Virtual Reality for Psychological Health: Why are we hesitating?

The world of Virtual Reality (VR) is ever-expanding. In fact, it’s endless: that’s part of its appeal. As a Clinical Psychologist, I’m committed to improving psychological health. I believe our minds are amazing and complex: this is why they can bring us incredible joy and devastating pain. My career has allowed me into the privileged position of supporting people at some of the toughest moments in life: the death of a loved one, when undergoing treatment for cancer, following a suicide attempt and when managing the impact of a traumatic event.

Most psychologists will agree that the “therapeutic relationship” is pivotal in psychological therapy: we’re social beings. Psychological therapy involves trust, compassion and genuine human connection - that’s not all it is though. Psychological therapy can include teaching, exposure (to painful emotions and fearful situations), reflection on one’s own thoughts and behaviours, and learning and practising new behaviours: all areas where VR could be a powerful ally.

Some perceive VR as a new, and potentially dangerous tool. We’ve been here before though. Telephones, televisions, cinema, the internet: all technologies which were considered dangerous or detrimental to human functioning by some people at some time. All technology has the potential to be harmful but can also add undoubtable value to our lives. It’s the function (how & why) and context (when & where) of the behaviours related to these technologies that’s important. Providing we notice and recognise when the use of technology goes from enhancing to harming then we can maximise this technology for our emotional health.

What does this mean in practice? For example, when does distraction become avoidance? We can play a computer game or watch a film to relax. We know relaxation is good for us physically and emotionally. If we do that same behaviour excessively then it becomes avoidance: our lives become small and we stop engaging with the world beyond that game or film. If we telephone a friend because we live too far apart to visit regularly, then we’re enhancing our life. However, if we only communicate with others by phone because we’re fearful of connecting in person: we’re avoiding.

The same logic applies with VR. If we only live our life in a virtual world, then we’re avoiding (and we can’t yet know the extent to which living in a purely virtual world might be detrimental). However, the immersive nature of VR can increase the power of interventions for learning, overcoming fears, and experiencing the pure enjoyment of situations we may not otherwise be able to access (for health, financial or other reasons).

We now have evidence to support the use of VR within areas such as; post-traumatic stress disorder (Cukor et al., 2015), specfic phobias (Freeman et al., 2018), psychosis (Rus-Calafell, Garety, Sason, Craig, & Valmaggia, 2018), emotional eating (Manzoni et al., 2009) and pain management (Pourmand, Davis, Marchak, Whiteside, & Sikka, 2018).  Although there is a need for further studies to confirm the safe use of VR within psychological interventions, I would suggest that we need to consider VR as simply another therapeutic tool. VR, like pen and paper, can be made use of when our clinical judgment suggests it is helpful to do so.

Technology is ever-evolving. This is both exciting and, at times, unsettling. I believe psychologists have a unique and important role to support, promote, understand and monitor the use of these technologies. This belief motivated me to launch Underpin Psychological Consultancy (underpin.org.uk) to provide such evidence-based, meaningful advice and consultation. I also believe that VR can enhance psychological therapy whilst maintaining the values, models and theories that underpin the profession. These are ideas I hope to explore further, and I invite like-minded individuals across health, psychology, immersive technology and other professions to continue these discussions and projects with me.

References

Cukor, J., Gerardi, M., Alley, S., Reist, C., Roy, M., Rothbaum, B. O., Difede, J. & Rizzo, A. (2015). Virtual Reality Exposure Therapy for Combat-Related PTSD. In E. C. Ritchie (Ed.), Posttraumatic Stress Disorder and Related Diseases in Combat Veterans (pp. 69–83). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-22985-0_7

Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., Nickless, A. (2018). Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. The Lancet Psychiatry, 5(8), 625–632. https://doi.org/10.1016/S2215-0366(18)30226-8

Manzoni, G. M., Pagnini, F., Gorini, A., Preziosa, A., Castelnuovo, G., Molinari, E., & Riva, G. (2009). Can Relaxation Training Reduce Emotional Eating in Women with Obesity? An Exploratory Study with 3 Months of Follow-Up. Journal of the American Dietetic Association, 109(8), 1427–1432. https://doi.org/10.1016/j.jada.2009.05.004

Pourmand, A., Davis, S., Marchak, A., Whiteside, T., & Sikka, N. (2018). Virtual Reality as a Clinical Tool for Pain Management. Current Pain and Headache Reports, 22(8), 53. https://doi.org/10.1007/s11916-018-0708-2

Rus-Calafell, M., Garety, P., Sason, E., Craig, T. J. K., & Valmaggia, L. R. (2018). Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychological Medicine, 48(3), 362–391. https://doi.org/10.1017/S0033291717001945