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Nupur Goenka (based on an interview with Dr. Lucia Valmaggia)

'Red pill or blue pill': Virtual Reality for mental health

7 minutes read

January 07,2021

In the action/philosophical classic movie, ‘The Matrix’, Morpheus’s words to Neo describe the world of Virtual Reality (VR) rather elegantly; “Your mind makes it real”. Over the last three decades, the world of VR has taken several industries by storm. We have constructed simulated training programs for flight and space engineers to condition and prepare them before they risk their own and other’s lives in the field. We have disrupted the gaming industry so individuals can interact with fantasy worlds as if they were really in them. The last five years has even seen VR technology become cheaper and more accessible leading to accelerated research. It’s in this spirit that we consider the possibilities of Virtual Reality in mental health.

One of the core strengths of VR technology is its ability to design, construct, maintain, and manipulate a world that is entirely under your control. You can create any setting (e.g., a pub, a kitchen, a park, etc.), add avatars or characters, and define their language, behaviour, dialogue, and background noise. There are several reasons the field of mental health can benefit from this; it gives you the ability to observe different people’s reactions to the same situation, isolate social triggers, and even gradually expose a person to triggering scenarios. VR can do this within the mental safety of a world they know is virtual instead of setting off immediate trauma in someone by facing reality.

Consider an example of being in a pub where a person looks at you and then looks away – as simple as that. Based on your mental state, experiences, and history, the way you react to this might be completely different from someone else. Some may assume the person likes them, others may not give it a second thought, some who have anxious tendencies may think the person is judging them, and yet others who fall in the spectrum of paranoia may feel threatened. The point is that we’re all products of our unique life experiences so we may handle the same situation in so many different ways. By using VR technology, we can isolate and analyse the differences in these reactions.

When a person going through mental health difficulties experiences a social situation that is triggering, their threat system often gets activated. By being in this ‘heightened’ state, it is difficult to later remember the details of what happened. As accurate memory can be compromised, it may take a long time for the counsellor or therapist to understand the person’s triggers to help them cope. With VR, we can expose them to various ambiguous settings (e.g. a pub) and observe how they are reacting to manipulations of parameters (e.g. the number of people they meet, background laughter, dialogue exchanged, and so on). This can potentially allow the therapist to get a better understanding of the specific triggers the person faces and plan their therapeutic journey accordingly.

Contrary to common belief, it is not easy for someone to calm their minds and bodies down when they are experiencing a panic attack. If it were that simple, they would have likely done it a long time ago, and the attack would not have occurred. In reality, it can take a while to relax your entire system down once it’s triggered. When people face these situations, they tend to start avoiding them as much as possible (obviously). One of the things VR therapy systems can do is to put the person gently back in the setting (or a ‘minimal version’ of it) and help them learn how to deal with it rather than avoid it. We construct environments and situations that can ‘incrementally’ expose people to their triggers in a completely safe and controlled setting and, over time, work through their responses and reactions to them.

People who have more extreme reactions to social triggers can also benefit from VR therapy. In real-life, you are dealing with humans who you can’t control, and this can be risky. Suppose a person reacts very negatively to a situation and behaves ‘strangely’, then, adverse reactions from other people in that setting can set off a vicious cycle for the individual getting triggered. The idea is to help them face those scenarios in real-life by restructuring thinking patterns and teaching them how to gradually calm their threat system down.

A reason VR is growing in popularity is because it has an uncanny ability to ‘fool’ your mind into balancing mental safety with uncomfortable reality.

When you put VR goggles on, you respond to the simulation as if it were real, and at the same time, your mind ‘knows’ it’s not real. Since you ‘know’ it’s not real, it enables you to function on a level where you can still think coherently and try different strategies of coping that may not be possible for you otherwise.

One of our projects explores VR therapy for people who struggle with eating disorders such as anorexia nervosa and find it difficult to approaching places where food is prepared. We constructed a ‘cartoon’ kitchen where the individual can be gently introducted to the environment and even interact with food. We also created a ‘likeable’ little pink elephant in the kitchen so they could form a positive association with the setting. Over time, this allowed the person to expose themselves to an uncomfortable situation in a safe way. They gradually primed their minds and bodies to deal with things such as picking up and handling food to prepare for a journey of self-healing.

The VR industry has come a long way in the last 5-10 years. We’re at a point where we can realistically imagine researching and benefiting untapped fields such as Mental Health. We can even think about scaling out the access of this technology to the healthcare community across the world.

Around five years ago, it cost approximately 60,000 GBP to set up a VR lab. Today, the headsets available in the market are significantly cheaper, much easier to set up and cost anywhere between 200-300 GBP. This price point continues to be too expensive for the majority of the world; however, the cost trend is an encouraging sign and has increased accessibility, accelerated experimentation and opened doors for the general population.

Even today, it can be costly and time-consuming to design, program, and maintain a virtual world, especially when you have limited funding in a research setting. To manage this, we have developed a library of environments to keep reusing based on the project. For example, we have a street, a school, a living room, and even have different avatars for characters that come alive in the simulation. Although you can buy ready-made avatars to cut your cost, they’re usually created for the gaming world and are extremely far from resembling typical people. For this reason, we built a library of avatars that are more realistic and therefore, more useful.

Today, our project is only available to university labs, but eventually, we want to make it available to everybody in the mental health care community. We have also studied that our VR therapy is most impactful when you have a therapist guiding you through your journey. Therefore, to truly scale-out and make it accessible to people in their own homes, we have started exploring making the therapist a virtual character in the simulation itself.

There is little doubt that we can get even more creative with the applications of Virtual Reality in mental health. There is so much we can do to help those who face mental health struggles face triggering situations in real life. Perhaps it can ease us out of our comfort zones without inflicting the mental trauma that too many of us deal with. It begs the question, can fooling your mind in a simulated world actually help you confront your own reality?  

Written By
Nupur Goenka (based on an interview with Dr. Lucia Valmaggia)

Dr Lucia Valmaggia works as Reader in Clinical Psychology and Digital Mental Health at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London where she leads the Virtual Reality Lab, and she is a Consultant Clinical Psychologist at the South London and Maudsley NHS Trust. In her career to date she has conducted research, which is clinically relevant and directly applicable to the delivery of clinical services. Her work has focused on the prevention and early detection of mental health problems, in particular psychosis.
Twitter: @Lucia_Valmaggia

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