1Innovation and Research Department, Badalona Serveis Assistencials, Badalona, Spain.
2Clinical Researcher at IDIAP Jordi Gol, Barcelona, Spain.
Jose Ferrer Costa
Email: jfcosta@bsa.cat
Received : Jan 02, 2024 Accepted : Feb 09, 2024 Published : Feb 16, 2024 Archived : www.meddiscoveries.org
The escalating incidence of mental health disorders calls for innovative therapeutic interventions. Virtual Reality (VR) has emerged as a significant augmentation to traditional therapeutic strategies, including cognitive-behavioral therapy and exposure therapy. This technology creates immersive, interactive, three-dimensional environments specifically engineered for the treatment of mental health conditions such as anxiety, depression, PTSD, burnout syndrome, phobia and addictions. This mini-review highlights recent advancements in VR-based interventions, corroborating their efficacy and exploring their potential to revolutionize patient engagement and individualized care.
Keywords: Virtual reality; Mental health; Therapy; Burnout; Anxiety; Depression; PTSD.
The mind is involved in all human processes, even a mere contusion in a distal part of the body, causing initially only physical pain, is interpreted in the brain, implying in our minds an accompanying suffering that can be experienced as anxiety, worry, or fear. This interconnection between the physical and the mental realms forms the basis of our comprehensive understanding of health and well-being. In particular, the way we perceive and react to physical ailments often transcends the immediate sensory experience, engendering a complex psychological response. Mental health is a fundamental component of human well-being, and the disorders in this area are impacting approximately one in every eight individuals globally. This category includes a wide range of conditions that manifest as significant disruptions in thought processes, emotional regulation, or behavioral patterns, often leading to distress or dysfunction in key areas of daily life [1].
In 2019, 970 million individuals were living with a mental disorder, a figure that has since seen significant increases, particularly with anxiety and depressive disorders, which rose by 26% and 28%, respectively, in 2020 due to the COVID-19 pandemic. The global prevalence of mental disorders, such as anxiety, depression, Post-Traumatic Stress Disorder (PTSD), phobias, addiction and neurodevelopmental disorders, underscores the urgent need for innovative and effective mental health care [1].
The prevalence of conduct disorders in the general population varies, with lifetime rates ranging from 2% to 10% [2]. Over 40 million individuals, including children and adolescents, are living with conduct-dissocial disorder, characterized by persistent defiant or disobedient behaviors that violate societal norms or the rights of others. Effective psychological treatments involving parents, caregivers, and educators exist, emphasizing cognitive problem-solving or social skills training [1].
People suffering from mental disorders, disruptive behavior and neurodevelopmental disorders like ADHD and Autism Spectrum Disorder (ASD) can benefit from a range of treatment modalities including psychoeducation, psychosocial rehabilitation, family interventions, cognitive-based therapy, and more. Despite the existence of these effective treatment options, most people with mental disorders still lack access to effective care [3].
The complexity of mental health care extends beyond clinical treatment to encompass broader social factors such as education, employment, housing, and relationships. Understanding the role of these social determinants is vital, as they can be linked to both physiological and psychological stressors, and they are an essential consideration in both assessment and treatment planning [4].
The treatment of mental disorders requires an integrated approach, considering both physiological and psychological factors along with Social Determinants of Mental Health (SDMH). As emphasized by Lenz and Litam (2023), incorporating SDMH into therapy is vital, although its practical application is still evolving [5]. This broader understanding of mental health requires innovative treatments to enhance and personalize mental health care. The contemporary landscape of psychiatry is witnessing a transformational shift with the integration of augmented, virtual, and mixed reality technologies [6].
Virtual Reality (VR) has emerged as a cutting-edge modality in modern mental health care, offering new horizons in the treatment and management of various psychiatric disorders. By simulating real or imagined environments, VR offers a unique platform to integrate psychological interventions, creating an immersive and controlled setting for patients to explore and engage with their mental processes. VR offers a shift towards a more holistic approach that addresses not only symptomatology but also positive functioning [7].
a. Anxiety disorders: The integration of VR into anxiety treatment protocols offers a multifaceted and promising direction, enhancing existing therapeutic interventions. While the positive findings encourage the use of VR applications, the evidence also underscores the need for further research. The challenge lies in determining the precise roles and advantages of VR in promoting not just symptom reduction but also overall well-being and positive functioning. Careful exploration and continued innovation in this field will determine the long-term success of VR in meeting the complexities of anxiety disorders and mental health care.
Anxiety during minor medical procedures can emanate from two primary sources: the unknown nature of the medical environment and the inherent fear associated with the procedure itself. Even for individuals without a specific phobia concerning the procedure, the sheer fact of being in a medical setting contributes to situational anxiety, possibly linked to the fear of illness or the implications of the procedure [8,9]. This form of stress can be highly distressing for some patients and may even result in post-traumatic stress disorder. Recent literature demonstrates that the application of Virtual Reality (VR) can effectively manage both pain and anxiety during various minor medical procedures, for both pediatric and adult patients [8,11].
Virtual reality holds significant potential as a therapeutic modality for anxiety disorders. A recent review by Schröder et al. (2023) supports the efficacy of VR interventions for this pathology, particularly for Behavioral Assessment Tasks (BATs) related to social anxiety. Technological advancements now permit more interactive and realistic avatars, which can be operatorcontrolled in real-time. Notably, studies indicate that fear responses elicited in VR environments may actually exceed those in real-life scenarios. In this regard, VR appears to be a robust tool for inducing and measuring anxiety responses, potentially eclipsing conventional in vivo techniques. Some objective parameters like salivary cortisol levels, cardiovascular activity, and other physiological markers were found to be comparable in relation to VR and in vivo BATs [12,13].
b. Schizophrenia: A similar use of real-time controlled avatars is a transformative treatment for auditory hallucinations in schizophrenia named HekaVR. While conventional approaches often encompass medication and psychosocial therapies, they may not fully address the personalized nature of hallucinatory and delusional experiences. VR therapy provides controlled environments that emulate individual hallucinatory patterns, offering targeted therapy tailored to each patient’s unique experience. These controlled simulations offer a breakthrough therapeutic platform for mitigating hallucinatory and delusional symptoms in schizophrenia patients [14,15].
In a noteworthy contribution to the literature, a systematic review by Lan et al. [16] scrutinized over 2000 studies, shedding light on the promising role of VRT and AR in psychosis management. Their findings underscore the value of incorporating VRT into conventional treatment regimes, including medication and psychotherapy. The review found that VRT not only improved clinical outcomes such as medication adherence and motivation but also effectively aided in the diagnosis of schizophrenia. This substantiates the argument for the broader application of VRT in both the diagnostic and therapeutic aspects of psychotic disorders.
c. Depression: In depression, VR-based interventions focusing on self-compassion, positive experiences, and pleasure induction have shown encouraging results in decreasing depressive symptoms [17]. In populations where medication for depression may be less viable, such as those on hemodialysis, VR-based interventions offer an alternative route. The Joviality trial evaluates a 5-week VR-based positive psychological intervention aimed at reducing depressive symptoms in this group. The study’s rigorous design accounts for feasibility, acceptability, and a range of clinical outcomes, thus underscoring the transformative potential of VR in mental healthcare settings. [18,19].
Another promising avenue for mitigating depressive symptoms is the integration of VR-delivered interventions to promote exercise adherence, as supported by studies. Exercise and VR interventions individually have been shown to alleviate depression and enhance quality of life [19,20], and reduce both negative and anxiety symptoms [21].
d. Post-Traumatic Stress Disorder (PTSD): In the broader landscape of virtual reality applications in healthcare, the focus has largely been on establishing feasibility and acceptability. However, when it comes to Post-Traumatic Stress Disorder (PTSD), virtual reality has moved beyond these initial stages and has been increasingly validated as an effective intervention. Studies have shown that the incorporation of traumatic cues into virtual environments not only leads to significant reductions in post-traumatic symptoms but also contributes to alleviating associated issues like social isolation, depression, and anger. Yet, it’s worth noting that virtual reality as a stand-alone intervention may not address all aspects related to the disorder [22].
Research has shown its efficacy in reducing symptoms among diverse populations, including intensive care unit survivors and military veterans. Various approaches such as graded exposure therapy and multi-modular interventions have demonstrated positive outcomes. Studies have also noted the importance of optimal timing for intervention and the value of a strong therapeutic alliance. These advances underscore the maturation of VR-based methods from experimental to evidence-based therapies for treating PTSD [23-28].
e. Burnout and stress reduction: VR in stress relief and wellbeing promotion beyond the traditional psychiatric domains, VR has extended its utility to stress relief, encompassing stress related to COVID-19 and general well-being promotion. The creation of virtual natural scenarios and various relaxation protocols has shown efficacy in reducing stress, negative affect, and enhancing social connectedness. Moreover, interventions targeted at nonclinical populations, such as workers or college students, have demonstrated effectiveness in stress reduction and promoting positive functions.
f. Phobias and addictions: In the realm of phobias and addictions´ disorders, VR has enabled traditional exposure therapy to be delivered in a highly tailored manner. This method promotes learning new skills, encouraging increases in self-efficacy and mastery, fostering qualities such as courage, persistence, and goal setting. While Virtual Reality Exposure Therapy (VRET) has shown promising results in reducing symptomatology related to phobias and anxiety disorders, the improvement in positive functioning is still inconclusive, demanding further exploration.
The studies encompassing VRET and VR-Cognitive Behavioral Therapy (VR-CBT) reveal a nuanced and promising landscape: Phobias: Two notable studies assessed VRET in the context of SAD. Kampmann et al.’s study compared VRET with individual In Vivo Exposure Therapy (iVET) and found improvements in both but a greater decrease in symptoms for iVET. Another study demonstrated the feasibility of VR-CBT, with significant reductions in social interaction anxiety, depression, and improved positive functioning, maintained at follow-up.
g. Teaching soft skills to individuals with mental impairments: The application of VR in teaching soft skills to individuals with mental impairments offers a multifaceted and innovative approach. From immersive learning environments to personalized interventions, VR provides an extensive range of tools to enhance the quality of life and societal integration of those affected by mental impairments. Its flexibility, cost-effectiveness, and alignment with broader mental health strategies position VR as an essential and promising technology in mental health care and education.
| Aspect | Application of VR |
|---|---|
| Immersive environments | Creating realistic settings for safe practice of social interaction, communication, and emotional regulation. |
| Personalized learning | Customized content for cognitive, emotional, and functional development, emphasizing key competencies. |
| Enhancing social skills | Virtual training to foster confidence and resilience in real-life social situations. |
| Controlled exposure therapy for addiction | Providing controlled exposure to triggers, teaching coping strategies for addiction recovery. |
| Resilience training | Teaching mindfulness and emotion management techniques for stress and emotional challenges. |
| Community integration | Simulating real-world scenarios to understand societal norms and foster empathy, flexibility, and negotiation. |
| Personalized intervention | Modular design to tailor soft skills teaching to individual requirements and progression. |
| Evidence-based approach | Continual feedback and data-driven adjustments for effective interventions. |
| Cost-effective solutions | Extending the reach of training to a broader audience, including underserved areas. |
| Alignment with mental health strategies | Aligning with global mental well-being goals, positioning VR as a vital tool in mental health care and education. |
Analyze the potential benefits and challenges of using VR in mental health. Consider ethical considerations, accessibility, the need for trained therapists, costs, etc. Emphasize the collaboration required between technology developers, mental health professionals, and researchers.
The integration of Virtual Reality into mental health treatment represents a promising advancement in the field. Current evidence demonstrates the potential of VR to enhance traditional therapies by providing targeted symptom relief and fostering overall mental well-being. While findings from various studies, such as the one showing superiority of VR applications over waiting list controls in anxiety treatment, validate the approach, they also call for continued exploration and refinement of VR software and methodologies. Future success depends on the concerted efforts of researchers, clinicians, and developers in harmonizing traditional therapeutic principles with innovative VR technologies. With a careful and considered approach, the future of mental health care through VR appears promising, offering new avenues to meet the growing demand for effective mental health interventions.
