The Executive Suite: VR could soon bridge the access gap in mental health

The COVID-19 pandemic has led to a mental health crisis that the healthcare system is not staffed to address. Today, more people are in need of mental and behavioral healthcare than ever before: according to a global study conducted last year, the prevalence of major depressive disorder and anxiety disorders have increased by 28% and 26%, respectively, since the beginning of the pandemic.

This dramatic rise in demand for mental health services has overwhelmed a healthcare system that was already under-resourced. Psychotherapists are working around the clock to manage their swelling patient lists. In this field, saying “no” to people seeking treatment for themselves or their loved ones can be uniquely challenging. How do you turn down a mother whose child was discharged after a suicide attempt? How do you make a referral to another mental health provider when you know their waitlist is just as long as yours? Unfortunately, most of us have had to have these tough conversations with people who need our services. As therapists, we need another way to get people the treatment they need.

In response to increased demand for mental health services, a flurry of digital solutions have flooded the market. Many of these solutions are designed to be low-intensity, low-touch; they’re mental health apps and tools that provide guidance in mindfulness and meditation. They aren’t designed to treat people with full criterion mental health diagnoses, and they don’t require the touch of a mental health professional. They are a great resource for people who have more mild symptoms, are waiting for a psychotherapy slot, or are using them to supplement full-scale treatment. Other solutions, like teletherapy, are designed to be high-intensity, high-touch; they offer platforms that help connect patients to actual therapists. While these platforms bridge gaps in access to care and can help patients avoid waitlists, they still depend on the existing workforce.

Virtual reality (VR) may be the magic antidote to mental health’s supply-demand crisis. It is a high-intensity, low-touch alternative: it has the ability to create immersive intervention experiences built on the foundations of empirically-supported psychotherapies without heavy reliance on psychotherapists.

VR could revolutionize the way people experience therapy

When people think of VR in a mental and behavioral health setting, many visualize receiving therapy from a practitioner virtually. This is a misconception.

Twenty years ago, therapists began utilizing VR treatments for exposure therapy, the front-line intervention for avoidance, because it offered better control over a patient’s environment than traditional treatment (treating aerophobia virtually is much easier and more cost-effective than joining patients on round-trip flights). Even then, these were not freestanding interventions featuring virtual therapists. Rather, they were enhancements to in-person therapy; patients would sit in an office with their therapist and were exposed to their fears and phobias using VR.

We have made incredible progress with VR in the mental and behavioral health space since then, thanks to advancements in simulative technology and a greater understanding of the neuroscience of VR. As VR becomes more commercially viable, VR solutions for mental and behavioral health will become much more accessible, independent, and flexible than traditional modes of psychotherapy.

Theoretically, the effective mechanisms of action of in-person CBT would still be active in virtual CBT programs. Effective CBT typically focuses on understanding and treating problematic behaviors, physiological sensations, and emotion-driven thinking. Many of the CBT exercises people practice in-person with a therapist can be translated into guided, immersive experiences in VR. Instead of receiving prompts from a therapist, a patient would be guided through these mechanisms by intelligent software.

The enhanced focus induced by VR immersion acts as an attentional anchor, and could increase the impact and efficacy of mindfulness meditation, an effective intervention for lowering sympathetic nervous system arousal. Good mindfulness meditation practice can help people cool off their fight-or-flight stress by being more present in the moment, by focusing on their breathing, by imagining themselves in a peaceful, safe environment. A psychotherapist might ask a patient to imagine themselves sitting on the bank of a river as they work through their practice. VR can guide people through the practice of mindfulness meditation with the added bonus of complete immersion. You are not imagining yourself on the bank of a river. You are on a virtual river bank.

From there, VR programs may be built to work on the same cognitive reframing mechanisms a patient would receive in person. Cognitive therapy can be challenging for many patients in-person, as it calls for meta-cognition. In other words, a patient needs to think about their own thoughts. If this is not administered expertly by a psychotherapist, patients may feel like their therapist is just telling them new thoughts that they are supposed to have, and they may internally discount these new ways of thinking. In VR, a patient can potentially interact with their thoughts in a more visual and immersive way that may make it easier to learn cognitive reframing techniques.

The ability to manifest your thoughts, to be fully present with them, to judge them on your own without battling with therapist-driven reframes, has the potential to revolutionize psychotherapy and provide much-needed treatment to those who may not otherwise have access to it. Over the next few years, primary care providers should keep an eye out for opportunities to refer or recommend freestanding VR treatments for patients who need CBT, but may not have access to a traditional therapist.