After his father died of COVID-19 last fall, a distraught Doncan Martinez turned to an unexpected outlet: virtual reality.
The 24-year-old has found himself tackling the nascent field of virtual mental health care with a service called Innerworld, which offers peer-led mental health support through its app. The idea is to bring the principles of Cognitive Behavioral Therapy (CBT) into the Metaverse and allow users to interact with other people as anonymous avatars through voice and text chat.
CBT aims to help patients change unhealthy thinking or behavior patterns by developing appropriate coping skills and strategies. The American Psychological Association describes it as a form of therapy that helps people “learn to be their own therapist.”
However, Innerworld offers regular users the opportunity to support each other. Its founder Noah Robinson emphasized that the service should not replace professional therapy. Upon registration, Innerworld users must confirm that they understand that the application is not therapy.
“This is not therapy and we cannot provide crisis intervention,” Robinson said. “Our goal with Innerworld is to be a long-term place where people can come to help them prevent a crisis. Or we have people who are hospitalized, come for additional support.”
Once in the Inner World, users can choose from a variety of settings that mimic the environment, such as hiking trails or libraries. From there, they can interact with other avatars or view a list of peer-led activities such as group meditation sessions, addiction support groups, and workshops to overcome social anxiety. In one instance, Martinez said he participated in a game that asked users to guess what someone else was drawing.
The effectiveness of Innerworld’s approach is still being studied – the company hopes to release early data from a small internal trial that showed a reduction in symptoms of depression and anxiety in 127 participants. A $206,000 grant from the National Institutes of Health is helping Innerworld fund its research.
Gathering reliable long-term data is critical to evaluating a program, or any such program, says Barbara Rothbaum, a psychologist at Emory University School of Medicine. In 1995, Rothbaum published an article on the use of virtual reality to treat fear of heights.
“In terms of virtual reality, most apps now use a real therapist,” she said.
In fact, most VR therapeutic applications to date have focused on physician-led exposure therapy for arachnophobia and claustrophobia, as well as social anxiety and post-traumatic stress disorder.
However, Rothbaum added, “I do think [VR] could be useful for self-help, but the programs tested weren’t designed for that.”
Skip Rizzo, director of medical virtual reality at the USC Institute for Creative Technology, said he first recognized the potential of virtual reality for mental health in the 1990s. Rizzo pioneered the use of virtual reality to treat post-traumatic stress disorder in military personnel. A 2005 report documented a 34% reduction in PTSD in a Vietnam veteran who received VR therapy.
Rizzo said he sees potential in the Inner World – as long as the app continues to make it clear it’s not run by clinicians.
“Whatever their problems, they are worried about stigma or ashamed, and they may not want to admit directly to another person that they have these problems,” Rizzo said. “But they will most likely be in an avatar-based world where they can remain anonymous but still interact with people.”
Martinez said that he and other users he met in the Inner World felt they weren’t getting the empathy they needed in the real world.
“My real friends don’t know that I’m emotional. I’m very reserved about the emotions of my real friends,” he said. “I can open up from the inside because I know that I will not be judged. They won’t attack me.”
Robinson said he was motivated to create Innerworld after finding solace in online communities in his own life. He said he turned to the online game RuneScape when he became depressed after realizing he was gay when he was 13 years old. Anonymity allowed him to more freely explore those parts of himself that he feared to face in the real world. Robinson said he eventually confessed to his online friends.
In his work, Rizzo pilots a virtual reality project with the help of doctors that provides social support to Ukrainian refugees. Refugees moving to Bucharest, Romania have access to a virtual version of Kyiv’s city square, where they can interact with other refugees as anonymous avatars.
Meanwhile, a startup called BehaVR launched an app called First Resort last week. The VR app guides users through “chapters” to learn the skills taught in CBT sessions.
Risa Weisberg, a professor at Boston University’s Chobanan and Avedisian School of Medicine, is the chief clinical director of BehaVR. Because people’s brains process virtual reality experiences the same way they process real life experiences, “you don’t perceive these interventions as something you read or hear, it’s an experience,” she says. ”
By 2021, eMarketer estimates that U.S. VR reach could grow to 64 million people this year. Weisberg said the expansion comes at a time when more people are seeking mental health care, but many also see it as unaffordable due to high costs.
“It’s all coming together at the same time, which makes the next few years really fit for accessing mental health technology and VR interventions,” she said. “I think we’re going to see a huge increase in that metric.”
However, Rizzo said his main concern with Innerworld is that people who need professional help may try to use the app instead. In the meantime, Rothbaum said randomized clinical trials are needed to see if these types of programs actually work.
Post time: Dec-02-2022