Embodied Therapy in Virtual Reality
An interview with Rachel Xu, the Co-founder and CEO of Curalens.ai, by Akhila Khanna.
When many young adults were deciding between colleges and summer internships, Rachel Xu strapped on her VR headset. She began dreaming up Curalens — a virtual island where a therapeutic journey between mental health practitioners and their clients can begin.
Akhila Khanna, an MA Drama Therapy candidate at New York University interviewed Rachel Xu, the Co-founder and CEO of Curalens, to understand how immersive technology can bring alive embodied therapeutic techniques. In this in-depth interview, Rachel shares her struggle with mental health, her love for technology, her apprehensions and excitement about VR and the raging fire in her belly that keeps her innovating in the face of the unknown.
A: Why Virtual Reality (VR)?
R: Two years ago, I was working for a few VC firms where I was researching VR and its applications across disciplines like training, education, traveling and even real estate. I found it to be so multifunctional! Unlike a phone, which is two-dimensional, VR is three-dimensional. You walk into a virtual parallel world where you can achieve the same or even greater effects than in the real world. You can never walk on water or fly in the real world, but you can in VR. You can achieve that second layer of what even the human imagination cannot do. This is what inspired the idea behind Curalens — to enable a mechanism that is imaginative, creative and at the same time, therapeutic.
When I did my own user research, studied programs on VR, and attempted gaming tools like Unreal Engine, I became even more curious: how can VR bridge the gap between possibility and impossibility? At the onset of the pandemic this question took on a heightened meaning — how can VR virtualize settings that depend on in-person, experiential interactions?
A: When you realized the imaginative and creative potential of VR, why did you choose to integrate it with therapy?
R: A few years ago when I was going through a difficult time in my personal life, I connected with Diana Chu, a licensed drama therapist and now the co-founder of Curalens. I remember we were traveling on a bus and there were a lot of distractions around us. She told me to close my eyes and guided me through a meditative drama therapy exercise. I felt something in me shift.
I had experienced other therapy techniques before like Cognitive Behavioral Therapy (CBT). The CBT therapist asked questions like “How was your day today? Rate it on a scale of 1–10.” It felt like the therapist was checking a list off, telling me to do exercises at home, and not building a personal relationship. Ultimately I felt like not going to therapy because answering a checklist felt stressful and I’d much rather talk to friends and family. Also, while only talking about my problems in therapy I felt I was intellectualizing my answers rather than allowing myself to feel changed by them. There is a difference between realizing a feeling and internalizing it.
Drama Therapy exercises made mental health not only personable and fun but also made me feel my feelings in a way no other therapy experience had (fun fact: I have no performing arts background!). This inspired me to explore the accessibility of techniques like Drama Therapy and CBT in a technologically creative and active way.
A: How do you create that embodiment or activation within a virtual landscape?
R: Let’s take an example. In an in-person session a drama therapist might have you revisit moments from your childhood by role-playing interventions with you. The act of reflecting on your past with a stranger in the room can often feel difficult, distanced, awkward and impersonal. Even if you are being asked to explore those moments in an embodied or metaphorical manner, many of us who are self-conscious and/or not used to the symbolic language of Drama Therapy, can feel resistance.
Through VR we can instead create a virtual time machine, where in a gamified way, clients — let’s call them users — can immerse themselves into their past moments. In VR, users embody their own transformations in an environment which they have control over. When they wear the VR headsets, they cannot see themselves being witnessed (or judged) by the physical presence of someone else. They are immediately transported into a reality that is not limited to their therapists’ office. This can open up a window into their imagination and subconscious, which can eventually be more effective and revealing in the treatment process than in-person therapy.
A: You mentioned control, how does VR enable the user/client to experience this agency?
R: Imagine a therapist asks you — “What were some positive thoughts that you had today?” It might be difficult to think of thoughts right away. Even if you do, as I mentioned earlier, you may struggle to internalize it. You might say, “I felt strong,” but you are unable to accept or live this thought on a daily basis. VR bridges the distance between ‘realizing’ a thought and ‘internalizing’ it by providing agency to the viewer to fully embody their thought. You can enter into the happenings of your day (through the virtual time machine) and then be prompted: “What did your wise-self say to you today?” Through VR you can record the answer of your positive thoughts: i.e “I am strong.” That thought will then figuratively grow into a thought bubble on a blossom tree. The user can even walk into their thought bubbles if they’d like! With more such prompts the user will be surrounded by blossom trees in a garden that they have grown through their positive thoughts. The scene ends with the thought bubbles forming into a seed that the user can actually put into their pocket.
The blossom garden is one of many visual metaphors that users can engage with to remind them of their own resilience. We want the user to understand that when you plant your positive thoughts, it can grow into a garden. You can spend a lot of time in this garden and cherish it forever because you have built it with your own positivity.
The effects of growing a thought bubble into a blossom tree, figuratively walking into it, and then transforming that thought into a seed, can only be achieved in the virtual world. When the user is in their thought bubble, the AI prompts them to meditate by replaying their own voice recording back to them i.e “I am strong”. The visual, vocal and explorative choices within the virtual landscape are all figurative ways for the user to internalize and take ownership of their actions.
A: Is VR then a tool to be used by therapists in their sessions or can it be used independently?
R: We see value in a therapist guiding a user through this experience because otherwise everyone will be immersed in their own virtual worlds! To start off, we want to equip therapists with a VR headset and introduce them to the various effects like walking into a thought bubble, growing a bubble etc. We want to educate mental health practitioners with the cognitive and behavioral benefits of integrating psychology built through the arts with technology.
Ultimately in the future, when VR is widely available for everyone we want to offer therapists and clients the possibility of actually meeting on a virtual therapy island instead of meeting in-person. There will still be a personal connection to your therapist, except that they will be entering into a world with you and treating you inside VR.
A: So, two people would put on their own headsets and meet in the same virtual space?
R: Yes exactly! That’s going to be completely different from going to your therapist’s office, which can feel stressful or limiting. Sometimes when clients wait outside a therapy room they have to collect themselves before stepping into their session. Through the immersive music and meditative visuals in VR we are trying to calm the user down as soon as they enter the therapy island.
A: VR is still quite new for many. What makes you believe it will be widely adopted in the future?
R: Using VR right now is like getting used to a smart phone when it was first introduced. There is a learning curve, but the more we use it, we will understand the user flow and its explorative choices.
When we first used the phone it was heavy, expensive and had mostly gaming applications. Over the years it became portable, affordable and useful for texting, calling and social networking. It’s the same with VR. Earlier people were not buying VR sets because they were too expensive — around 500$ — but now the cheapest VR set is 200$. Five years ago the VR headset that I have today was ten times bigger and in a few years it might even shrink to the size of goggles! A couple of years ago VR was only used in video games and now it’s being integrated into social media on the Oculus application store. Current trends demonstrate that VR could replace smart phones in the next three-to-five years, which is our estimated timeline for launching Curalens.
Infact, Covid-19 has accelerated our speed of research and development. With less and less social gatherings continuing to happen, how can we feel more connected to ourselves and others? No single technology is supposed to last forever. Even currencies don’t exist forever. I really believe that VR will be the heir of mobile phones because it’s more advanced, more immersive, more real and answers directly to the needs of our time.
A: Do you have any apprehensions about using VR for a therapeutic purpose?
R: Yes, of course I do. The danger of VR on the human psyche hasn’t been explored enough. Physiologically, being in VR for too long can cause an eye strain. You can feel dizzy when you come out of it because of the current weight of the headset. Many of the psychological effects, however, remain unknown. When you are in VR, you might get really addicted and excited. When you get out of it, there could be withdrawal symptoms from the rush of high-to-low. This is why we are partnering with universities who do comprehensive research pre and post launch, led by Dr. Nisha Sajnani — the director of Drama Therapy at New York University. These are the initiatives we are trying to do right now rather than quickly launching on the market.
A: How else are you planning on tackling the ethical implications of integrating technology with mental health?
R: Along with our research and partnership with universities, we are ensuring that we are abiding to all HIPAA (Health Insurance Portability and Accountability Act) guidelines. There are currently eighteen protocols that ensure the safety of a client. We are planning to add one more regarding how we disguise a user’s voice. Along with de-identifying every single user we have, there will be a way to de-identify their voice recognition as the AI will be recording their voices.
We are also extremely strict in terms of who joins the Curalens team. Everyone who we bring in is a very empathetic, mission-driven, compassionate, mental health advocate. Even with VCs who we are bringing into the fundraising round — we are ensuring that they truly love what we are doing instead of thinking of Curalens as only a money-making venture.
A: What inspired you to address the need in the mental healthcare sector specifically?
R: Honestly, my childhood. I grew up in China where the culture and government policy around mental health was and continues to be unimaginable. Mental health is still perceived as a “myth,” and people who are experiencing mental instability are labelled “crazy.” In school when children would self-harm, teachers would send them back home because they were scared their behavior would influence other students.
This is not only a China problem though. When I came to the U.S. I personally tried school therapy, private practitioners and online platforms like Betterhelp. Each time, finding a therapist was very difficult (and I belong to the upper class bracket!). Therapists were either too busy, too expensive or not wanting to connect with me at a deeper level. The more I researched, I realized that the mental health care support for people who are struggling is still so insufficient. Universities like Stanford, Harvard or Berkeley only have an average of 27 therapists responding to 20K students. Imagine what the situation is like at public schools that have 40K students?
Looking at the wealth disparity it’s clear that the mental health support worldwide is not enough, even in flourishing countries like the U.S.A. That’s where technology can democratize the process. There aren’t enough therapists out there but there are a lot of people who need therapy. Once the technology for Curalens is developed, I would like to donate our headsets to people in East Asian countries because I know that is where the need is the greatest.
Our investors also recognize this need. A lot of VC firms in the U.S. have mental health as their theme this year. It’s encouraging that money-driven people believe mental health-technology is a promising industry. This came to my surprise. I guess as the world is becoming more tech-driven, the solutions to our problems also need to be.
A: Where does your entrepreneurial spirit come from?
R: I wrote this in one of my journals recently. I grew up in a very entrepreneurial and explorative household. My mother never went to school, not even kindergarten, but after years of hard work she is now the CEO of a senior centre in China. She cannot read, and sometimes you cannot even communicate with her, but that doesn’t stop her from leading this huge company. Everyday when I talk to her she tells me (in her very innocent way) to always do good to humanity. That’s the mindset she has ingrained in me. Having a mother who is uneducated yet so mission and humanity-driven has been a big part of my growing-up. She is so focused on providing the elders in her senior centre with better quality food, shelter and care. This job fills her life with joy and meaning. With Curalens, I feel I too can live out my purpose.
A: Finally, what are three words you would use to sum up your relationship with Curalens right now?
R: Grateful — I interact with people so much more than just the technology. With so many hate-crimes happening in the world right now I feel very grateful that I get to work with compassionate and like-minded people who want to do good in the world.
Explorative — This is my first start-up and having such a diverse team who want to chase this impactful opportunity together is very exciting.
Advantageous — I personally love when there is innovation involved because then I don’t know what’s going to happen. Life is too boring if I know what is going to happen. To be part of a larger community chasing the unknown and making that a better unknown is very advantageous for everyone involved.
Written by Akhila Khanna, an MA Drama Therapy candidate at New York University. She currently designs and facilitates theatre-based interventions for corporates, non-profits, schools and universities in India, the U.S and Canada. You can read more about her work on her blog!