Virtual Reality - the Panacea for a Growing Mental Health Crisis?

Opinion article by Barnaby Perks, CEO of Oxford VR.
The World Health Organisation puts mental illnesses among the leading causes of disease and disability in the world, with depressive disorders the fourth leading cause of global disease burden. By 2020, it expects mental health to rank second behind ischaemic heart disease.

The effects of mental illness don’t just impact the individual; they are much more far reaching. Family members, employers, economic productivity and health and welfare systems are all affected. There's no shortage of high-quality, evidence-based psychological treatments for many mental health problems. What is lacking is the skilled clinicians to deliver them to the growing numbers of people needing help.Could Virtual Reality (VR) play a central role in the future of treatment delivery?

Evolution and access to VR as a digital health tool

Virtual Reality was first developed in the mid-1960s and essentially the elements haven't changed greatly over the years. More recently, VR has powered the consumer electronics world via gaming headset devices and offers a whole new way to play, immersing the user deep in adventures and experiences inside a simulated world. This experience has the potential to transform the way society tackles mental health problems.

Clinically validated VR interventions are a powerful aid to face-to-face therapy. VR's therapeutic value stems from its ability to create compelling simulations of scenarios in which psychological difficulties occur. For example, it negates the need for a therapist to accompany a socially anxious patient to a real-life crowded shopping centre. Once in the VR scenario, the user can practise ways of overcoming their fears.

When we add a virtual coach, VR becomes an even more potent, and efficient, therapeutic resource.This virtual coach guides the user through the therapy session, asking questions about thoughts and feelings, and providing instruction, advice, and encouragement.The intervention is presented every time in an engaging, but standardised way, thereby ensuring adherence to evidence-based treatment protocols. In many cases, this means that the therapy can be delivered without the need for a therapist to be present, thereby offering real potential to improve access to treatment currently constrained by therapist capacity.

VR treatments for phobias, anxiety, psychosis, depression and addiction

Innovations in healthcare treatment planning need to be underpinned by a clear scientific evidence base. Building on Professor Daniel Freeman's near two decades of psychological research, the team at Oxford VR is well positioned to produce evidence-based therapies that can transform treatment access and operating economics for the world's most common, costly and debilitating disorders.

Indeed recently,we completed the first review of every study that has used VR to assess, understand and treat mental health conditions(1). In over 25 years, and 285 studies across the range of anxiety disorders, the results unequivocally confirm that VR is a proven modality for delivering rapid, lasting improvement for patients.

In 2018, we conducted one of the largest randomised controlled trials of fear of heights treatments, in which 100 people who had suffered a fear of heights for an average of 30 years were randomly allocated either automated VR therapy or no treatment. The VR therapy was delivered via 30-minute interventions in a clinic, where a virtual assistant guided users through a cognitive treatment programme.

The findings, published in the Lancet Psychiatry(2), showed results that were better than outcomes typically delivered by premium face-to-face therapy. All participants in the VR group showed a reduction in their fear of heights, with the average reduction being 68%. Half of the participants saw a reduction in their fear of over 75%. These results demonstrate the dramatic effects on psychological wellbeing that automated VR therapy can produce.

Oxford VR is preparing other projects that deliver clinical psychological therapy via immersive technology to bring about powerful and positive change. Take gameChangeVR, a UK NHS-funded project, led by the University of Oxford and Oxford Health NHS Foundation Trust and comprising fifty people across fifteen organisations working to transform the lives of patients with psychosis.

Many individuals with psychosis find day-to-day life so anxiety-provoking that they simply withdraw. Everyday tasks such as getting on a bus, doing the shopping or speaking to people become very challenging and overall mental and physical health deteriorates. Psychological intervention can be very beneficial to coach people in the situations that trouble them most and encourage them to move beyond their fears. A shortage of skilled therapists means this is seldom delivered. This is where high-quality, automated psychological therapy using immersive VR can have a big part to play.

Right now, we’re helping to builda six-session automated treatment that's easy to use, engaging and right for patients' needs. Then comes a largemulti-centre NHS clinical trial across the UK to demonstrate the benefits. The final stage will see us develop an implementation package to roll out the treatment.

Social anxiety is another debilitating condition for which VR can be a powerful treatment option. It is defined as the fear of being judged and evaluated negatively by other people leading to feelings of inadequacy, inferiority, self-consciousness and depression(3). With funding from Innovate UK's Investment Accelerator scheme, we are working with the AnDY Research Clinic based in the School of Psychology and Clinical Language Sciences at the University of Reading in the UK to develop a VR treatment for young people with social anxiety.

VR to complement existing treatments and accelerate therapy access for patients

There is still much debate about the role of digital technology in delivering evidence-based mental health interventions. Our view is that immersive VR technologies will notreplace human clinical interventions; rather they will typically complement existing treatments.It is our belief that if we're serious about addressing the mental health crisis, we have to let go of the idea that therapy can only be done face-to-face and recognise the huge gains that technology can potentially provide to accelerate access to evidence-based psychological therapies.

A guide to 'How immersive technology has the potential to accelerate a response in global battle against mental illness' can be downloaded by clicking on the link.

1. Psychological Medicine, 'Virtual reality in the assessment, understanding, and treatment of mental health disorders', 22 March 2017
2. Lancet Psychiatry, 'Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial', 1 August 2018
3. The Social Anxiety Institute, 'What is Social Anxiety?'.

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