Instant Genius - How virtual reality is helping patients with phobias, anxiety disorders and more

Episode Date: January 11, 2021

In the New Year issue, we cover the biggest ideas that you need to understand in 2021, and in the past few episodes of the podcast we’ve been talking to the experts who will explain these ideas in their own words. For the next in the series, we speak to Daniel Freeman, a Professor of Clinical Psychology at the University of Oxford. Daniel has been working with VR technology since 2001 and is a founder of Oxford VR, a University of Oxford spinout company. He tells us about using virtual reality to treat mental health problems. Let us know what you think of the episode with a review or a comment wherever you listen to your podcasts. Subscribe to the Science Focus Podcast on these services: Acast, iTunes, Stitcher, RSS, Overcast Read the full transcription of this episode [this will open in a new window] Listen to more episodes of the Science Focus Podcast: Anthony David: Why is there still such stigma around mental health? Pete Etchells: Are video games good for us? Sandro Galea: What is the difference between health and medicine? Helen Russell: What does it mean to be happy? Gordon Wallace: Is an implantable electronic device the future of medicine? Dean Burnett: The neuroscience of happiness Dr Lucy Rogers: What makes a robot a robot? Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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We'll look out for us in your app store. Hello and welcome to the Science Focus podcast. I'm Amy Barrett, editorial assistant at BBC Science Focus magazine. In the New Year issue, we're covering the biggest ideas that you need to understand in 2021. and in the past few episodes of the podcast, we've been talking to experts who'll explain these ideas in their own words. For the next in the series, I'm speaking to Daniel Freeman, a professor of clinical psychology at the University of Oxford.

Daniel has been working with VR technology since 2001 and is a founder of Oxford, a University of Oxford spin-out company. Daniel, what types of therapy are there currently on offer? There are some fantastic therapies. a number of them developed in the UK, particularly cognitive behaviour therapy, CBT, which has excellent evidence for treating problems such as anxiety and depression, and forms of it also used for conditions such as schizophrenia. So there's a number of really good psychological talking therapies for a number of mental health

conditions. But the issue tends to be getting them to enough people. Why is that a challenge? Well, I think there's been a sort of fantastic recognition over the last few years that many, many people will have mental health problems. And any one year, about one in four people, may have a mental health problem. So this is a very large number. And actually, there aren't so many therapists and there aren't so many therapists skilled in the most effective treatment. So if you go to the right centre seeing, the right therapist doing the right treatment, outcomes can be really good. But I think we're moving from this recognition that there are a lot of mental health problems,

but what do we do next? How do we get these really good psychological therapies to more people? So you've mentioned the talking therapies, but what other kind of therapies are there on offer? Yeah, so typically with mental health problems, people are either treated with medication or psychological therapy or a combination of the two of them. the main sort of evidence-based treatments tend to be cognitive behaviour therapy, but there are other therapies too. I think what's very good in the NHS is that there's a focus on using the therapists that have been shown to work in clinical trials and it's got evidence behind them. And the best therapies tend to have a very clear idea about what causes the problem, use that knowledge to develop really good therapeutic techniques, and then show that in clinical trials.

And I think what's I think shared, I think, across some of the most effective therapies is going outside into the situations that trouble people and really making learning, new learning in those situations. So a bit more like sort of, almost like having a personal trainer or a coach next to you is helping a person work through some of the problems in the situations that trouble them. Often that really tends to bring about a lot of change. Right. And so that's where VR therapy comes in. Well, exactly, because VR is immersing you in situations. So one of the most powerful ingredients in therapy is about going out there and trying things in the situations that trouble you. And VR, you can present those situations in a clinic room and you can present it in novel in different ways.

And what's really exciting is that because a person knows its simulation, it's not real. It gives them the psychological freedom to try and. thinking are behavingly differently. So it's actually wonderfully therapeutic. It doesn't break the spell knowing it's VR. It actually really helps people give a bit of flexibility in their thinking to try things anew. So we're finding it's remarkably powerful.

That's surprising because you might think that being aware of the environment being kind of falsified is actually going to make you, I don't know, less likely to believe that it can apply to a real word scenario. Yeah, I think that's probably the issue that people bring up the most to me, you know, it's not the real world, so is it going to apply to everyday situations? We've got lots of evidence that transfers, and increasingly, the way I view it is that while you're in VR, for the overwhelming majority of your brain, it is the real world.

Your senses, your main senses, your vision and your hearing are replaced by the digital simulation. So that's what your brain is processing. You are there. And of course, you know, I've seen it firsthand where you only practice something in a simulation with someone, and it does then immediately after, when you go into a real world situation with someone transfer. And I think, really, you know, a sort of similar situation where people are even more convinced as if you're training to be a pilot and you're doing simulations, people understand that works. And I think VR is the same in that way. That's true.

And you've mentioned that, you know, CBT is commonly used for things like depression and anxiety. Are those the mental health problems that VR is best used on, or are there other things? No, I think for pretty much most mental health conditions, there is a potential for VR to be used. The evidence, or where it's being used, at least at the beginning, has been anxiety disorder. So we know it works really well for that. But there's no reason it can't work for other conditions. we just need it to be tested and shown to work. So what I would highlight is that VR is not a solution in itself.

You've got to develop the right content and you've got to test it. So just because it's VR doesn't mean it's going to work. You have to have really smart content. You've got to have the content developed with people who've had some of the difficulties they influence the design. You've got to have the right theory. You've got to have the right treatment techniques. But if you get it right, potentially it can be used for pretty much most mental health conditions.

But compared to perhaps in going to see you one therapist, it sounds like it might be considerably more expensive to do. No, I think that what we've been doing in Oxford is pioneering, automating delivery of psychological therapy in VR, so that we think for some conditions, one wouldn't need a therapist, and for some you might just need more minimal contact. And then if you automate it, there's the potential to get it to millions more people, And I think that's the excitement. We know if you've got a good therapist, doing the right therapy, outcomes could be great.

But there are too few therapists. There are some great schemes in the UK to increase the number of therapists, and that's great. We need more therapists. Improving access to psychological therapies in the UK is a brilliant change in the NHS to get many more therapists trained, many more people getting the best help. But we still need other ways, too. And I think VR could be a fantastic way of getting really, really, good evidence-based therapies to many more people. It's not the complete solution. We still need therapists. There are still complexities in mental health, but for certain things, I think it can

really change it. And I think it's coming. It will come in a number of years. It will be, it will be used. It works so well for the treatment of mental health problems. I think the question is just when's it going to arrive. It's kind of hard for me to visualize what that kind of therapy might be like. So say I'm someone, you know, who's got anxiety, for example, and I've come to one of your studies to take part in the research. What actually happens when I, you know, put the VR headset on, or does something happen before that point even? No, so you could put the headset on,

and we have a virtual therapist coach called Nick, is a Scottish accent, and she'll talk you through about how to use VR. and then she'll talk you through about the understanding of the mental health problem. Say it's fear of heights or something. She'll explain what causes fear of heights and what one needs to do to overcome it. And in our Fear of Heights program, she'll then take you to the atrium of a very large shopping centre. And she'll say, you know, which floor do you want to start with? Do you want to go up to the first floor or the fifth floor and you get to choose which floor you want to go to?

and I'll just take you up there on each floor, there'll be a task around fear of heights. So in a fear of heights, people fear that something bad's going to happen, that they're going to fall off, or they're going to throw themselves off, or the building's going to collapse. So there's a whole range of tasks

to bring a person right up to a height, not put up their usual defences, but to actually spend time around heights and learn that nothing bad's going to happen, and actually they're going to be okay. So they form this new memory of safety. And so by the height, it might start off that you get closer to the edge,

but there's a balcony there for that sort of lowered. So you might then stand right near an edge. And then later on in therapy, you'll be going out on a sort of on a platform to rescue a cat from a tree. So you're doing things you could never do in the real world, but in VR you can do it. So there's a playful element too.

So you make it a bit more fun, although it is terrifying if you have a fear of heights. But there's a nice contrast. People are, on hand, terrified, but there's also a smile of delight where they're rescuing this very mournful cat from the tree in the shopping centre. And that's one of the things about VR. You can push the learning in ways you can't in the real world. So people can come on in leaps and bounds. So then, you know, we typically do half an hour sessions. Fear of Heights, it's around six

sessions, something like that. On each session, you sort of, you know, progressively gets more difficult. So there are a harder task to do. But in the end, what we're trying to do is help people make new learning and get that to stick. And so you've seen patients actually using this. What is the kind of most positive response that you've seen? Oh, lots of positive responses. So in our Fear of Heights trial, the average reduction in Fear of Heights was 68%. Wow.

So there's a large reduction with just two hours of therapy, which means that people can, well, Fear of Heights is an interesting one. often people it's easy to avoid it apart from work situation or family ones so then after people are saying well i went with my children and went on sort of you know go eight way up in the trees things they'd never have done before and they're taking part more and the work we're doing with people with schizophrenia uh we're working with people who find it very difficult you know just to go into the local shop or get on the bus to go to somewhere they want to do and then of course if you can free them up for anxiety where they don't worry about doing these things it opens

up a lot of possibilities in life. So anxiety really puts a weight on people's shoulders. And when you can help people overcome that, you know, you can see the changes in people's lives. And in terms of building these simulations, what's kind of involved from that point? And how do you go about planning what you're going to show? Yeah, it's a great question. We have a very in-depth design process. We're very keen that we produce for our treatments that are, at least, least as good as the best face-to-face therapy, if not better. So we're not interested in watered-down therapy. So we involve a lot of people. So we involve people who've had the sorts of difficulties. So we work with a wonderful mental health charity, the McPin Foundation, who help support us

bringing people who've had the difficulties. So they're involved in the design process. We'll have psychologists and my team there. We'll have VR computer scientists there. We'll have experts. We'll have experts in sort of user interaction, so lots of people. And what we might start off with is the target, we'll have the basic psychological principles, but from then on, it's a huge fun part of the process designing it and all these ideas that can come from everyone. You've got to align it with the right psychological principles. You've got to think about what's this achieving therapeutically, but then there's a great interaction between lots of people suggesting stuff. And then sometimes the VR programs will say, well, that's going to take, that's far too difficult to do that.

and other things they go, no, that we could definitely do. And there are things we thought too difficult. They'll say, no, that's the fix. So it's a really wonderful process. It's often, you know, there'll be a board, a blank board at the beginning. In the end, it will be filled with, you know, lots of ideas. And then we moved to sort of honing down how you actually play this out in VR in detail. So we have storyboards.

We'll have a script. We'll have all timings for different things to happen. So it's a bit more like a movie at that. point. And then there's a whole bit about programming it once you've got the script or set up. So you do recordings of people in motion capture. So we animate our computer characters using recordings of real people's movements. We obviously have actors for the sounds. There's a lot of work for the environment artists and the computer programs to put this in action. So it takes a lot of effort to do that. But of course, if you get this right, you've got a powerful

treatment and then you've got a powerful treatment that can be scaled up. So I think very much it's worth the investment getting it right. Absolutely. Why is virtual reality the best way to do this? Because obviously there is kind of augmented reality or there's things like, you know, showing just films or other experiences. So why VR? Yeah, I don't think it has to be VR. I mean, I think there's, and I think there's probably stages. I like VR a lot because I think it does shut out the real world and immerses people in the world that we're trying to do the therapeutic work in. So I think that, I think it helps get the person to really censor in that place.

And I think that works. But I think later on, you could do augmented reality, you could blend it, you could move from VR into augmented. That makes lots of sense to, and in other works we've done, we've just used this to a mobile phone to provide reminders and things without even using any immersive elements too. So I think you could build up a whole range of different ways of doing it. So augmented, I think, could be great. But the first steps, I think, certainly for people,

when they've got quite a sort of often quite sort of strong problem, I think we've found the VR and just shutting out the rest and getting really immersed in that super-pity world has been really helpful. But I don't think it's the only way. there's obviously lots of ways that tech could be used in mental health and I think we need to explore that but of course we always need to make sure that it works well and it's what people want is the crucial thing too and of course it's difficult to kind of run these sort of studies I assume because not in other kind of scientific areas you'd have a control group where they're not getting a particular treatment but obviously

you couldn't withhold mental health treatment from someone who needed it so how do you go about planning this sort of research Well, that's a very interesting. Clinical trials are very interesting. So how you design it depends on really what's the key question you want to answer. What you can't do in these trials is blind the person's receiving treatment. So you can't make it double blind with the assessors in the person receiving treatment. Don't know they had it. Rather like a pill, you could have, you don't know whether you've got the active one or not. But of course, if you've got therapy, then you're involved in the therapy. So you can't blind the person. They know they're getting some form of help. But we reach it. We a range of designs, really, depending on what we're trying to answer. So we've got one study for severe paranoia where we're comparing a sort of VR cognitive therapy to equal time in VR doing relaxation. So we have sort of controlled for the time in VR. And that really answers the question about whether it's the particular techniques we're using VR that's helpful. But in a larger study called game change, we're simply testing in one group the addition of our VR therapy

to standard care. And in that study, we're answering the question, does simply adding our VR therapy help. It doesn't tell you necessarily which aspects of causing the change, but it will tell you whether it helps. However, clinical trials are very interesting because we also building something called mediation analysis where we measure some of the psychological processes that we're interested in. Then we look statistically to see whether change in those processes are leading to the change in the outcome we're interested in. So there are also very interesting ways in clinical trials where you can learn not just about outcomes, but about the mechanisms leading to change in the outcome. And those are sort of more explanatory trials. You can build that

in. We're very keen on that. So the methodological issue really is simply that you can't blind the person to know and they get some form of help in a psychological therapy. But other than that, all the normal rigour of clinical trials we can do. You said, term psychological process. Can you just explain what that actually is? Yeah, so we're very keen to develop psychological treatments based upon the best psychological understanding of a condition. So, for example, in that fear of heights example, I was talking about this idea that is these misinterpretation of heights. For example, there's ideas that you're going to throw yourself off heights. Don't just want to. It's just what's called the call of the void. Lots of people

would have experienced that kind of feeling, almost by standing by a tube train, sometimes people are a bit like worrying about whether they're going to sort of rush off. They don't want to, but it's a fear, and it's a cognition. And we think that's important. We also think what actually happens is you've got this cognition of fear, and you build up all these defences, so you avoid going near heights, for example, and therefore you never test out your fear or you don't look at heights. And that way you think, well, I've only been saved because I've put up my defences.

So I've just named two psychological processes. There's cognitions there and there's defences, what we call safety-seeking behaviours. So in a clinical trial, you can measure both of those processes throughout, and then you can see whether change in those processes predicts change in the outcome, the overall fear of heights, for example. So there's a nice way of building to trials and understanding of mechanisms. So if we're seeing that time in VR can have a positive impact on our mental health. Should we then be concerned that, you know, the development of VR games or VR experiences

could have a negative impact on our mental health? Well, I mean, I think, as with anything, it's always about the content, same as social media and things like that. There's wonderful opportunities there, but there are also ways that it can cause difficulties. I think that's the same with VR. It's a bit, like I said earlier, the tech itself is not necessary in answer. It's all about the content. So certainly mental health treatment, what you do is you want to show it works and also you pay attention to any sort of adverse effects or side effects. So one needs to keep that in mind. But yes, of course, with all things, there's a potential for content that is that is unhelpful and can affect people's mental health badly. I think that's clearly possible. And are there any

side effects that you've found to this sort of therapy? No, we haven't. So the one in VR that one pays particular attention to is motion sickness. So if you don't, depending on the type of kit and the sorts of things you get people to do in VR, you can get motion sickness. And that's not very nice. So we try and design stuff to make sure we're not getting that. And that's one of our design sort of elements

we're always paying attention to to make sure we're not using VR in ways that could bring that on. But of course, and people have had this to use VR on phones, those sorts of more basic versions of VR can bring these sorts of things on, and that's not so nice. So that's probably the main one. But in a large trial, we're going on the moment, we're assessing a whole range of sort of more sort of minor ones, really,

as well about whether people are feeling any sort of dissociation or other sorts of unpleasant feelings from being in VR. On the whole, we're not picking up much of this at all, but it's crucial that we measure it. So we've got to certainly in that current trial, a large assessment going through a whole range of detail. So once that trial is over, we're better look at those data to see.

But on the whole, it seems it's rare. So I started working with VR, working with people with severe paranoia, and everyone was very worried that people would get paranoid about the kit. But we didn't find that at all. We found if you explain what the kit is and its purpose to people with severe paranoia, they get it and actually rather enjoy. getting access to sort of state of the art of VR equipment. So one has to pay attention to these sorts of concerns.

One needs to make sure one measures it in trials. But actually, we've found a real sort of positivity around VR treatments that I've not seen for any other sort of treatment. And are there any kind of precedence to a positive outcome or any particular types of people groups, things that you've noticed work better? Great question. So that's a question of clinical trials about moderation. Are there some factors that predicts the outcome? We've not found it in our studies. To date, though, the studies have probably been too small to necessarily detect that sort of subgroup. And certainly for fear of heights, it's very clear. It's just pretty much works for everyone. But in the larger trial we're doing with patients of schizophrenia, we'd be able to look at that sort of issue. But I don't think Winnis is expecting to find it. We're expecting that it should work for most people to some extent, but we all only in that when we've got the data in.

So it is a good question. Clearly, not everyone will respond. If there are ways of understanding that, that could then lead to enhancing and improving conditions. So it's a great piece of research one does, is to look, well, it's all very well it works, but it's not working for everyone, or it's not working.

It could work better for some people. Why is that? And one tends to both look at the clinical trial data, but also talk to people who've had the therapy to learn in depth about that as well. So in the current game change trial, we've got the PIN Foundation carrying out interviews with some of the participants to really explore that level. And we can then triangulate that with the trial outcome results. So in all psychological therapy treatment, one is always wanted to do better and one therefore not over only uses the sort of formal trial data, but does sort of more of a debrief with patients who've had it so you can learn from that. I mean, it's mental treatment. Obviously, we're all

realizing how important that area is. And there's a real passion, I think, to improve treatment and to listen to people who've had these conditions to learn from that. And you've mentioned a couple of conditions. So we've talked about depression and anxiety, but also paranoia and schizophrenia. Now, the first two are ones that we perhaps have maybe a better understanding of, but for anyone listening who maybe doesn't quite know the details of paranoia or schizophrenia, as that's the one that you're kind of looking at next, because you maybe just dive into those a little bit more. Yeah, so my main area really in research, even before VR, is about mistrust.

And that's probably quite topical at the moment where we can see lots of distrust around. There's a type of mistrust called paranoia, which is when you erroneously think that others are trying to harm you in some way, that they may be spreading rumors or they may physically harm you. And really, this is excessive mistrust. So we're interested in when people aren't trying to do that to you, because of course people can do bad things. So paranoia is when you have the ideas, unfounded ideas, that people are trying to do that. to you and there's a whole spectrum of severity in the population. So some people have it mildly. Lots of people have these sorts of thoughts. And of course, that's sensible because you have to decide whether to trust or mistrust. So this is perfectly normal sort of psychological processing.

But sometimes people can get rather too skew to be mistrustable and sometimes that can be paranoia. And when that becomes very severe in terms of you believe it very strongly and you get very distressed and impacts your life, it can be at the level of what we call it. persecutory dilution and that's the most severe end of the paranoia spectrum and that typically is considered a symptom of mental health conditions such as schizophrenia it's not the only symptom but it's often quite a key one used in diagnosis so paranoia is a particular type of mental health experience and it's and it's used sometimes at the severe end as part of the diagnosis of conditions in psychosis. And so how can VR therapy kind of counteract that mistrust?

Well, we've got great evidence that it can. So it is rather analogous to the fear of heights. What you've got is people who believe very strongly that when they're around other people, that they're going to do something bad to them. And therefore, typically they avoid other people, they may avoid eye contact. If they're out and about, they're going to rush around. And so what we do in VR, is enable people to drop these defenses and find out, well, what is going to happen when I'm around these computer characters? Are they going to attack me and do bad things? So we get people to spend time around others in VR.

We get them to make high contact, get up close. Again, push things that you wouldn't do in the real world, but to really learn it's okay. And of course, the VR people are having these thoughts, they're having the paranoid thoughts just as they would about real people, because VR triggers normal reactions, yet they've got this conscious awareness. They know it's a similar.

They can try things a bit differently, and they can think, well, maybe these thoughts aren't quite so accurate. Maybe actually it's okay. And then we get people to then do that in the real world. And in that way, we build up these new memories. It's all right to be around other people. And we've got some very nice initial data from a few years ago, and that's led to much larger trials that we're doing at the moment to try and to show that what we've seen at a smaller scale level will generalize. which we're pretty confident about. And so how many people could be helped by this?

How many people are there currently, like, were affected by paranoia and schizophrenia? Great question. So in the game change, what we're working on is there's people with schizophrenia. There's an end result that many patients get too scared to leave the house for a number of reasons. It might be just their fearing negative judgment from others. It might be paranoia. And about two-thirds of patients with schizophrenia have those sorts of difficulties, and there are over 200,000 people in England alone

who have a diagnosed of schizophrenia. So this could help many NHS patients. And how far away are we actually from this being an offered treatment, a commonly offered treatment? Well, that's another very good question. So there's different stages in treatment development. There's a whole bit about developing a treatment and showing it works.

And that's why I do a lot of my work. But then there's a whole area of getting something put into service. services and used. And that can, you know, be a major endeavor to what's called an implementation. So, you know, you've got to provide it. You've got to have staff trained to use it. And that can take sometimes as long as the treatment development phase. But in game change, we're trying to work very closely with implementation scientists who are doing a lot of studies about one of the barriers and facilitators to get these treatments into services. So we're already working very closely with the NHS to trying to get adoption as fast as we can.

There is no real technical hurdles here, but there is a bit about getting these new treatments into services. I mean, I think the reality is it's going to take a few years for all this to happen. It does take a lot to change systems sometimes, but I think there is a huge appetite for this kind of work. And in your opinion, will they ever replace human therapists? My view really is that we need more therapists. There are lots of instances where VR therapy is probably won't be suitable. There are lots of instances where there's a complexity there that you're going to need, a skilled, professionally involved.

But I think for many people, I think there is the possibility that they wouldn't need to see a therapist and that they could do these sorts of things at home. I mean, fundamentally, you can view VR almost as a sort of educational tool. And, you know, if you want to go and give a speech at work or something, then you could practice it in VR. And, you know, it's just as a sort of learning tool. And, of course, if you've also got social anxiety, then you could do the same practice and it will be even more helpful

and it will make you feel better about it. So there's a nice blending between, you know, just making, sure that you're doing things as well as you can do. So I think many of us in the future probably will be using VR for lots of things. Regardless of whether mental health disorder or even have a mild version, you could just use this just to sort of top up how you're performing. So I think it's a really nice way to normalize mental health problems and the need to think of our mental health and to try stuff. So I said before, I think all of this will come in the future. It's going to involve having the headsets at a price and at ease of use of quality.

But I think that will happen. Exciting. And I just wanted to go back to what you mentioned about mistrust. And obviously we have seen mistrust is kind of on the radar currently with all this talk of vaccines. And there's a lot, I'm sure you've seen online about them. Is there any way that you can see these two things overlap? your current work and the current situation?

Well, I've certainly been doing research with the Oxford vaccine developers here about people who are hesitant about vaccines. We've just been reporting on some work in the general population looking at how many people are, for example, mistrustful of the COVID-19 vaccines, but also why identifying the sorts of beliefs that drive that and also some of the longer-term drivers of mistrust. it's you know there are lots of reasons for it there are perhaps some ways that VR could be used we're not at the stage yet of doing that I think it says invitation I think at the moment

we're very much focused upon how do you present information accurate information strongly and well and what are the sorts of things that people need reassurance about so we're at that stage really of thinking about vaccine hesitancy. But, I mean, obviously, this is not the main explanation of vaccine hesitancy, but of course some people are just fried of needles. So potentially one could do some things in VR with needles, for example, but there's probably lots of other ways one could use VR potentially, although I think, of course, with just the sheer scale and timing of the endeavour ahead,

we're probably not going to be using VR for that at the moment. But interesting idea. I hadn't thought about that, but I perhaps should. And I just wanted to ask if all the work you've done over the years on this kind of thing, what's for you the biggest thing that it's taught you about mental health problems? For me, I think it is two things really. It's the powerful learning that takes place when you can go out and practice something. And within that, enabling people to have the confidence to try things in you

and have a new curiosity about things and to try things a bit differently. So it's kind of reinforced that key bit in terms of change. It's all very well. And it's all very well sometimes talking about changes, that one needs to make, but actually going in there and practicing it is crucial. And of course, talking about it in a room can be hugely helpful and part of the process of getting there, but sometimes it's about the action part of change and implementing that. That was Professor Daniel Freeman, talking about exciting developments in mental health

treatment using virtual reality. For more stories of science and technology innovation, including the ideas you need to know about in 2021, pick up the latest issue of BBC Science Focus magazine or head to ScienceFocus.com. If you've enjoyed this episode of the Science Focus podcast, please do leave a review wherever you're listening to us. Thank you for listening to the Science Focus podcast from the BBC Science Focus magazine team. With the UK's best-selling science and technology monthly, available in print and in several digital formats throughout the world, find out more at sciencefocus.com or look out for us in your

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