (42%) reported symptoms of either anxiety or depressive disorder relative to 36% in August 2020. These numbers indicate the toll the pandemic had on individuals. The pandemic exacerbated the highest rates of PTSD and anxiety among healthcare workers (22.8%). This rise in mental health care needs during the pandemic caused the healthcare industry and local communities to depend more on VR therapy. Overall, according to a study entitled, “Impact of the recreational use of virtual reality on physical and mental wellbeing during the Covid-19 lockdowns” an increase in VR usage during the lockdown helped keep people occupied and improved their mental health and physical wellbeing detailing that over 75% of increased VR use was for fitness, 55% for socializing and 37% for meditation. Although virtual reality treatment for mental heatlh needs to be used cautiously as not everyone can tolerate it, there are over 5,000 studies that reveal VR can diminish pain, steady nerves, and boost mental health. For example, an early study on VR and PTSD found that of 20 service members who enrolled in and completed the study treatment protocol, 75% had experienced at least a 50% reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post-treatment. Average PTSD scores decreased by 50.4%, depression scores by 46.6%, and anxiety scores by 36%.

Implications:

Originally applied to PTSD, virtual reality treatment has since been broadened to include areas such as anxiety and stress disorders, schizophrenia, autism, dementia and pain. Recent studies have shown that VR-based strategies have positive impacts and have successfully been used to manage mental health issues. For example, a literature review of 36 articles examined VR use during clinical trials and the effects it had on individuals when therapy was administered. It revealed that VR environments can help alleviate the symptoms of depression, improve cognition, and even positively impact social functioning. One study in particular examined the effect virtual reality headsets have on pain distraction during immunizations. It found that the use of the VR headsets improved those who had fears and pain in 94.1% of subjects. AR/VR therapy is also a cost-effective strategy to help individuals cope with phobias, anxiety and other underlying issues. Given the increase in PTSD cases following the pandemic, VR and AR are receiving more attention as potential treatment modalities because of their effectiveness and ease of use. This type of therapy can broaden access to care for those whose time for treatment may be limited or who can now access the treatment because of the continually declining cost of the technology. While the cost of virtual reality equipment in the early 2000s was about $25,000, VR headsets are now available for under $300. Additionally, though the decrease in cost allows for easier access by a larger population and can reduce disparities in those seeking care, it does not guarantee the quality of care. For example, researchers have reported a significant number of cases where individuals are both self-diagnosing and self-treating, leading to adverse effects.

AR and VR therapies need to be administered in a controlled environment with patients gradually introduced to the appropriate stimuli and scenarios in order to develop a proper therapeutic approach that will help them to overcome their fears. While there is solid backing for this approach, more well-designed, evidence-based research in this field is necessary. Literature reviews in this area revealed limitations in the current research and highlighted the need for future research, notably high-quality randomized controlled trials. This would allow researchers to gain important additional information related to side effects and adverse effects of the therapies. In the research process thus far, the benefits of AR and VR have produced successful results; however, there have been times when these environments were incomplete, untested, and not properly trialed by psychologists. For example, although there are many positive aspects of VR therapy, an article entitled “Virtual experience, real consequences: the potential negative emotional consequences of virtual reality gameplay” noted that there are negative emotional consequences in some VR scenarios such that users may experience vertigo, nausea, or dizziness. This is a clear indication that more research needs to be completed in the area to ensure end users derive the best experience from the technology and get the highest quality of care that can be rendered. Moreover, the process of developing and implementing VR needs to have clearer rules in place so that patients and providers can identify and report the successes, failures, and limitations of the treatment. In this way the necessary safeguards and improvements can be put in place. The importance of this is underscored by a report by Perkins Coie, which says that 68% of healthcare professionals believe that AR/VR training simulations will be the primary focus of new solutions and applications through 2022. The report highlights that the AR/VR market will be used to simulate surgical training for doctors and nurses, palliative hospice care, pain management, and 3D visualization of diseases at the molecular level. VR technology will also allow doctors to visualize and assess patients remotely to aid early diagnosis and treatment while protecting health workers from potential exposure to contagions. For AR & VR technologies to achieve these goals all necessary steps and controls for seamless integration into the clinical setting need to be considered and codified. This therapy is technologically driven and consequently sufficient initial and ongoing training needs to be provided as well as continued support and supervision to ensure that clinicians are using the technology as safely and effectively as possible.

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