The ins and outs of virtual reality-based care in behavioral health

Risa Weisberg, PhD, a primary care psychologist and the chief clinical officer at BehaVR, connected with Becker's to dive into an emerging mental health treatment: virtual reality-based care. 

Note: Responses have been lightly edited for length and clarity.

Question: Can you explain the technology behind BehaVR?

Dr. Risa Weisberg: BehaVR makes virtual reality-based digital therapeutic and wellness programs that are built upon psychological science. We take psychological interventions and mechanisms of action that have been repeatedly proven to be effective for the treatment of mental and behavioral health problems when delivered by a human therapist and turn them into virtual reality experiences. For the most part, this means that we build treatments based on cognitive behavioral therapy as well as gamified, graded exercise and movement. We leverage the power of VR to create simulated, sensory experiences that our brains process as real. By replacing what patients see and hear, we can create experiences that trigger emotional responses such as fear and anxiety to perform exposure therapy, relaxation to promote a sense of calm or to assist in learning of mindfulness practices and enjoyment and fun to promote movement in the treatment of chronic pain. We also utilize voice-to-text technology, which enables patients to see and interact with their spoken thoughts, which is helpful for learning cognitive intervention techniques.

Q: Is it better for treatment of certain mental disorders than others?

RW: Virtual reality has long been used to deliver exposure therapy for anxiety disorders or posttraumatic stress disorder and to distract patients from pain. There is a rich body of research evidence supporting the efficacy of this work. More recently, with advances in virtual reality technology permitting for fully interactable, 360-degree environments, VR has been used to create gamified movement experiences for fitness or physical therapy. We are now able to build interventions for a wide range of disorders. Most tech-based mental health is simply an extension of legacy models of care, for example, clinician and patient engagement now via video, but this doesn't solve for the inevitable breaking point of supply not equaling demand, even when geographic collocation barriers are removed. We are creating a mechanism in which learning new behaviors and thought patterns is untethered from the constraints of in-person care while also eliminating the time restrictions of virtual clinician availability. 

For example, First Resort is our general wellness solution that leverages evidence-based cognitive behavioral therapy principles to help individuals work through feelings of stress, worry, sadness and fear. On the other side of the spectrum, gameChange is a solution for patients with severe agoraphobia that was granted breakthrough device designation status for serious mental illness from the FDA last year. We are developing other products for social anxiety, depression, chronic pain and opioid use disorder. Any problem that responds to exposure therapy, movement, mindfulness practice and/or cognitive therapy is a good target for VR-based intervention.

Q: How does it compare to artificial intelligence-based treatment?

RW: Virtual reality is a digital medium. AI is a technology for powering insights and experiences from data science. Neither one is an intervention in itself, and both will only be as good as the patient experience and the psychological science on which the interventions are based. They are also not mutually exclusive and will ultimately be applied together. Currently, the most common use of AI in mental health treatment has been to create interactive conversation to deliver therapy. Some of these mostly provide emotional support, but some are providing cognitive behavioral therapy-based interactions. The effectiveness of most of these approaches is still being studied. Our VR-based interventions deliver cognitive-behavioral therapy not via simulating a therapist speaking with the patient, but by creating experiences with which the patient engages. The potential in the future to integrate AI into VR interventions is something we are exploring, and AI is already proving to be very powerful for many of the processes used in creating our products. 

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