Two perspectives: Virtual Reality to help treat depression

In the middle of February the British Journal of Psychology released a small new study [PDF] on the use of Virtual Reality (VR) to treat depression. The new therapy, which is part of ongoing work at University College London, uses a process of embodiment to help patients become less self-critical.

The study – carried out on 15 individuals being treated for depression – featured two phases.

In the first part, patients identified with an adult virtual avatar which mirrored their own movements. In this guise they were asked to comfort a crying child.

In the second part, they swapped roles with the child avatar, and instead listened to the words of compassion spoken in their own adult voice.

Out of the 15, nine individuals recorded reduced levels of depression after a one-month trial. Lead author Prof Brewin explained to the BBC: “People who struggle with anxiety and depression can be excessively self-critical when things go wrong in their lives.”

He added: “In this study, by comforting the child and then hearing their own words back, patients are indirectly giving themselves compassion. The aim was to teach patients to be more compassionate towards themselves and less self-critical.”

This is clearly only the start of much deeper research into the subject. And at the moment there aren’t too many people who have much knowledge on both depression and Virtual Reality. So, to find out a little more we have published two very different perspectives from experts in their respective fields.


Viewpoint from an expert in depression

Dr Tim Cantopher is a consultant psychiatrist and author of Depressive Illness: The Curse of the Strong and advisor to Dr.Morton’s – the medical helpline

This is an interesting study with very promising results. If we are to move away from a prescription based model of treating depression, given the shortage of psychologists and psychotherapists in the NHS, we are going to have to make ever-greater moves toward using technology in treatment.  We already have web-based CBT self-help such as ‘Mood Gym’ and ‘Beating the Blues’, but it looks like Virtual Reality is the next step.

I am particularly impressed by this study focussing on compassion toward oneself. In my view this is the single most important factor in allowing long-term recovery from depression. Sufferers tend to engage in a life of double standards, habitually berating themselves for perceived failures in a way which they would never inflict on anyone else. This is the main message of my book ‘Depressive Illness - Curse of the Strong’. If Virtual Reality can persuade sufferers to treat themselves as they would a vulnerable child, or indeed a loved friend, it will prove a very effective treatment tool.

I don't have personal experience of treating patients with VR, but then neither, to my knowledge, does anybody else. It is a new medium and we psychiatrists tend to be a bit slow to take on new treatments. I prefer to let others make mistakes with new treatments and jump onto the bandwagon when efficacy is established.

Just one caveat about the study. When I was doing research on anxiety, I found that non-specific factors were very powerful in reducing overall levels of anxiety in a population. Just chatting to patients, getting them involved in thinking about themselves and allowing them, through involvement in the research process, to feel cared for, will tend to lead to improvement in symptoms. Having said this, it does seem that VR has an important future in treating major depression, which is an awful disease and one of the biggest causes of disability worldwide.


Viewpoint from an expert in Virtual Reality

Dr Wendy Powell is a reader in VR at Plymouth University

Virtual Reality is all about putting the user into a digital space as if they were really there, creating a simulated experience that, at some level, is “believable”. VR practitioners often talk about “suspension of disbelief”, and a good VR system can make us do this. We know that it’s not real, but at some level we respond to it as if it is real. It is this aspect of VR that is so useful for treating mental health problems.

Firstly, it’s important to recognise that mental health problems are complex, and many conditions, including depression, may have a variety of causes. So for example depression may be due to a chemical imbalance (such as that seen in Seasonal Affective Disorder - SAD, or postnatal depression), or it may be reactive to an event, or sequence of events (e.g., post-bereavement), or it may be due to problems with self-image or self-esteem.

It’s the last element, the self-image and self-esteem components that have the most potential for VR treatment. Because VR can allow us to experience a different reality, it can potentially be used to give us a different image of ourselves. So, for example, we can adjust the appearance of an avatar in order to reflect a person’s own body image, but then introduce an accurate body image within the virtual space, so that they can see the difference between their own self-image and the real one. 

This recent study goes a step further, exploiting the potential that VR offers to experience the same events from more than one perspective. Similar techniques have been used to enable someone to visualise themselves in a different body, and even to practice social interactions in a virtual setting.

This ability to have “virtually real” experiences in VR has application for a wide range of mental health issues. It is now fairly well accepted that VR is a useful tool for “exposure therapy”" where, someone suffering from a specific anxiety or phobia trigger can experience the trigger in a virtual setting (for example, high places, spiders or aeroplanes), and learn to manage their anxiety with gradually increasing levels of stimulus. This type of exposure therapy seems to translate well into real world settings. In a similar manner, military personnel suffering from post-traumatic stress disorder (PTSD) are being treated in VR simulations of conflict zones (e.g., virtual Iraq). Again, by learning to manage the anxiety and other symptoms in a controlled setting under the guidance of a therapist, they can gradually regain control over their response to trigger factors, and reduce their symptoms.

A similar technique is being trialled to treat addictions. Recovering addicts can often control their cravings within a clinic setting, but when exposed to real-world temptation (for example, bars and parties) the resolve disappears and the cravings take control. By immersing them into a virtual world which recreates trigger situations, they can learn techniques to manage these stronger cravings, and reduce the chance of a relapse.

As technology improves and costs reduce, it is becoming more realistic for the equipment to be available in clinics, and even in patients home, allowing them to continue therapy between regular sessions. This, however, is a bit of a double-edged sword. Mental health problems, as previously observed, are complex, and treating them is a skilled process. Unregulated access to “treatment apps”, and unmonitored use could have the reverse effect, and increase the anxiety or depression, compounding existing problems. It's important that these types of applications are seen as a tool to be used under supervision, and not a free-for-all self-treatment option.  Maybe they will even need to be prescribed, much like controlled medicines?

For the future, I think that this area will continue to develop, and as the research matures we will understand more about how and when this type of treatment should be applied. With the increasing sophistication of wearable sensors, which can track our heartbeat, breathing, even our mood, we could use this type of bio-feedback to control the rate at which we progress through a VR treatment. 



Further reading:

New technology vs. ‘untreatable’ depression

‘Computer game therapy’: A treatment for depression


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