Virtual psychotherapy: developing VR to improve mental health and business success

Could virtual psychologists help alleviate mental health conditions in the future? Could a VR therapeutic tool enable us to achieve greater success at work, unleash our creativity and improve career achievements? Those are the questions being asked by a pioneering new project in virtual health.

It started with academic research study to explore the benefits of virtual reality in the psychological health sector, leading to the establishment of a project to explore the potential medical and industrial uses of this application. It involves creating virtual psychotherapy sessions using immersive technologies, where the user provides the analysis.

It’s the brainchild of Mel Slater, a computer scientist based in the psychology faculty at the University of Barcelona, professor of virtual environments at University College London, an immersive fellow at the UK’s Digital Catapult and co-founder of Virtual Bodyworks. This company was set up to investigate immersive virtual reality embodiment for medical, social and psychological rehabilitation, and is a spin-off from the University of Barcelona, Event Lab, ICREA and IDIBAPS. A pioneering researcher in the field, Mel has been working in this area since the 1990s when the earliest research into VR therapy showed positive results.

“There is some level of the brain that doesn’t distinguish between reality and virtual reality. A typical example is, you see a precipice and you jump back and your heart starts racing. You react very fast because it’s the safe thing for the brain to do. All your autonomic system starts functioning, you get a very strong level of arousal, then you go, ‘I know it’s not real’. But it doesn’t matter, because you still can’t step forward near that precipice.”
— Mel Slater

How does it work?

The key project, Personified Self Interaction, involves scanning the participant to create their 3D lookalike avatar. They enter a VR space and are invited to talk about their problems to ‘Dr Sigmund Freud’, the other avatar occupying the space.

Once they’ve done this, they occupy the Freud avatar, looking back at themselves. As Freud, they listen to the problem they have just shared and then offer advice on it. They return to their own avatar and listen to the advice from ‘Freud’, the advice they themselves have just shared. Freud’s response tone is deepened by a pitch change of -2 to change it from the participant’s own voice and make the experience more authentic.

The technology involves 3D scanning, tracking, and rendering with a variety of different systems and head-mounted displays. “It’s all standard VR off-the-shelf equipment apart from the 3D scanning,” confirms Mel.

What’s the science behind it?

Inner speech, when we talk to ourselves, is considered a critical component of self-awareness and self-related processing. Positive versus negative self-evaluations have been shown to activate different regions of the brain. This project externalises a representation of the self to whom the participant is speaking, and occupying that self and talking back to it facilities a genuine self-conversation.

Recent studies suggest that when we have an illusion of body ownership over a body different to our own this can change aspects of our perception, attitudes, behaviours and self-identity. The theory is that by having body ownership illusion of the body of a counsellor, the participant will be able to find a more satisfactory and authentic outcome to their problem and improve their mood.

The project started life three years ago as a research study funded by the European Research Council. Working in a VR research group in an academic environment, all skills needed were already in place to conduct the study and build the software needed to run the project, using the available hardware.

Initially working with the embodiment model, a second project was also funded by the ERC and a third study is currently ongoing with Oxford University. Results of the first study have already been published and results for the second project are currently under analysis for publication next year. Once all results are available, the commercial arm of the project – Virtual Bodyworks – will seek investment to put the findings into practice and launch the business.

Results and participation feedback

Overall under all conditions, the experience was positively evaluated by participants, who confirmed their mood improved after discussing their problems with ‘Dr Freud’. Interestingly, in parallel experiments where the counsellor was a self-representation, the improvement was lessened. In addition, the improvement was greater when the Freud VB moved synchronously with the participant because the synchronous VB movement was associated with a stronger illusion of ownership over the Freud body.

The results suggest that this form of embodied perspective-taking can lead to sufficient detachment from habitual ways of thinking about personal problems and so improve the outcome, says Mel. They also demonstrate the power of virtual body ownership to effect cognitive changes.

Results of the second study have not yet been published but anecdotally, researchers say the participants have been positive, Mel confirms. “What this affords is for people to get an outside perspective, to step outside their problem and outside their bodies, to see and hear themselves explaining their problem. We are generally better at helping friends with their problems, rather than solving our own.”

A Guardian journalist who experienced the Freud simulator first-hand had this to say. “I listen to my problems and then tear into myself – rightly or wrongly, I make a good case for not being boring, stupid and a rubbish journalist. I verbalise everything and dismiss it as solipsistic nonsense. I then return to my own avatar. ‘Good points. Well made,’ I say to Freud. And I mean it.

“When I take off my headset and leave the virtual world, my breathing is fast and shallow. I feel both ecstatic and emotional. Tearful, almost. Even if it doesn’t last, it’s been a useful exercise. I might say this kind of stuff to myself in my head, but it feels different when you say it out loud.”

What does the mental health sector say?

The project has also included running focus groups for clinical psychologists and their feedback has been positive. However, rather than using the VR experience to replace conventional therapy, they suggest it would be best used to supplement patient treatments and used in conjunction with traditional treatment plans. Practitioners from the British Association for Counselling & Psychotherapy stress that technology is there to be used alongside therapy, rather than instead of.

Commercial applications of technology

In addition to the academic research, the project is also utilising case studies and focus groups. A team will travel to New York at the end of 2017 to collaborate on a corporate project with a large multinational company, exploring the potential to develop the technology for commercial use.

“We want to expand the idea to see if it could bring benefits to both medical and commercial projects, and we have developed software for clinical psychotherapy and business applications,” explains Mel. “These techniques can be used in business to solve problems and to promote creativity, which is precisely what the New York group is interested in exploring.”

Will VR provide a cure for depression one day?

While the jury is still out on that, Mel does have the following to share from early clinical tests in this area.

“We published a study last year, led by Professor Chris Brewin of UCL, where we reduced the level of depression among a cohort of people through a VR intervention not that dissimilar from the current project. Part of having depression is that you are overly self-critical and cannot give compassionate thoughts to yourself. So, in the VR, you see a crying child. Beforehand, the therapist has given you a structure of things you should say to other people in order to give them compassion. You say these things to the child who starts looking at you and stops crying.

“Then, in the next phase, you are that child, so you then see and hear your previous self giving you the compassionate speech. When we gave this to a group of moderately depressed people three times, the level of depression decreased.”

In its current iteration, the technology has several different applications, as Mel explains. At an everyday consumer level, if somebody has a choice they need to make, the options can go around and round in the brain. To break through that stalemate, they can discuss the choices with the ‘expert’ – themselves.

At the level of clinical psychology, using the tool for counselling interventions, he says they are making positive progress but it’s not easy to break into a market that has long had a traditional way of doing things, adding that this is a common problem for new businesses.

And at the business level, he reveals they’ve had a very good reaction from the corporate community. “The New York project is being funded by a big multinational,” says Mel. They are willing to pay a group to go over there to explore the possibilities, based on what they’ve heard of our work so far.”

He also believes that the technology could be one way of easing pressure on mental health services.

“Issues that are fairly mild can become much worse over time and maybe this can be a stop-gap before patients see a real therapist. It’s very early days, we don’t really know yet, but these are the kinds of ideas we’re investigating right now.”

Words by Bernadette Fallon

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Freud Simulator, Medical, Mental Health, Psychotherapy, University College London, University of Barcelona, Virtual Bodyworks, Virtual Reality, VR