Seven ways that VR could help fight depression
A paper published last month provides new perspectives.
An estimated 10% of the European population is experiencing clinical depression right now. Less than half will ever seek help, and those who do run a high risk of not receiving optimal treatment. There are many ways to combat depression. Arguably, the most important is extending accessibility to evidence-based face-to-face or digital psychological interventions. Instead, there is an over-reliance on sub optimal pharmacological interventions that up to one third of those suffering are not even open to trying.
Since the number of available therapists is limited, clinicians, scientists and developers are coming up with clever ways of using digital technology to bridge the mental health treatment gap. Decades of research have shown that Virtual Reality (VR) technology can be incredibly useful in many areas of mental healthcare.
Yet, despite the abundance of websites, smartphone apps and other digital tools aimed at depression, there have been very few attempts to develop antidepressive VR-applications. What unique opportunities does this technology bring for developing new ways of helping those who suffer from depression? A paper published earlier this month in Frontiers in Psychiatry identified seven ways forward.
1. Improve the learning journey
Almost all psycho-therapeutic techniques require education. In its most basic use case, VR can be used as a medium to provide more effective education about the disorder itself and the treatment plan. At the very least, the patient needs to have the symptoms and therapeutic method explained in such a way that they understand the plan and rationale behind the treatment. Improving psycho-education can, in turn, improve the effectiveness of the treatment, as well as motivation and patient compliance.
VR is a powerful educational tool for many reasons. Notice how effortless it is to remember concrete things and places you have been in contact with, rather than abstract things like words. The illusion of reality created by VR lets the brain interpret virtual objects and situations as physical. In turn, reducing the effort required to learn new information.
Learning can also benefit from VR’s ability to reward and reinforce learning. For instance, when learners do well, instead of giving them a badge in the form of an icon on the screen, VR can make it feel like they received a real item. Think of it as gamification on steroids.
2. Get moving through virtual sports
Physical exercise is a proven way to improve mental health. “Get more exercise” may sound very trivial to those who don’t know its importance, but several large-scale trials have demonstrated that physical activity can treat depression.
Exercise triggers a biological cascade of feel-good effects in your body, contributing to brain function and health. Exercise also makes it easy to take one’s mind off worries, at least for a while. When it becomes a habit, it can also contribute to increased confidence, as we see visible improvement in what we can physically do with our bodies.
VR could make it easier to sustain these positive changes over time since it can make exercise more fun and motivating. One of the things VR can do is compel the user to move around. Some of the most popular VR games are physically demanding, and people have reported losing weight and getting fit from regularly playing them.
3. Fight loneliness with virtual meetings
When a person is depressed, they tend to withdraw from social life and activities. When trying to treat depression, encouraging the person receiving treatment to get out and meet people is important. VR has been vilified as a solitary and isolating technology, but many possibilities for meaningful social gatherings and activities do exist in VR.
In fact social apps are some of the most popular. Rec Room, for example, is a kind of virtual country club where users engage socially and compete in physical games like disc golf, boxing and basketball. Another app called VR Chat has millions of users and a video illustrating its potential to fight loneliness went viral last year. Facebook is also working on their own social VR world called Facebook Horizon and Mark Zuckerberg has stated that VR will be “the most social platform ever”.
VR enables meetings between people with a fidelity not possible before. It incorporates perceptual cues and interactions that are lost through video or other modes of communication. With VR, you actually feel like you are in the same room as the people you speak with.
Social isolation is detrimental to mental health and can contribute to depression. When treating depression, finding ways to mitigate social isolation is critical. Establishing an online social life and social interaction through VR could be a stepping stone towards getting out and feeling better in real life. What’s more, many apps combine physical exercise and social interaction, potentially compounding the positive effects.
4. Train social skills in virtual worlds
Good social skills is one factor that obviously can contribute towards improving social interactions, both in the real world and virtual life. The opposite is also true, a lack of social skills might, in fact, hold a person back from social interactions, increase isolation and increase depression. To improve, one can get social skills training, a generic cognitive behavioral therapy technique. It conceptualizes everyday social behaviors as skills to be taught, practiced, and implemented in order to live a more functional and fulfilling life.
A number of VR applications to train social skills, particularly through interactions with “virtual humans”, are already established. A VR app for training social skills on virtual humans that “feel like the real thing” could be a safe, cheap and powerful way for the patient to develop skills needed to get out of depression, and could be offered alongside other interventions.
5. Build scenarios for cognitive restructuring
Cognitive restructuring is a kind of psychological therapy that has been proven useful when treating depression. Usually, a person who is depressed has distressing and intrusive negative memories or thoughts. Alleviating the weight of those memories is one way of coming to terms with depression. In one therapeutic technique the patient is asked to imagine difficult past or fictional situations, and find solutions for resolving them. These solutions are then rehearsed mentally. This creates new, less disturbing memories that are easier to cope with.
In a variation of this technique, the patient can instead be tasked with imagining the outcome of a positive scenario. Visualizing the positive experience associated with different hypothetical future events helps shift cognition, and can reduce symptoms of depression.
These methods, however, relies heavily on clients’ ability to imagine different situations. One problem is that people’s capacity to imagine themselves in different situations varies greatly. When asked to close their eyes and imagine a specific situation or object, for instance, many find the task impossible. Their inner eye is blind.
VR is a great visualization tool, and could be used to help patients construct and manipulate negative and positive scenarios. Developing a VR-assisted tool for cognitive restructuring is certainly complex, but entirely possible. By helping users realize their thoughts and cognition by actually living through and experiencing these situations, rather than only imagining them, such a tool would make it easier to make imaginary scenarios come to life, conduct correct appraisal, and reduce the effects of negative memories and thoughts on mental health.
6. Develop a new sense of self through avatars
Cognition is embodied: the body we inhabit affects our thinking. An exciting line of scientific investigation explores the therapeutic effects of embodiment. In VR the user can be like the Greek god Proteus: they can change the shape of their own body. Researchers have noted changes in behavior and cognition when a person’s own avatar (their virtual body) is changed or transformed. This is known as the Proteus effect, and could be put to use against depression.
In one experiment, depressed patients found themselves in a VR environment where they were tasked to comfort a crying child, while “embodied” as an adult avatar. Their motion and voice while they comforted the baby was captured. Then, as a second step, their perspective switched so that they inhabited the body of the child, and experienced the motions and words of comfort they had themselves provided. This exercise led to decreased self-critical thoughts and a reduction in symptoms of depression. Why this happens is not clear, but one leading hypothesis is that the change in perspective itself enables better empathy. As the patient switches perspective, they come to perceive themselves as both able to comfort, and able to receive and accept comfort from another.
There could be many novel ways of leveraging the Proteus effect in VR. For one, the paper proposed a VR depression treatment variation of the Avatar therapy technique used to treat psychosis. The idea is to have a patient inhabit one virtual body, and share their own depressive, self-critical and negative thoughts to a virtual human sitting next to them. Then, they would be placed in the body of that listener, and hear their own words and voice played back from that perspective. This exercise could make it easier to externalise negative thoughts and look at them objectively, with the effect of correcting erroneous and depressive thinking.
7. Care for virtual plants and pets for better mental health
Treating depression is not only about removing negatives feelings (e.g sadness, fatigue and hopelessness), but should also aim to increase positive feelings. In combination with the aforementioned techniques, the paper also states that it would be appropriate to use VR for what fans of the technology already know is possible: create pleasurable experiences.
Games in general are pleasurable, but beyond the pure experience of “fun” that different games provide to different people, certain types of games may be more generally suitable for the treatment of depression. In particular, the paper proposes a VR variant of gardening therapy: a game where the user is invited to tend a virtual garden. This could potentially bring the combined benefits of physical activity, caring for living things (which creates a sense of meaning and agency) and being surrounded by nature, all of which have positive mental health impact. Similarly, they point to animal-assisted therapy in virtual worlds as another avenue to investigate. Could virtual pets have the same therapeutic effect as real ones?
Towards new treatments of depression with VR
Education, visualization and training are typical uses of VR, and all play a fairly straightforward role in the treatment of depression. However, VR could also contribute in new and largely unexplored ways, such as working with the Proteus effect or exploring brand new ideas such as therapeutic gardening or pet keeping.
Evidence suggests that smartphone apps and websites, with or without guidance by a therapist, can work as a treatment for depression. Personally, I bet that VR based interventions will evolve to have a big place in the fight against depression, perhaps more so than any prior technology. And I suspect that the ultimate design and application of VR for depression might not even be imagined yet, perhaps synergising with other technology like brain sensors, AI and virtual humans.
For researchers, developers and all other stakeholders, there are clearly plenty of avenues left to explore and develop before VR becomes the platform where the hundreds of millions of people who suffer from depression finally receive effective treatment.
This was a summary of a peer reviewed perspectives article published in Frontiers in psychiatry, if you wish to read the full text, It’s available for free here.
