This is a virtual reality
exposure therapy session for treating PTSD.
It's an immersive experience designed to help patients
confront trauma from conflict zones.
Virtual reality is, in my field,
a psychologist's dream to be able to build
simulated environments, put people in,
observe how they respond,
help them to respond differently
to support their therapeutic goals.
That's the essence of why we do therapy
or human research.
And this field,
known as clinical virtual reality, is growing.
Challenging popular preconceptions of VR
as a novel gaming device to include advanced medical
and psychological treatments.
It's being used for conditions ranging
from dementia to chronic pain,
as well as providing training
and remote health care sessions.
You know what's amazing about VR,
unlike any other audio visual medium ever created,
is how emotionally provocative it is.
Because our brain was never designed
to live in two realities at once.
Like that's not evolutionarily required of us.
We just accept the reality that we're given.
And so in VR,
you feel your brain believes that it is physically present
in some other world.
And that generates strong emotions.
Over the last five years,
we've probably had several million people
who've used virtual environments for addressing pain,
for learning social skills
if they're on the autism spectrum to improve their mood
and to help address social anxiety disorders.
So after years of intrepid research
and positive results,
can clinical virtual reality become a mainstream component
of modern healthcare?
Okay, I'm just going to make some things happen.
I'm gonna set off some--
Dr. Skip Rizzo is a psychologist
who's been working on clinical virtual reality
for the last 25 years.
Prior to getting mixed up with virtual reality,
in the mid-nineties, I was a clinical psychologist,
and I was primarily working in brain injury
and doing some work with anxiety disorders.
I got frustrated with the lack of technology
that could be usefully applied in the clinical areas.
And when I found out about virtual reality,
it just made so much sense to me.
We could build real world environments
that we could immerse people in,
and we could systematically control the stimulation
or the stimuli in the environment.
That to me was just an incredible opportunity
for not only testing or training or rehabilitating
function in functionally relevant environments,
but we can also maybe introduce gaming factors
into it so that we can enhance motivation.
One of the main areas where VR
has been found to be clinically effective
is in helping treat anxiety disorders and PTSD,
using VR for exposure therapy.
Exposure therapy helps a patient to confront
and reprocess trauma in a safe environment
until the symptoms connected with the trauma are reduced.
Existing strategies include imagining
or repeating the experience in real life.
The treatment of post-traumatic stress disorder
in virtual reality follows the exact procedures
of the evidence-based traditional approach,
except we're putting people in VR simulations
of what they were traumatized by
or what they've been having difficult experiences with.
We have the visuals, we have really good audio,
we also have vibration stimuli that makes it
so you feel like you're driving a Humvee,
you're feeling the vibration.
And we also use the sense of smell
where we can pop little scents into the experience
that are reminiscent of what that world would be like,
diesel fuel, gunpowder,
and all of these sensory modalities create the experience
of being back in the situation in a more realistic way.
Since 2005, Dr. Rizzo has led
the Bravemind Project,
a VR therapy program that helps veterans with combat
and sexual assault related PTSD.
So you put the headset on them,
you put them in this environment,
and you have it at a very low level
so that they can still feel comfortable,
but they know they're getting towards confronting
the challenges that they've been avoiding
or traumatized by.
Then you ask them to recount their trauma
as if they're experiencing it right now.
And so, speak out loud.
I'm driving down a roadway and heading towards Fallujah
in a Humvee and I'm talking to my best friend,
and all of a sudden I see somebody up ahead on the road
and they have a cell phone and an IED blows up
the side of our vehicle.
And so, they start to talk about what they went through.
But meanwhile, the clinician has the capacity
to make the VR world reflect what they're saying.
So in real time, we can make that IED go off.
And so, by doing that repeatedly,
and then systematically making it
more challenging over time,
you're helping them to confront and reprocess
the difficult emotional memories
from their traumatic experience in a way
that actually leads to reductions in the core PTSD symptoms.
The science is, you know, science is never complete.
It's always growing and evolving,
and we're learning new things every time we run a study,
but we can stand pretty strong here in saying
that the use of VR to deliver these kinds of treatment
does have sufficient evidence for its clinical application.
Now, Bravemind is being used
at more than a hundred military bases,
hospitals, and other sites.
And it's proven popular.
People, from our research anyway,
are more attracted to VR
and if they see VR as part of the therapeutic process,
they have more of an interest in seeking help with VR.
We've documented this with PTSD,
where we asked the veterans at the start of a study,
if you had your choice between the traditional therapy
or the VR therapy, which would you pick?
77% picked VR.
One of the early developers of VR
for healthcare is Dr. Walter Greenleaf,
a research scientist and behavioral neuroscientist
working at Stanford University's
virtual human interaction lab.
When I first got involved in working
with virtual reality technology several decades ago,
the systems were exciting,
but they're very different than what we have right now.
The computers that were used were Silicon graphic machines,
and they were the size of a small refrigerator
and cost more than half a million dollars.
For a long time, virtual reality technology
was viewed as scientifically inappropriate approach,
that it was gaming, it was entertainment,
it was something from science fiction
and not quite here yet.
And that's sort of caused some people to think
it was inappropriate, that medicine needs to be
much more serious
and the reality is
these are very powerful tools
and we could see the potential.
So the digital health revolution has been moving along
really for several decades,
but it's now just surging forward.
And VR is one of the key components to it.
It's very exciting for me to see that we're finally
at a point of time where the enabling technology
is both more comfortable, very powerful and affordable.
What I'm most excited about is seeing
how virtual environments could be used to address
some very difficult problems
that we haven't had as effective tools as we had like,
such as neuro rehabilitation
and cognitive rehabilitation.
The ability to capture movement dynamically,
to be able to build beautiful environments
that motivate a user to do the difficult task
of recovering from a traumatic brain injury
or from a stroke.
Systems are also being designed
for friends and family to join the patient
during their VR experience.
And Dr. Greenleaf hopes these multi-user experiences
could be developed further to create virtual support groups.
Virtual environments will allow us a very amazing way
to connect patients, not just with the clinical ecosystem,
but with each other.
We can have a person be in a multi-user virtual environment,
but show up anonymously as an avatar.
So that allows us in a very comfortable way
to have support groups.
So for people who might be struggling with addictions.
Not only can we use the virtual environments
as a way to teach them situational confidence
and learn refusal skills and learn to get on top
of their cravings and resist peer pressure,
it also allows them to connect with other people
who are addressing the same challenge
and share their stories.
And for someone who might be in a small town
or who's very concerned about privacy,
being able to get the sort of support in an anonymous manner
that's protected is going be so important.
Hey Doc.
Yeah, I didn't know anything about virtual reality
until about six years ago
when a guy named Walter Greenleaf came to my lab,
and he said we have this thing called VR, check it out.
Dr. Brennan Spiegel has been developing
VR treatments after experiencing the power
of virtual reality firsthand.
I realized VR has this incredible uncanny ability
to nudge the human brain into believing things
that seem fantastical or impossible.
And while it could be used for entertainment or for gaming,
it also could be used to support human health
in ways that we've been discovering ever since then.
Now, Dr. Spiegel and his team research
and administer clinical VR tools
targeting pain management.
We've treated now over 3,000 patients
with VR for both acute pain and for chronic pain.
So you imagine, for example,
somebody who's undergone an operation
for a bone fracture or anything,
and they're in the post-op area experiencing pain.
And the first reaction is to reach for medications,
but sometimes, you know, we realize we have a pharmacy
in our own body.
We have natural opioids coursing through our body.
And if we had a way to deploy those opioids,
those painkillers that we have in our spinal cord
without having to always reach for another opioid,
that's what we recognize as an opportunity.
You know, when we first started using VR,
we found that over 80% of our patients
found it positive or beneficial.
If I had a pill where 80% of the people right off the bat
felt a positive experience,
that would be an absolute blockbuster drug.
Dr. Spiegel's patient,
former Air Force Colonel Tom Norris,
has suffered from chronic pain for over 30 years
and has had positive results through VR treatment.
Tom puts on the VR headset and is then immersed
in a virtual reality environment
that both distracts him from his pain
and teaches him useful coping tools.
The first time I used VR,
I was initially taken aback because you're enclosed
in a black environment.
Then when they started doing the breathing exercises,
which I believe was one of the first things,
they had included on the headset
a sensor to measure your exhalation and your inhalation.
And the application showed the breathing process
as little tiny motes of light.
And I got entrapped, basically,
by the scene
and the ability to see my breath in motion.
It sucked me right in, to be honest.
When you see your breath in motion,
and then you see an effect caused by the motion
of your breath, you know, in this case,
it would be a tree would bloom or colors would change,
it reinforces the idea that something positive happens
when you breathe in a VR situation.
It works.
I mean, there's no question about it.
You can see it in the body expression.
You can see it in the breathing rate.
You can see somebody just sort of relax into bed
and their blood pressure drops,
their breathing rate slows, their heart rate slows
and they're having a physiologic response,
not just a cognitive response,
but a physiologic full body reaction
to being in the virtual reality.
But while VR has been a successful tool
for this patient,
Dr. Spiegel doesn't want people to develop dependencies
on virtual environments.
No, we don't want people to live
in virtual reality forever.
You know, we don't want people to have to keep reaching
for VR the way they might have to reach for,
let's say a pain pill.
Because eventually, people will get bored
of being in virtual reality
or be so familiar with the worlds that they're in.
When VR is effective, it's actually teaching people
about their mind and body
and the connection between the two.
VR is effective when we're training people
how to live in a real reality or RR more effectively
to have a richer experience in the real world.
There are also questions about how VR
will fit in with existing healthcare systems.
I'm sure there are some people that are concerned
that the use of virtual environments in medicine
will displace or replace the need for us
to have clinicians involved, and that's not going to happen.
It's gonna be a very powerful tool to extend their reach
and extend their abilities to help their patients.
If we design our systems right,
it should also save them time.
I think that's something we have to be careful with
as we roll out this next wave of technology
there is an existing medical ecosystem
and anytime you bring something new into it,
you need to make sure that it reduces costs
and makes things a little bit smoother
and a little bit easier.
At this point, I don't think we need more science.
What we really need is insurance companies
to recognize the benefits of VR and to pay for it.
We need to train more clinicians
in how to use virtual reality.
We need to come up with the protocols and procedures
for how to deliver this new treatment to patients,
both in the hospital and as outpatients.
And that's what our team is working on
is how to actually implement virtual reality
as a new branch of medicine.
We know that there are a lot of people
that have challenges in terms of mental illness
that, you know, will never seek therapy.
I think the World Health Organization has estimated
about 600 million people have mental health conditions
on the planet right now,
of which, fully two thirds will never see
the inside of a therapy office.
Can we use technology to get them in there
to get care to them in a way
where they can get over these challenges
that have limited what they can do in everyday life
and to make their life more meaningful?
So that's a very exciting prospect
as we move into the future.