The Future of Mental Health: Treatment Via Virtual Reality & Psychedelic Drugs
VR FOR THERAPY
From http://techcrunch.com/2016/01/06/virtual-reality-therapy-treating-the-global-mental-health-crisis/ (VR for treating PTSD and other mental disorders)
re: VR as a Mental health platform: “Virtual reality (VR) has been used for decades as a tool for therapists to administer virtual reality exposure therapy (VRET) in a safe and controlled manner. Due to cost and technology limitations, it has not been widely available, to date. With the advent of affordable mobile VR headsets, such as the Gear VR, there is a new opportunity to apply telemedicine to decentralize mental health treatment, reaching more patients and improving lives around the world.”
re: Doing the research to bring it into the mainstream: “A key challenge today is the lack of clinical evidence and data to support if and how VR can be used to administer effective treatment both in the clinic (expanded use) and remotely. Companies wishing to penetrate this market will need to conduct well-designed, randomized, controlled, properly powered clinical studies in order to change or influence treatment paradigms.”
re: Potential applications of VR therapy: Some examples might include remote teletherapy by qualified practitioners who use VR as a supplementary tool, in-clinic VR therapy, virtual therapists created using artificial intelligence or patient-directed VR therapy in the absence of a professional therapist.
re: Virtual Reality for exposure therapy (dependent on level of realism): CBT goes hand in hand with ET, which gradually encourages patients to face the troubling thoughts and fears directly. Over time, this effectively lowers the peak anxiety the person experiences when they are exposed to whatever causes the anxiety. Virtual reality is now convincing enough to simulate many of these anxiety-inducing stimuli, and is a safe, controllable and effective way to conduct various types of ET and CBT. Although ET is an obvious fit with VR, there are many other psychiatric conditions, such as childhood developmental disorders and autism, where VR may play a more dominant role in the future.
re: VR for treating PTSD: Virtual reality has been used fairly extensively to deliver prolonged exposure therapy (PET) for PTSD since the 1990s, mostly for the treatment of soldiers and war veterans. Dr. Albert “Skip” Rizzo, director of Medical Virtual Reality at the Institute for Creative Technology at the University of Southern California, is a leader in this field. His application, called Bravemind, was developed in partnership with Virtually Better, who sells the product to institutions around the world.
The Canadian government purchased two copies of this software in 2014 for $17,000 each. The system consists of various components, such as the VR environment, which is controllable and customizable, a vibrotactile platform, which delivers sensations associated with explosions and firefights and even a scent machine, which can emit smells like diesel fuel, garbage and gunpowder at specific times during the simulation to increase immersion. There have been a number of clinical studies (completed and ongoing) that investigate the safety and effectiveness of Bravemind.
A recently published study found that the VR therapy alone was as good as a combination of drug therapy and VR therapy.
re: Eye-movement Desensitization & Reprocessing for PTSD Treatment: Beyond Care is working on a VR software solution for PTSD based on the principle of eye movement desensitization and reprocessing (EMDR). EMDR works by having a patient recall a traumatic memory, then having the patient follow a moving object with their eyes only at the same time. The dual task of memory recall plus eye movement taxes the working memory, causing the traumatic memory to become less clear and vivid. Eventually, after repeating this process, the memory permanently loses its ability to trigger such intense emotional responses.
re: Experiments Comparing VR Exposure Therapy with traditional ET: A recently published meta-analysis of 14 clinical trials showed that VRET was similarly effective in treating specific phobias as real-life exposure therapy. Some examples of companies using VR to treat anxiety disorders are presented below.
re: Companies Working on VR Systems for Exposure Therapy: The Virtual Reality Medical Center has a system for treating those afraid of flying. It includes software and hardware, complete with airplane seats and a subwoofer system to mimic the sights, sounds and feeling of flying.
Virtually Better also has software to treat fears such as flying, heights, public speaking and storms. This company has partnered with leading academic institutions, research and treatment facilities to undertake new R&D projects concerning childhood anxiety and childhood social phobias.
CleVR is a company in the Netherlands developing VR systems for fear of flying, heights and social phobias, also backed by scientific research. The company is undertaking a randomized controlled trial to study the use of VR as a therapist’s tool to treat psychosis and social phobia. Through proprietary dynamic virtual emotion technology, the overall atmosphere of the simulated social situations can be controlled.
Psious is a company in Spain that offers a clinical toolkit for therapists to administer and control VRET to treat patients with phobias; it includes VR hardware, a customizable software platform and biofeedback devices.
VirtualRet is another tool for psychologists and therapists to help evaluate and treat phobias such as public speaking, flying, heights, blood and public places. They provide a range of virtual environments, hardware and parallel services.
A company from Sweden called Mimerse is developing gamified psychological treatment tools for VR for the mass market in partnership with the Swedish Government and Stockholm University. Their first game, “Itsy,” is focused on treating arachnophobia without involvement from a real-world therapist. Coinciding with the game’s release on the Gear VR app store, a randomized controlled study is being conducted comparing VRET using Itsy versus real-world exposure therapy. Because the majority of phobia sufferers don’t receive professional treatment, mass market games like Itsy could offer immense value for individuals globally
From http://www.wired.com/2015/03/virtual-reality-wont-just-amuse-will-heal-millions/ (exposure therapy)
re: Efficacy vs Traditional ET & Democratization With Falling VR Costs: “The simulations aren’t perfectly immersive—it’s obvious you’re in a computer-generated world when wearing a headset—but studies have found VR to be more effective at treating some phobias than traditional exposure methods like mental visualization or photographs. The problem is that historically, VR systems have cost tens of thousands of dollars, making such therapy available to a small percentage of people. Psious, however, is now able to sell a bundle of hardware—including a Homido headset, a smart phone and a haptic feedback device—for $300. “We haven’t invented anything,” Psious co-founder Dani Roig acknowledges. “We just democratized these kind of treatments.”
re: Helping Burn Victims Manage Pain via VR: “But the company’s most important project may be SnowWorld, a first-person action game designed to help burn victims manage their pain designed in conjunction with University of Washington researchers led by Hunter Hoffman. Researchers have been using the game to help distract patients from their pain for years.”
re: Rise of Smartphones Driving Down VR Costs: Rose says the most important factor driving down the cost of VR gear is the rise of smartphones, which dramatically lowered prices for components such as gyroscopes and accelerometers. “Four years ago we were using $4,000 sensor networks.” he says. “Sensors are now really cheap, and they’re everywhere. Displays have gotten better and smaller.”
re: Self-image enhancement via VR Avatars: But scientists claim we could better learn to accept ourselves, and ultimately boost our self-confidence, with the help of a virtual reality ‘avatar’.
Experts say that receiving therapy in a virtual reality world, using a computer generated image of yourself, reduces self-criticism and boosts self-compassion and feels of contentment.
re: Experiment in using Compassion to Treat Self-Criticism via VR: “The study, which was published in Plos One, examined how 43 healthy, but self-critical women, experienced the world through a life-size virtual version of themselves. This gave a first person perspective of a virtual room through the eyes of the avatar.
The participants were all trained to express compassion towards a distressed virtual child while in their adult virtual body.
As they talked to the crying child, it appeared to listen and respond positively to their words and gestures.
After a few minutes, 22 of the participants entered the body of the virtual child so they could see their virtual body double deliver their own compassionate words and gestures to themselves.
The remaining 21 participants observed their original virtual adult body express compassion to the child from a third person perspective.
Scientists looked at the participants’ mood and personality traits before and after the experiment.(…)
Women who experienced a first person perspective through the eyes of the virtual child were soothed – they felt safe and content and had increased self-compassion and a lower level of self-criticism.”
re: The Effects Of the VR Body Illusion: ‘When you wear a head-mounted display and look down towards yourself and see a virtual body replacing and moving like your own and also see it in a mirror, this gives a powerful clue to the brain that this is your body.’
re: Anecdote of Ken Kesey promoting LSD in the same way people now promote VR: With jars of psychedelic compounds, Kesey organized an epic road trip with his ‘Merry Band of Pranksters’ across the United States; which bears subtle similarities to road trips happening now with VR. Kesey and his team introduced people to ideas of mind-expansion through the use of psychedelic drugs they had in hand. Today, people pass out virtual reality experiences instead.
re: Timothy Leary’s comparison between VR & Psychedelics: At this point, Timothy Leary got involved with a company called VPL Research who was selling virtual reality products. Those working at VPL, like Jaron Lanierand Mitch Altman, would see Leary on a regular basis at their lab. The comparisons between psychedelics and VR were so strong for Leary that he modified his popular catchphrase “turn on, tune in, drop out” to “turn on, boot up, and jack in” to go along with what he was calling the “LSD of the 1990s.” 
re: Terrence McKenna on Future of VR, circa 1995: The importance of virtual reality, as I see it, is it is a technology that will allow us to show each other our dreams. We will be able to build structures in the imagination that we cannot now share with each other. I image a world where children begin to build their virtual realities by the time they are 5, 6, 7.
By the time they are 20, these virtual realities may be, practically speaking, the size of Manhattan. Well, then what real intimacy will mean is saying to someone, “would you like to visit my world? My world with my visions, my values, my dreams, my fears…” In a sense, what virtual reality is is a strategy to let us turn ourselves inside out so that we see each others’ minds.
re: VR “Presence” & psychedelics: “He’s part of a niche group of VR psychonauts using drugs like marijuana, mushrooms, ketamine, and acid to enhance “presence,” the holy grail of virtual reality—when your brain is fooled into feeling like you’re actually there. Mind-altering chemicals can enhance presence by speeding along the suspension of disbelief.”
re: Importance of content, especially when combined with drugs: “Some users said the drugs actually relieved the nausea associated with immersion, also called simulator sickness. Scientists have been studying whether cannabis can help relieve motion sickness. But almost everyone I talked to recommended avoiding dark, scary simulations and horror games.”
re: Designing experiences specifically for chemically-altered minds: “Rothman, the investor, is taking that a step further, studying whether we can develop interfaces designed specifically for chemically enhanced users. He’s dubbed the field “stoner interface design.” He’s created some data visualizations where the color palette is specifically chosen for users under the influence, and is currently looking for funding to support further research in the area.”
PSYCHEDELICS FOR THERAPY
re: Why Psychedelics Biologically Can Help Mood Disorders: A previous brain imaging study, by the same team, showed that psilocybin decreased blood flow to certain important “hub structures” in the brain, meaning that closely linked brain areas became less tightly synchronised. The scientists believe that this could explain why the drug appears to help patients overcome conditions such as depression, addiction and post-traumatic stress where pathological patterns of thought become so entrenched they are difficult to reverse.
re: Studies Showing Positive Links Between Psychedelics & Mood Disorders: A US study in 2014 showed that LSD helped patients with life-threatening illnesses overcome anxiety about death, in 2012 MDMA (the active ingredient in ecstasy) in combination with psychotherapy was shown to be effective at treating post-traumatic stress disorder and a 2006 study from scientists in Arizona found that psilocybin relieved symptoms of obsessive-compulsive disorder.
re: Troubles Funding/Legitimizing Psychedelic Research: He equated the barriers to research to the Catholic church’s censorship of Galileo’s work in 1616. “We’ve banned research on psychedelic drugs and other drugs like cannabis for 50 years,” he said. “Truly, in terms of the amount of wasted opportunity, it’s way greater than the banning of the telescope. This is a truly appalling level of censorship.”
Ravi Das, a neuroscientist at University College London who is researching the effects of ketamine, agreed that there is an institutional bias. “The potential benefits are definitely downplayed in face of these drugs being used recreationally,” he said. “People view their use in a research setting as ‘people are just having a good time’.”