Experts ‘cautiously optimistic’ about extended reality for mental health care

At Thursday’s vMed 2023 conference hosted by Cedars-Sinai Medical Center in Los Angeles, speakers discussed the place of extended medical reality in mental health care and the risks and benefits associated with treating mental health in the metaverse.

“I completed a 200-page report for the European Commission, and they wanted to know what the opportunities and challenges are as we move from virtual reality to XR health to the metaverse,” said Dr. Brenda Wiederhold, clinical psychologist and co-founder of Virtual Reality Medical Center.

“I am optimistic, but I will say that I am cautiously optimistic. We need a little supervision. We can’t let tech companies watch themselves all the time. I’m not a big government man, but I think we have to put some rules in place. »

The future of medical extended reality (medical XR) must build on the successes and failures of the past to realistically move forward, Wiederhold said.

” We put [anxiety] patients in the environment. We have them confront what they are afraid of, change that physiological response, that cognitive response, confront them with those emotions, and then have them change their behavior so that they can translate that and no longer have that fear or that phobia in the framework of the real world,” she says.

The virtual reality experience differs for each individual, meaning the emotional processing by patients using the modality will vary, as will individualized long-term effectiveness.

“It’s fine if you learn something in VR, but if you don’t use it in the real world, it’s not that great,” Wiederhold said.

Yet VR is a tool that providers can use, not a replacement for the provider. Specifically, studies have shown the benefits of virtual reality as a behavioral activation modality, a mental health approach that focuses on treating depression by understanding how behaviors influence emotions.

Dr. Margot Paul, postdoctoral researcher in psychiatry at the University Stanford School of Medicine, described how she and her Stanford colleagues investigated the feasibility and clinical significance of virtual reality as an intervention for major depressive disorder.

“My study was done during the COVID pandemic, where people couldn’t go out and do things they would normally want to do,” Paul said. “So if people could engage in enjoyable activities, things that gave them a sense of pleasure, but just in virtual reality, could that elicit the same mood responses as doing those activities in real life? life?”

Early results proved virtual reality to be clinically meaningful and feasible to reduce participants’ major depressive disorder. Paul has since expanded the scope of the ongoing study.

Beyond efficiency, virtual reality can improve access to mental health treatment when there is a need more mental health care providers, said Skip Rizzo, psychologist and director of medical virtual reality at the University of Southern California’s Institute for Creative Technologies.

“We’re going to see a lot of how virtual reality makes a difference in terms of measurable gains with our clinical populations, but I want to focus on removing barriers to care,” Rizzo said.

Rizzo highlighted the 25 years of science behind the use of virtual reality in mental health care, showing that modality alongside health care providers can make a difference in care outcomes. Yet he highlighted access to mental health care that uses virtual reality is difficult.

Clinicians are essential to introduce the option of VR therapy to patients for widespread adoption, but there is a need for medical providers to be trained in the use of VR for mental health care.

“You don’t see that in graduate schools, you don’t see specific courses, maybe there are a few…but it needs to be a standardized thing for young clinicians in all areas of healthcare have training and familiarity, not just with the clinical stuff, but how to use a helmet and where to get it,” Rizzo said.

Virtual reality should appeal to both providers and patients, but simultaneously solidify the relationship between patient and provider.

“The metaverse has value in making care available: first hide behind the avatar and talk to people who have the same problems as you, or to a clinician. Reduce stigma and [it’s] maybe a solid thing for direct clinical care, making it accessible and available to more people,” Rizzo said.

“Yet we must remember that a good part of the effect size and clinical benefit comes from the therapeutic alliance with a human being.”

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