After his father died from Covid last fall, Donkan Martinez was overcome with grief and turned to an unlikely outlet: virtual reality.
The 24-year-old found himself wading into an emerging field of virtual mental health care, through a service called Innerworld, which offers peer-led mental health support through its app. The idea is to bring the principles of cognitive-behavioral therapy, or CBT, into the metaverse and allow users to interact with others as anonymous avatars via voice and text chat.
CBT aims to help patients change unhealthy thoughts or behaviors by developing relevant skills and coping strategies. The American Psychological Association describes it as a form of treatment that helps people “learn to be their own therapists.”
Innerworld, however, gives everyday users the ability to support each other. Its founder, Noah Robinson, emphasizes that the service should not replace professional treatment. Upon registration, Innerworld users must acknowledge that they understand that the app is not therapy.
“It’s not therapy and we can’t provide crisis intervention,” Robinson said. “Our goal with Innerworld is to be a longer-term place where people can come and help them avoid getting to the point of being in crisis. Or we have people in the hospital who are coming out and looking for extra support. »
Upon entering Innerworld, users can choose from a variety of settings that emulate environments such as hiking trails or libraries. From there, they can chat with other avatars or browse a list of peer-led events, such as group meditation sessions, addiction support groups, and addiction management workshops. social anxiety. Martinez said he once joined a game where users guessed what others were drawing.
The effectiveness of Innerworld’s approach has not been studied, so collecting long-term data is crucial to evaluating this or any similar program, said Barbara Rothbaum, a psychologist at Emory University School of Medicine. . Rothbaum published an article on using virtual reality to treat fear of heights in 1995.
“When it comes to virtual reality, most apps now have used a real therapist,” she said.
Indeed, most therapeutic uses of virtual reality to date have focused on clinician-directed exposure therapy for conditions such as arachnophobia and claustrophobia, as well as social anxiety and mental illness. post-traumatic stress disorder.
However, Rothbaum added: “I really think [VR] might be useful for self-help, but the programs that were tested weren’t developed for that.
Skip Rizzo, director of medical virtual reality at the University of Southern California’s Institute of Creative Technologies, said he first recognized virtual reality’s potential for mental health in the 1990s. Rizzo helped pioneer the use of virtual reality to treat PTSD in the military. A 2005 report documented the case of a Vietnam War veteran treated with VR therapy who experienced a 34% decrease in clinician-assessed PTSD.
Rizzo said he sees the potential for Innerworld – as long as the app continues to make it clear that it’s not run by clinicians.
“People who are worried about the stigma around the problem they have, or who are ashamed, might not want to directly admit to another person that they have these problems,” Rizzo said. “But they might be more likely to do so in an avatar-based world where they can maintain their anonymity while still interacting with people.”
Martinez said he and other users he met on Innerworld felt they weren’t getting the empathy they needed in the real world.
“My real friends don’t know that I’m very emotional. I’m very conservative with my emotions with my real friends,” he said. “I can open up to Innerworld because I know I’m not going to be judged. I’m not going to be attacked.
Robinson said he was motivated to create Innerworld after finding solace in an online community in his own life. When he was 13, he says, he became depressed after realizing he was gay, and he turned to the online game RuneScape. The anonymity made him more comfortable exploring parts of himself he was afraid to face in the real world. Robinson said he finally came out to his friends online.
Innerworld isn’t the only program trying to use virtual reality to help people access mental health support.
In his own work, Rizzo pilots a clinician-facilitated virtual reality project that provides social support to Ukrainian refugees. Refugees who have moved to Bucharest, Romania, can enter a virtual version of a Kyiv city square, where they can talk with other refugees as anonymous avatars.
A startup called BehaVR, meanwhile, launched its app, called First Resort, last week. The VR app walks users through “chapters” on the skills that would be taught in CBT sessions.
Risa Weisberg, a professor at Boston University Chobanian and Avedisian School of Medicine, is the clinical director of BehaVR. She said that because people’s brains process virtual reality experiences the same as a real experience, “you don’t experience the interventions as something you read or hear; you experience them as something that happens to you.
Weisberg thinks that’s why VR exposure therapy has worked in the past.
Virtual reality reach could reach 64 million people in the United States this year, according to a 2021 estimate from eMarketer. Weisberg said the expansion comes at a time when more people are seeking mental health care, but also many are finding it. inaccessible due to high costs.
“It all comes together at the same time to make the next few years really ripe for getting mental health techniques and interventions in VR,” she said. “I think we’re going to see a huge increase in that area.”
Rizzo said his main concern with Innerworld, however, is that people who need professional help might try replacing the app instead. Rothbaum, meanwhile, said a lot more research is needed to determine if these types of programs really work. Ideally, she says, there should be clinical experiments with control groups that track user outcomes.
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