Virtual reality: transforming the delivery of psychology therapy

Today's guest blogger is Poppy Brown, who was awarded the John Grace QC PhD Scholarship in 2017. Her research is being carried out at theDepartment of Psychiatry, University of Oxford. She's investigating the use of virtual reality to help patients with persecutory delusions who struggle in social situations.

Difficulties interacting with the world lie at the heart of many mental health problems. A key goal of psychological therapy is to help people to get back to doing everyday activities, reducing avoidance of places and people due to anxiety.

The most successful therapeutic interventions help people to modify the way they think, react, and behave in the real-world situations they find challenging. But achieving this while sitting face to face in a small therapy room isn’t easy.

We tend to remember information best when our physical and mental state is the same at time of learning and recall. This is known as state dependent learning. The implication is that if we want someone to remember a psychological technique that will help, for example, to reduce their anxiety while out supermarket shopping, it is generally best to actually visit a supermarket during the therapy session in order to train the technique.

Such active, ‘in-situ’, coaching rarely happens in mental health services. There is simply not the time or the money. It is here where virtual reality (VR) can help.

VR consists of a computer-generated image, a display system that presents the necessary sensory information, and a tracker that gives feedback on the user’s movement in order to update the image. In VR, everyday environments and situations can be simulated, allowing individuals to repeatedly experience the situations that they find difficult. The virtual environments are life sized, allowing you to walk around and interact with the environment as if it were real. While in VR, individuals can learn how to overcome their difficulties using evidence based psychological treatments. This overcomes the practical challenge of physically getting out to the required real-world scenario during therapy. This is one of many advantages of VR.

Further advantages of VR

1. Individuals are more willing to enter virtual scenarios they find scary or difficult because they know it is only a simulation. It is easier to try things out that are too scary or perhaps too embarrassing to try in the real world.

2. It feels real. Although we know the environment is just a simulation, we nonetheless respond psychologically, emotionally, and physiologically the same in VR as we do in the corresponding real-world environment. Take a moment to think about something you find anxiety provoking. How easy or difficult do you expect you’d find a VR scenario of your fear?

3. Learning made in VR transfers to the real world. In one study of 30 patients with persecutory delusions (a severe paranoid belief), fear of real-world social situations halved after a single VR coaching session.

4. Scenarios can be graded in difficulty, and even personalised. For someone who fears walking through crowds, for example, they could start by entering a virtual street with just one or two other people (avatars). Following this, the number of people around them could be gradually increased.

5. Tight control of scenarios. Unlike in the real world, in VR we can control exactly what happens in a scenario, including how the avatars behave and respond to the user.

6. Automation: scalability and access. Perhaps the most significant advantage of VR therapies is that they can be automated. This means that in VR with you there can be a virtual coach who explains the therapy to you and encourages you. They suggest options to try out and practise. While there is also someone physically in the room with the user for additional support and guidance, this person can be a graduate psychologist or peer supporter rather than a highly trained psychological therapist. As a result, VR therapy is cheaper to deliver and far more people could have access to it.

Continuous hardware improvements mean it’s becoming increasingly affordable and feasible to make use of VR technology in services for the treatment of a range of mental health problems. While the technology would never replace therapists, it could drastically alter the number of people able to access therapy.