"Virtual and augmented reality will be increasingly common in psychology and mental health"

Ivan Alsina-Jurnet is psychologist, university lecturer and specialist in the use of ICT applications in psychology, mental health and education. He offered a conference organised by the CORE Mental Health at the Institut de Neurociències on how these technologies can help specialists in their professional practices.

05/05/2016

"We've seen users experience virtual situations as real. This helps patients confront their fears in a protected, controlled and safe environment. And the psychologist is provided with a simple tool which can be integrated into the protocols of traditional treatments."

Alsina-Jurnet designs applications for two technologies which he does not hesitate to qualify as “disruptive” for these disciplines: virtual reality and augmented reality. At the conference he gave at the INc he spoke on how these could help professionals evaluate, monitor, treat and study different psychological and mental health disorders.

- In psychology and mental health, are virtual reality and augmented reality newly applicable technologies?
- They are not new, but they are the two most recent and disruptive technologies existing today. The costs of applying them have gone down in the past few years and they are increasingly used in clinical psychology, neuroscience, psychotherapy and mental health, given that they can induce emotions, reactions and thoughts which are practically identical to they ones appearing in real-life situations. Therefore, it is possible to bring into the professional office or research lab elements, situations and contexts which are very similar to those existing in the daily life of patients.

- How do they work?
- Both of them play with the concept of presence as a key factor. Virtual reality introduces the user to a totally virtual environment, while augmented reality brings virtual elements into the real world. Both place patients in clinically relevant situations which are related to their pathology. The key is that we have confirmed that the user experiences these virtual situations are real, whether that be inside a place when they are afraid of flying or being in open spaces when they suffer from agoraphobia. Unlike the real world, however, we can help patients confront their fears in a protected, controlled and safe context. For the psychologist, this is a simple tool which can be integrated into the protocols of traditional treatments.

- Since when are they used in psychology?
- The first virtual reality system was used in the United States in 1992. But until only a few years ago these technologies were too expensive for users. The equipment could cost up to 100,000 euros, which makes it absolutely inaccessible. Now, all professionals can have their own virtual or augmented reality equipment and use it for different purposes.

- What price are they now?
- The most popular and standard good quality devices being used now are virtual and augmented reality helmets, which connect to the computer. A few years ago, these helmets could cost several thousand euros. Now, they can be found for six hundred to nine hundred euros. But the new tendency now is to use a smartphone and 3D glasses, which can cost anywhere from five to twenty euros, depending on their quality. The smartphone is put inside the glasses, so that way users can have their own virtual or augmented reality equipment.

- Are they really effective in treating mental disorders and pathologies?
- Hundreds of scientific studies have been conducted and show very good therapeutic results and clinical efficacy, both in psychology and in neuroscience. In fact, over twenty years of controlled studies endorse the efficacy of virtual reality in the treatment of psychological disorders.

- What types of disorders are currently treated?
- The most frequent disorders are still those related with anxiety. Especially in the field of phobias, which is where it was first used and on what the majority of companies focus their applications. However, as time passes, more complex disorders are being assessed and treated, such as social phobia, agoraphobia, post-traumatic stress, etc. Now there are even applications to treat eating disorders, such as anorexia and bulimia. Another area in which this is arousing much interest is in addictions, although for now the applications that exist are all in English, which makes it difficult when working with non English-speaking patients and in places where there are high levels of tobacco and alcohol consumption.

- How does an application to treat addictions work?
- The functioning of these applications is similar to that used for anxiety disorders. Patients are exposed to and must confront situations and contexts related to the use of the substance, a virtual bar for example. Within this contexts, the psychologist applies the treatment techniques they consider most suitable, such as relaxation techniques, cognitive restructuring, assertiveness and other social abilities, etc.

- Are they also used to treat neurodegenerative diseases, spinal cord injuries or strokes?
- Yes, in these cases the applications are aimed at rehabilitating the motor and cognitive abilities of the injured parts. The applications usually use a motion capture system to carry out different types of tasks. These tasks can include different exercises, levels of difficulty, etc.

- Can all the applications be downloaded on smartphones?
- This is the current trend and it is where companies developing virtual and augmented reality applications in the fields of health sciences are headed. In the sector we see a gradual decrease of applications for computers. In my opinion, smartphone applications and 3D glasses will win this race. These applications are cheaper and easier to use by professionals, and this makes them perfect for clinical visits.

- And they can also be used on tablets?
- Yes, but these devices have focused on applications in cognitive rehabilitation and stimulation. In the field of psychological assessment and treatment, it is more important to use helmets or 3D glasses. What is ultimately the objective is to "transport" the patient to the situation making them feel uncomfortable.

- Are these applications commonly used in Spain?
- No, basically for the economic reasons I mentioned earlier. There are still very few applications which can be used with inexpensive devices. And not to mention that professionals are not familiarised with these technologies and their use in mental health. Unfortunately, training in this area is still scarce.

- Would you say they work better than traditional methods?
- Firstly, I must say that these technologies do not suppose a change in paradigm in the field of mental health. They are simply new tools professionals can choose from in addition to the wide variety of tools and techniques already at their disposal. In my opinion, virtual and augmented reality must be integrated into the protocols of traditional treatments.

Nevertheless, both technologies offer a series of benefits and lines of improvement in psychological treatment. For example, they are especially useful in patients with little imagination because it helps them experience a problematic situation in a clear and concise manner. Having them live these experiences for real would be too complicated for economic reasons and time, confidentiality, etc. In these cases, a good alternative is to use these emerging technologies, which have demonstrated to have the same effectiveness as live experiences.

In the case of psychological assessment, the main limitation of traditional tests is that they present isolated stimuli with no context. That makes it fairly complicated to apply results to the daily life of patients. Virtual reality and augmented reality, in contrast, allows us to represent surroundings, complexities and even social interactions existing in the real world. That makes it possible to increase the external and ecological validity of traditional tests.

- To what extent are health professionals interested in these technologies?
- There is a real demand and interest on behalf of professionals. Nevertheless, the main problem is the scarcity in training in this field. The more familiarised they become and the more applications offered, the more these technologies will be used in daily clinical practices.

- Is there any risk that patients begin to treat themselves?
- The majority of applications are created to be used within normal treatment protocols and therefore require a professional-patient contact. However, an interesting line of development would be the creation of applications a mental health professional could "prescribe" to their patients to be used at home. In any case, applications in the mental health field must always be used under the direction and guidance of a therapist.