If we look into the global numbers available on depression, ‘concerning’ is the word that would be too mild to describe the situation. According to estimates put out by the World Health Organization, an estimated 5% of adults suffer from Depression worldwide.
In numbers, nearly 280 million people worldwide suffer from depression. Alarmingly, over the years, suicide has become the fourth leading cause of death in 15-29-year-olds, claiming more than 700,000 lives annually.
While there exists an urgent and intense need to treat and ease depression effectively, more than 75% of people in low- and middle-income countries get no treatment due to the lack of investment in mental health care, inadequacy of trained healthcare providers and the taboo and stigma that come with mental disorders.
Although the relief-delivery mechanism remains complex, competent people and relevant institutions and organizations around the world are trying to come up with innovative and efficient solutions. The incorporation of virtual reality is one such solution that comes with revolutionizing potential amidst this gloomy landscape.
Virtual Reality to Combat Depression
A recent study exploring the integration of VR in fighting depression was led by Kim Bullock, a clinical professor of psychiatry and behavioral sciences. Bullock is also the founder and director of Stanford’s Neurobehavioral Clinic and Virtual Reality and Immersive Technologies Program.
The core objective of the study was to assess the feasibility and efficacy of applying extended reality behavioral activation (XR-BA) in treating people suffering from MDD or Major Depressive Disorder.
While explaining why this technique could prove crucial and efficient in treating people suffering from MDD, Prof. Bullock said:
“People who might otherwise have barriers to getting treatment might be open to using this technology in their own homes.”
The study involved 26 participants diagnosed with Major Depressive Disorder (MDD). It was designed to assign half of the participants to traditional behavioral activation while the other half received a VR headset. These headsets helped them participate in a myriad of activities, from table tennis and mini-golf to taking tours around foreign cities or attending shows. The depression score – for both groups – decreased by similar amounts.
The study, raising much hope, pointed towards the use of VR as a feasible, non-inferior, and acceptable enhancement to traditional behavioral activation. Given VR’s ability to provide easy access to several places that could otherwise be out of our reach, these positive results may open up new avenues for treating individuals with depressive disorders.
In the words of Kim Bullock:
“It can reduce the barriers to getting mental health treatment in a number of ways.”
Bullock also gave an idea of what these barriers could be for patients suffering from MDD. She said:
“They might be stuck in a hospital bed or not have the means to access joyful activities or the motivation to leave their house.”
The thirteen people in the trial who were asked to engage in VR activities received a VR Meta Quest 2 headset. Margot Paul, the clinical assistant professor who carried out a small feasibility study as an opener, had the following to say:
“One of the most common pieces of feedback we got was that using the VR inspired people to get out and do things in the real world. These virtual activities got their motors running just enough to get out of bed.”
VR devices come with a coolness quotient, which could also prove effective in de-stigmatizing mental health treatments. However, it is not the first time that VR has been thought of as something that could offer relief to mental health disorders and people suffering from it.
Margot Paul, Kim Bullock, and Jaremy Bailenson were involved in a somewhat relevant study in 2022. It was a feasibility randomized controlled trial to see the efficacy of virtual reality behavioral activation for adults with major depressive disorder.
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VR as a Method of Delivering Behavioral Activation (BA) for Adults Diagnosed with MDD
This particular study aimed to examine the efficacy of the method during a global pandemic. It compared standard or conventional BA treatment with VR-enhanced BA treatment.
Participants chosen for the VR-BA treatment were part of a 3-week, 4-session protocol via a VR headset to complete their BA homework. A host of parameters played a role in measuring efficacy, which included dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model.
Like the earlier study, this test also offered positive results. It validated VR BA as a safe and feasible technique worthy of further exploration for the treatment of MDD. The study noted that the ‘VR BA feasibility in participants with MDD’ registered ‘high levels of acceptability and tolerability.’ While explaining the specifics, the results said that the average VR BA participant’s clinical severity was down by 5.67 points, which was a ‘ clinically meaningful change in severity from a moderate to a mild level of depression.’
Multiple times, VR-BA could emerge as a first step to help improve MDD participants’ moods and increase their motivation. Therefore, the question arises: Are businesses working on VR solutions exploring them enough? The short answer is yes! There are companies emerging with innovative solutions. With time, one can say with certainty that more will emerge.
#1. Amelia by XRHealth
Amelia is one of the most well-known VR solutions in the mental health space. A one-stop-shop VR platform, Amelia, has won the trust of 2,000 therapists and 20,000 patients across 70 countries. To date, it has delivered more than 160,000 VR sessions and boasts of providing the most comprehensive VR library for mental health professionals.
Developed in a fully scientific way, Amelia offers comprehensive VR software for mental health professionals’ therapy sessions. Empowered by a range of immersive environments, these professionals can choose environments with adaptable settings that best suit the patient’s needs and capacities. For training and support, each VR subscription plan contains manuals, webinars, videos, and example cases.
With Amelia’s VR exposure therapy software for mental health professionals, therapists can apply various techniques by combining different VR environments.
Headquartered in Barcelona, Catalonia, Spain, Amelia has had the support and backing of 12 investors.
Amelia’s latest round of fundraising was in June 2022, with ENDRA and CDTI Innvierte leading the rounds. The funding enabled the company to raise its total funds to 7 million Euros for the year.
#2. Virtually Better
Based in Decatur, Georgia, United States, Virtually Better offers a range of VR products for health treatments, phobias, substance use disorders, posttraumatic stress disorder, and other relaxation protocols. The company has a phobias suite, addictions suite, relaxation suite, and PTSD suite.
Clinical psychologists helped develop the Phobias Suite, which the company claims is a state-of-the-art virtual reality exposure therapy system that improves a range of mental health symptoms associated with phobias. Similarly, the addictions suite offers 3D VR explorable environments for a variety of substance use disorder cases.
One of the most groundbreaking solutions developed by the company includes Bravemind, an application for clinicians who specialize in treating PTSD or Posttraumatic Stress Disorder.
The merits of Virtually Better’s solutions attracted many reputed academic institutions to collaborate with it. These institutions include the University of Central Florida, the University of California, Los Angeles, The University of North Carolina at Chapel Hill, and the University of Georgia. At a solution level, the company offers both software and hardware solutions.
The range of solutions offered by companies like Amelia and Virtually Better reaffirms VR’s potential for extensive use in mental health, including depression and psychological fears.
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VR for Mental Health: How to Engage with it
However, there are different opinions relating to the nature of the use of these VR solutions. According to Daniel Freeman, a clinical psychologist at the University of Oxford, VR serves better as an aid for therapists rather than a standalone treatment.
Freeman himself has worked on propounding his assumption by building high-quality, automated VR therapies that feature computer-generated avatar guides. These avatars ensure that a real-life therapist does not need to be present at all times.
The first therapy solution that Freeman built came to be known as gameChange. The program aimed at treating agoraphobia, the fear of entering spaces from which it might be difficult to escape. The course was designed for a duration of six weeks.
During these six weeks, the participants met approximately six times with a virtual coach inside their head-mounted displays. The coach guided the participants through everyday situations that could be seen as scary to navigate.
This study or test was reportedly the largest to date where VR was deployed to treat a mental health condition. The reports were positive. Researchers noted a reduction in anxiety as a result of their approach. Moreover, as far as the case of specific agoraphobia is concerned, VR-based therapy was found to be effective.
Another expert who has worked significantly with VR-based therapy was Albert Rizzo, the director of medical virtual reality at the University of Southern California’s Institute for Creative Technologies. Rizzo’s work was important because he looked at the scenario from the other end of the spectrum. He did not go for building avatars that would work as therapists. On the contrary, he designed virtual patients for clinicians to have training.
Undoubtedly, VR treatments have been helpful to patients. Anne Lord Bailey, co-leader of the Veterans Health Administration’s Extended Reality Network, claimed to have received daily emails from prospective patients who requested VR treatment. Such treatments specifically worked in the area of Posttraumatic Stress Disorder.
By 2022, the VA Medical Center in Asheville, North Carolina, had more than 60 VR headsets, which were deployed to treat anxiety, substance use disorders, and a range of medical conditions.
However, some concerns need solutions for VR to treat depression more inclusively. VR – for patients in developing or low-income countries – needs to become more affordable.
VR-based solutions also need to become ethically perfect for widespread adoption and use. In the long run, personal data-sharing norms and practices might become a concern.
Getting it ready on a theoretical level and making it prudent for multifarious practical applications are two different things. Creating virtual scenarios that replicate and mimic real-life problems can not be done by a medical professional alone. It requires significant investment in technology and the support of computer professionals who are well-versed in the nuances of VR. Since it deals with space as sensitive as mental health, it can not be deployed on the ground without robust testing and inspection.
The researchers must first validate their scenarios with a sample group of patients and then publish their efficacy and reproducibility in peer-reviewed journals. Only then will these therapies become safely efficient.
According to clinical psychologist Barbara Rothbaum, although it has been 30 years since she demonstrated that VR could be used to attenuate fear of heights, “there are some barriers.”
Like every scientific development, it will take more and more time to finetune these solutions. But, on the positive side, VR has already been established as a credible method for easing depression. And not only depression, its implementation can prove helpful for a lot more areas, including anxiety disorders, addiction, pain, ADHD, autism, Alzheimer’s disease, traumatic brain injury, stroke, etc.
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