Prosthetic Gods: Therapy and Virtual Reality

“Man has, as it were, become a kind of prosthetic God. When he puts on all his auxiliary organs, he is truly magnificent; but those organs have not grown on him and they still give him much trouble at times.” - Sigmund Freud, Civilization and Its Discontents

Let’s play with the parallels between therapy and science fiction, shall we? Client and therapist author an alternate reality in a hopeful future.  And like science fiction protagonists, we need to tackle new worlds with technological as well as psychological flexibility. Therapist and client conceive this reality with words alone for now, but virtual reality technology offers the opportunity of a new and improved training arena: clients can face their fears within the support of a therapist’s office, on a predictable time table that allows them to practice skills immediately after learning them. Responses can be observed in real time, processed and problem-solved immediately afterwards while the memory is fresh.

Unfortunately, therapy and technology don’t usually hang out at the same bars. Your average therapist relies on training and intuition, pollinated with updated research.  The most essential piece of equipment extraneous to the person might be the box of tissues. While technology may not be central to the therapeutic process, though, we’d be foolish to decline its gifts.

Immersive virtual reality for entertainment has existed in rudimentary forms since the 1960s, exploding in technological capability in the 1980s, and then re-emerging as a major cultural force in the mid-2010s with the availability of affordable consumer-grade models such as the Oculus Rift. Psychology research departments began exploring the clinical applications of VR in the mid-1990s. In recent years both professional and consumer interest in VR for mental health issues has rapidly increased.  

Overwhelmingly the mental health field’s interest in virtual reality therapy has focused on exposure therapy for anxiety disorders, especially phobias, social anxiety, and Post-Traumatic Stress Disorder. The Department of Veterans Affairs is perhaps the most prominent investor in clinical virtual reality, especially for the treatment of PTSD. However, one review of the literature revealed effective uses as diverse as helping people navigate triggers for substance abuse, management of eating disorders, and coping with pain management (2016 Valmaggia et. al).

The consumer market promises a new set of tools for those who prefer to address issues on their own, but the products at this point remain underwhelming.  Despite some determined digging, I could still find only a smattering of VR games currently available that target self-help for mental health issues.  The few examples I found included Limelight, a game that challenges the player to face public speaking fears with increasing difficulties of situations and audiences (I wonder if there’s a tomato-dodging level); and Arachnophobia, wherein one controls the pace that a room slowly fills with spiders.  The reviews for both products are generally...not positive. And I can understand why. Although these could be useful products, the graphics and interactivity are outdated to a level that would be distracting and even comical for many users.

The most intriguing product to me---as in, something I’d actually want to play---is DEEP VR, which perhaps to its advantage is less clinically specific than the other games mentioned. DEEP VR relies on a custom-made controller based on your breath. Varying the depth of inhalation and exhalation allows you to ascend or descend within a bioluminescent suboceanic world.  Developers of the game describe their intent as encouraging players to learn diaphragmatic breathing for anxiety and depression management. In this interview the game’s chief developer describes his interest in games as “a Trojan Horse”, something that masquerades as play with a deeper goal of fostering wellness, especially for adolescents and young adults. Kind of like putting your dog’s medicine in peanut butter.

It’s easy to imagine that improved availability of virtual reality therapy could help bring clients into therapy who for reasons of preference or access are not being served.  And it’s easy to imagine many of those currently getting therapy, getting better and faster results. The technological and market scaffolding for virtual reality is still very much being built, and it’s exciting to see what may emerge.

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References

Valmaggia, L, Latif, M., Kempton, M., Rus-Calafella, M. (2016). Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence. Psychiatry Research, 236 pp. 189-195. Retrieved 27 January 2019 from https://doi.org/10.1016/j.psychres.2016.01.015 .

Veterans Affairs Office of Technology Strategies (2017). Virtual reality in healthcare. TechInsight, 4(11). Retrieved 27 January 2019 from https://www.oit.va.gov/library/programs/ts/ti/2017/TechInsightVirtualReality.pdf


Hannah Frankel