What VR Will do for Psychologists: Where Startups Fit in
What Startups Could (and can’t do) in VR psychology
When I think of all the possibilities for Virtual Reality (VR), the thing that excites me most as a veteran and son of a clinical psychologist, more than all of the video games, 360 videos, and drawing tools, is what VR will do for mental health treatment. How it’s going to completely change their treatment methods for traumas and phobias and how it will even help clinicians improve their work with patients.
I sat down with Skip Rizzo, Skip has been interviewed and profiled by every publication from The New Yorker to Popular Science and one of the most well known researchers in the field of Virtual Reality and PTSD.
This week I’m publishing the last part of our conversation where Skip tells how VR programs will manifest themselves in psychology and why startups need to be careful when creating treatment programs in VR.
Are VR programs going to become a super specialty in the psychologist’s universe or will it require certifications? How do you see this developing?
SR: Yeah, that’s a good question because first off, anything you develop in VR is based on something that already works in the real world but is hard to deliver.
It’s cumbersome, the effects might not be as strong as they could be in VR so you’re already going for knowledge based and a clinical expertise level in the world. Now you have to train those clinicians how to use the technology to effectively deliver whatever treatment or assessment that they’re doing.
So there is a learning curve and I believe that training of clinicians in this area will become as important as the development of the applications. We’ve already done numerous training sessions with health care providers on how to use the Bravemind system. Because you don’t learn how to operate a piece of equipment but you’re a therapist so you have to have that entry level skill to understand prolonged exposure therapy in its traditional format before you can even begin to start messing around with the VR version.
Training for clinicians and how to use various types of equipment is a big area that will emerge as we start to get more uptake of the actual applications. Right now, we’re still in the early adopter phase. There are a lot of clinicians out there that have no idea what VR is.
I go to a psych conference and I bring a gear with me before a talk and I get up to the podium, I want to ask how many people have ever tried a VR headset? Raise your hands … the number is about 10–20% of people in the audience. So what I do is toss the gear out to the audience and have some spherical video cool thing being run and I have them actually try it. All of a sudden you see jaws drop. and then I’ll do my talk and I’ll follow up saying what you’ve been trying out there is the simulation and think about this if you’re skeptical of the value of VR in clinical applications.
“How many people have ever tried a VR headset? … the number is about 10–20% of people in the audience.”
Think about flying home from this conference. Do you want your pilot to have been certified to deal with an aircraft simulator or would you prefer they learned it from reading it out of a book or on the job training? Well, that’s what VR offers. Ways that we can help our patients by use of simulation technology to better engage in treatment or learning or rehabilitation. Things that matter for clinical care. And people start to get it but we’re still a long way from the massive psychology getting it. In fact, our naysayers are people who are technology averse. They feel that any time you bring technology into a clinical setting you’re putting a barrier between you and the client. I think that’s a foolhardy perspective but people have that view. There’s a distrust of technology. Like you’re using it so that you don’t need to have well-trained clinicians.
Can you elaborate on the VSP, the Virtual Standardized Patient? How customizable are they? What is the amount of immersion that you can provide to a clinician to help them be effective?
SR: Here’s the interesting thing with that. First off, the structure of the system is we have 40 different characters in the system that represent the full spectrum of age and ethnic background. So a 5-year-old kid, a 75-year-old African American male, a 32-year-old Hispanic female, we have a really wide range. Each character can be inflated to three different weight levels. So here you start to see why VR makes so much sense because now you have all this flexibility. Now comes the hard stuff — language-dialogue management. We can build out templates for different clinical conditions that can be put in, but we need a critical mass of expert clinical educators to go in and author stuff.
We’ve got to build the interface in a way that they can build dialogue and they can build patient standards that represent different clinical conditions. So we’re initially making an open source to partners that want to try to learn this and author cases that they’ll have some ownership of as the system evolves.
Building a toolkit that the clinicians with no computer programming expertise can operate on is as much of a challenge as building the actual human rendering and all that. So that’s where we’re at with that and the thing of it is, we’ve got a toolkit that works pretty well with expert users. Now we have to make it more useable and the way it’s delivered up to this point has been on a big TV monitor. So you got a big virtual human sitting in front of you. I mean you can do it on a laptop, you can do it so it runs on the cloud. You can do it in your dorm room. You don’t need the super high end of things, it’s more about interaction. And as people interact with these characters, and they get credible responses, it doesn’t matter if they’re on a little laptop versus a big screen as people are involved with the interaction. So interaction is a big thing, more so than immersion.
However, with that said we’ve now started to translate a number of our virtual humans and running them in the Vive and the Oculus. It’s amazing how realistic hey appear in 3D and you get an emotional reaction. I was popped in front of this hot female character and I actually felt like I was intruding on her virtual space just because that’s the way the system was initially prototyped. You popped in and you get real close to the character. So I had an emotional reaction even though I’m familiar with these characters and have seen them on big screen displays.
So, maybe there is something we can do with these headsets and in particular, if we can do it with the Gear VR at a low cost…immersive training in a way….captivating and compelling and where you’re in a higher fidelity context. So I actually turn my head and see my office rather than just looking at a patient sitting with the black background behind it. But that’s an empirical question in what our aims are here? Our aims are to improve function, improve performance, improve learning, and improve psychological help.
Cool, let me just wrap it up with one last thing.
What are you looking forward to and what do you think is going to lead to the absolute ubiquity of these devices?
SR: Let me start with what I’m looking forward to. What I’m looking forward to right now is the next major movement in VR is going to populate these virtual worlds that we’re creating with virtual people that you can have credible interactions for whatever purpose it may be.
We’ve gotten good at building virtual worlds. I mean it’s a commodity, a graduate student, an undergraduate can go and build a really cool virtual environment now. But now what do you do in those worlds? Then it becomes about the interface and the interaction. How do you better interact with the content in the virtual world? And how do you populate these worlds with virtual people that serve some purpose? And whether it’s clinical, whether it’s psychosocial interaction, whether it’s virtual sex, whatever?
The things that get me excited because I’m always looking ahead. Anybody can build this, but how can we evolve and push the limits so that we can use the technology in a more sophisticated way. So I’ll continue to do that focused on all these wide ranges of clinical applications I’ve described to you and a bunch of new ones we have under wraps right now that we’re going to start working on.
What excites me every day is the idea of doing something no one has ever done before. With VR, it’s easy earlier on because not a lot of people were working in the area. So you build a virtual classroom and test a kid with ADD and feel comfortable that you were the first person in the history of the world to ever do that. Now that everybody is using VR, and a lot of people are developing VR. So what you need to look at now are the things that really add value. And amplify the power of VR to do your objectives in more sophisticated ways. So I’m 62. I’ve got another 18 good years left in me to do this work.
Maybe we’ll have the same conversation in 2030 and it’ll be a whole different world where all this stuff will be involved, and it’ll be engaging and fun and exciting and no wall, no barriers. There’s always going to be great stuff to do to advance this work in clinical care and in all the other areas of education and journalism that I think are important, and improving psychosocial interaction and helping people to understand the value of diversity and cultures and things like that. So I think that’s great.
Now your second thing about startups was my view on startups or whatever?
I think that with you’re seeing a lot of startups pop up in the mental health in rehab space primarily in the last two years. Maybe 10 or 11 popped up looking at phobias and looking at relaxation and mindfulness training.
And some of them were good intentioned but a lot of them are really startups by people more familiar with the gaming industry than they are in this domain. And that’s problematic because it’s two different ecosystems. With gaming, if you build a cool game, people pay to play it and you’re a success. With a clinical application, it’s more than pay to play. It’s like you have to do research before you make a claim about what a system is going to do clinically. You have to show that you tested it out with the population and that it was replicated and that it had value and that it…what you could do in your office with just talk therapy.
So it’s a higher bar that you have to aspire to and you’ve also got to consider patient safety. The principle in medicine is first and foremost the principle, and the Hippocratic Oath is to do no harm. So you can’t just throw things out there and claim that it’s going to fix people and maybe even be unethical about it. Where you make it like it’s self-help when really you need a good clinician to do a proper diagnosis and to help administer treatment in a rational form. So startups that I’m involved in my role in consulting or advisory board. I have a very strict guideline for how I want it to go.
I don’t want to see things get built and sent out for a profit. That doesn’t do any good for people or even worse, harms people or gives them the illusion that VR is going to fix them rather than the actual therapy is going to fix them.
VR in terms of any of these clinical applications is a tool, it’s a technology. Technology doesn’t fix anybody. It’s how it’s used, how the clinician administers it. I agree that something can be self-help. In the fear of public speaking. Look at that as a skill builder that when you can do it in a self-help format. But certainly not PTSD, certainly not some of the other phobias, certainly not a lot of the others.
I think it’s sort of like if you don’t want to pay for a lawyer and you’re charged with a crime and you go to court and you say you’re going to defend yourself. The old adage is he who defends himself in the court of law has a fool for a lawyer and a fool for a client. I think it’s the same thing in these areas. While there’s a long history of self-help books, if you go to any bookstore, you’ll see tons of books. Well, these books might read the first chapter and it sits on a shelf.
Startups try to exclusively focus on the web and call it a clinical application, they’re going to run into a lot of trouble unless they do their legwork. With that said, I’m very excited to see the energy and enthusiasm although I do predict that there will be a bubble that will pop of wild money being thrown around at some startups that I’m shocked. I’m shocked that these investors must have money to burn and they get advice from a friend and I can just see the writing on the wall. Just as it was in 1995 and 1996 where people didn’t do their homework. The VR road was littered with the wreckage of ill-formed ideas that lost a lot of money and we’ll see that again here.
Click here to read about the current state of VR in psychology
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