Speaking of Psychology - Improving lives through virtual reality therapy (SOP19)

Episode Date: January 12, 2015

Advancements in virtual reality technology have not only led to improved experiences for people who enjoy video games but they are also treating very serious psychological and physical disabilities. In this episode, psychologist Albert “Skip” Rizzo, PhD, discusses research into the effectiveness of virtual reality therapy and how this technology can improve the therapist-client relationship. APA is currently seeking proposals for APA 2020, click here to learn more https://convention.apa.org/proposals Learn more about your ad choices. Visit megaphone.fm/adchoices

Virtual reality technology is not just for gamers. Over the last decade, research into advanced virtual reality therapy techniques has shown it to be effective for people with physical and psychological disabilities. A psychologist at the forefront of this research tells us how virtual reality is helping people literally face their fears and learn to overcome them. I'm Audrey Hamilton, and this is Speaking of Psychology. Skip Rizzo is the director for Medical Virtual Reality at the International. Institute for Creative Technologies and a research professor at the University of Southern California.

He conducts research on the design, development, and evaluation of virtual reality systems, focusing on clinical assessment, treatment rehabilitation, and resilience. Welcome, Dr. Rizzo. Hi. Thank you for having me here. Your work in developing virtual reality therapies focuses on combining advancements in computer technology with psychological science. How is virtual reality therapy being used in clinical settings right now? Right now, the biggest use of virtual reality in clinical settings is probably an area of exposure therapy,

and that is probably because the technology is well matched to the needs of the clinical application. We see with exposure therapy the goal really is about helping a patient, whether it's due to a simple phobia or PTSD, to engage, to confront and to process difficult traumatic memories. Now, in the traditional format, you typically do that in imagination alone, but when you have a disorder where avoidance is one of the cardinal symptoms, sometimes patients may need a little extra boost. So if we can put them in simulations that mimic or resemble some of their traumatic experiences and do it in a gradual yet progressive hierarchical fashion, then it really is well matched to what the need of the clinical approach is. Can you give us an example of how exposure therapy works and how the virtual reality therapy works in this type of therapy? Well, exposure therapy has been around for quite some time. It's a behavioral approach that's been applied initially for persons having fear of heights, fear of flying, fear of spiders.

And the therapist typically guides the patient in imagination to gradually get closer and closer to what it is that they fear. and by a process of extinction learning, which is basically face your fear and it becomes less frightening once you're actually confronted by it. What happens is patients lose that sort of irrational fear. Now we're talking about fears that aren't real, in real life kinds of fears. I mean, we're not trying to get somebody to jump in through traffic or, you know, do swim with sharks or anything like that. that. We're talking about things like we're, you know, somebody that lives in New York City but has a fear of snakes and they won't leave their house, even though there's probably very unlikely

chance there's any snakes in LA, I mean in New York, aside from Wall Street. But maybe I should have a better example there. You know, these are fears that debilitate people and functioning in their everyday life. So the fear of flying, you know, it's pretty safe to fly. compared to driving in a car actually. But people that are fearful of flying, if they do exposure therapy, typically you get a very good treatment response where they confront that fear in the therapy session

and it carries over to their real life. And VR, what we try to do is to help that process along by putting people in simulations of their feared environment and then systematically making it a little bit more provocative once they've attained a certain level. So if it's fear of flying, they're in a plane and they're flying along. They can turn their head and look around, see the passenger, look next to them, look out the window.

But then once they've gotten through that, then maybe you want to introduce a little turbulence or a thunderstorm, and we can do that with the technology and make it a little bit more scary. And the longer we can get the patient to stay with it, all of a sudden that fear kind of fades away. It extinguishes, as we call it. psych literature. And it carries over from the virtual environment, which is very similar to the real world in a lot of ways, so that people can now start taking flights and not being as

frightened. Other than exposure therapy, are there any other clinical settings where this is being used? Pain distraction is a big area where VR makes a big difference because if you put somebody in a virtual reality headset, you're occluding their view of the wound site, and while they're getting their daily wound care, say for burn victims, they're engaged in playing a game, and they're in their own world, so to speak, so that what you see from the research is dramatic decreases in the perception of pain, and there's a lot of theory behind why that happens, but it works, and people spend less time between pain delivering sessions, like with the daily wound care, thinking about pain, worrying about pain. So that's one area where

We've seen dramatic clinical results. We also see results in assessment, you know, where we're putting people in simulated environments and asking them to respond in a cognitive fashion. So, for example, with children with attention deficit, hyperactivity disorder, we've built virtual classrooms where we can put kids in the classroom. They have to pay attention to what goes on

on the blackboard or what the teacher says. Meanwhile, we got kids sit next to them fidgeting, throwing paper airplanes, maybe a school bus driving by a window. So we can begin to measure cognitive performance under a range of challenges, but also the challenges of the everyday life environment of the classroom, where distraction is a lot different than if you're testing a child in a quiet office environment, you know, the therapist's office or a clinician's office. It sounds like virtual reality therapy has come a long way.

How has work with military veterans, particularly those who served in Iraq and Afghanistan encouraged more research into this type of therapy for conditions such as post-traumatic stress disorder. So what happened in around 2003 as the Operation Iraqi Freedom Adventure took place, we started seeing more and more people coming back with PTSD and the military recognized this as well. And so they began to focus on novel treatments, ways to get people. engaged in treatment. And virtual reality was one of those areas where they were well familiar in the military with simulation technology for training, but not for clinical care. So it was new to them, but they started seeing the results from

civilian literature showing that you get a good clinical outcome using virtual reality in this area. So they funded significantly a lot of the basic research to develop these applications and to test them. And so we began building a virtual Iraq and Afghanistan simulation around 2004 and have progressively grown the application based on feedback from clinicians and patients that we've treated and have gone through probably four iterations now to a very high fidelity environment that It has smells. It has...

Really smells? Yeah. We can... Bad smells. Yeah, not good one. You know, diesel fuel, rotting garbage, burning rubber, things like that. But we created a multi-sensory environment so that we can help a patient who's typically avoidant to go back and confront and process those difficult emotional memories and get a good

therapeutic outcome. So we're really basing the use of virtual reality on the evidence-based treat. of trauma-focused therapy, prolonged exposure, or cognitive processing therapy, or EMDR, where people really are encouraged to confront the things that emotionally hurt them initially and to process them in different ways. So that's an example of where the military has really driven the technology and the application, but now we stand poised to translate that to civilian applications. So the first thing you think of is urban warfare with the police department or firefighters

or victims of terrorist attacks. We've got the technology to do this, and a lot of that has to do with the urgency of war driving a need to develop better treatments for PTSD in the military population. You have said that virtual reality therapy can help reduce the stigma of mental health treatment. Can you elaborate on that? Why do you think that is? Well, if you look at any virtual reality environment, at first blush, it looks like, you know, call of duty, or it looks like any common game that, you know, people play for entertainment. And our view has always been that if you want to draw a digital generation of service members into treatment, why not use some of the things that they're more comfortable with as a draw? So the idea of using virtual reality to deliver. liver exposure therapy was in one part informed by theory that we knew we were working from an

evidence base with traditional treatment but the other part was the idea of maybe getting a 20 year old that played a lot of video games growing up to look at this and say wow you know I can I can maybe get some help and this almost almost kind of looks like fun but in reality once they try it. It's not a game anymore. Right, right. Because we're really, we're really pushing them to. But it gets them in the door a little easier. Yes. Yes. So, and I think, you know, you can say the same thing in the future for, for everybody, whether they're service members or not. Millennials, the current generation, younger generation coming up, you know, this is a ubiquitous

technology that they see everywhere. You know, clinicians at their peril may ignore this because they feel it may impair the therapist's client relationship. But actually, in some cases, I think it brings the therapist to a closer understanding of what the client has gone through. When a client is going through a simulation of a traumatic event, for example, the therapist is seeing it. I mean, they're seeing what the patient sees in the simulation, and then that becomes grist for the mill for discussion. And, you know, we are basing it on a traditional, you know, face-to-face format where the whole session isn't conducted in VR. There's, you know, 30 minutes in VR, and the rest of the session is processing what went on in the session. When a patient describes a scene and the clinician has a control panel where they can make elements of that description appear in the simulation,

all of a sudden, they're looking at it themselves and they're hearing the sounds of, maybe somebody screaming after an IED goes off or a jet flying over. And, you know, I think in some way, they're getting closer to the patient compared to just the patient's narration as they imagine it in their head. Well, great, Dr. Rizzo, thank you so much for joining us. Okay, thank you. Thanks for having me. To see video examples of Dr. Rizzo's work, please visit our website at speakingofpsychology.org.

With the American Psychological Association, speaking of psychology, I'm Audrey Hamilton.