𝗧𝗮𝗯𝗹𝗲 𝗼𝗳 𝗖𝗼𝗻𝘁𝗲𝗻𝘁𝘀:
Neuroscience and Four Use Cases
Patient Education & Health Professional Training
Preparing the Senior Care Workforce
Mental Health, Therapy & Addiction
Pain Management and Future Directions
𝗣𝗮𝗿𝘁 𝗢𝗻𝗲: The Neuroscience and Four Use Cases
For the past few years, we have been watching, and working to facilitate, the evolution of virtual reality (VR) in healthcare. We even built a 𝐋𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐇𝐮𝐛 where we collect and curate peer-reviewed basic science research. In that time, we have witnessed the expansion of VR across healthcare as the number of use cases and success stories seemingly grow by the month, day, and experience.
In this report, we discuss the neuroscience behind VR and show that VR is effective because it broadly engages multiple learning and performance systems in the brain in synchrony. We then discuss 𝗳𝗼𝘂𝗿 𝘀𝗽𝗲𝗰𝗶𝗳𝗶𝗰 𝘂𝘀𝗲𝘀 𝗰𝗮𝘀𝗲𝘀 in healthcare where we see VR providing the greatest good.
𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗽𝗿𝗼𝗳𝗲𝘀𝘀𝗶𝗼𝗻𝗮𝗹 𝘁𝗿𝗮𝗶𝗻𝗶𝗻𝗴: Medical procedure and device training, hospital familiarization, and empathy building.
𝗦𝗲𝗻𝗶𝗼𝗿 𝗰𝗮𝗿𝗲 𝗮𝗻𝗱 𝗰𝗮𝗿𝗲𝗴𝗶𝘃𝗲𝗿 𝘀𝘂𝗽𝗽𝗼𝗿𝘁: education and training around cognitive, emotional and physical changes with normal aging and dementia, empathy building.
𝗠𝗲𝗻𝘁𝗮𝗹 𝗵𝗲𝗮𝗹𝘁𝗵, 𝘁𝗵𝗲𝗿𝗮𝗽𝘆, 𝗮𝗻𝗱 𝗮𝗱𝗱𝗶𝗰𝘁𝗶𝗼𝗻: PTSD, depression, substance abuse and addiction.
𝗣𝗮𝗶𝗻 𝗺𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁: alternatives to opioids or during painful medical procedures like venipuncture, or cancer treatment rehabilitation
We will end with a few closing remarks on what we consider to be very promising and plausible future directions based on what we have learned and experienced along the way.
Let’s begin with the question driving our collective curiosity: Why is virtual reality so effective in the first place? It is all in the neuroscience.
“Learning is an experience. Everything else is just information.”
This quote from Albert Einstein is supported by the neuroscience of learning and performance, and is the primary reason why VR is so effective in healthcare. As we explain below, all four use cases outlined above require broad based engagement of learning and performance systems in the brain. Education and training in healthcare — whether for patients, professionals, seniors or their caregivers, to give just four examples — are specifically about “learning”. Much of mental health and therapy is about the “unlearning” of destructive behaviors, such as drug use, or the “unlearning” of perseverative behaviors like rumination. Even pain management is about “learning” to redirect one’s attention from something painful to something enjoyable.
As outlined in Figures 1 and 2 below, the human brain is comprised of at least 𝙛𝙤𝙪𝙧 𝙙𝙞𝙨𝙩𝙞𝙣𝙘𝙩 𝙡𝙚𝙖𝙧𝙣𝙞𝙣𝙜 𝙨𝙮𝙨𝙩𝙚𝙢𝙨. As Einstein so eloquently stated, experience is at the heart of learning (and performance).
𝗙𝗼𝘂𝗿 𝗟𝗲𝗮𝗿𝗻𝗶𝗻𝗴 𝗦𝘆𝘀𝘁𝗲𝗺𝘀
The 𝙚𝙭𝙥𝙚𝙧𝙞𝙚𝙣𝙩𝙞𝙖𝙡 𝙨𝙮𝙨𝙩𝙚𝙢 has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory (Figure 1). Every experience is unique, adds rich context to the learning and is immersive. The critical brain regions associated with experiential learning are the occipital lobes (sight), temporal lobes (sound), and parietal lobes (touch/smell). In other words, the experiential regions cover a vast expanse, neuroscientifically speaking. Experiential learning might represent the sights, sounds, smells and tactile aspects associated with a hospital, emergency room, or post-acute care facility. It also might represent the sights, sounds, smells and tactile aspects of a war zone, the street corner where an addict normally gets their “fix”, or the facility where a patient receives chemotherapy. At its core, experiential learning provides the context and scaffolding that grounds and contextualizes learning.
Figure 1. The Experiential and Cognitive Learning Systems
Figure 2. The Emotional and Behavioral Learning Systems
The 𝙘𝙤𝙜𝙣𝙞𝙩𝙞𝙫𝙚 𝙨𝙮𝙨𝙩𝙚𝙢 is the information system (Figure 1). It processes and stores knowledge and facts using working memory and attention. Critically, these are limited resources and form a bottleneck that slows learning with more information coming in and available to the learner. This system encompasses the prefrontal cortex and hippocampus. This is the “everything else” aspect of learning that Einstein alluded to. Unfortunately, this system is slow to develop, not reaching maturity until an individual is in their mid-20s, and it begins to decline in middle age. In addition, processing in this system is adversely affected by anxiety, stress and pressure. The cognitive system processes the information you see in most traditional media: in an anatomy and physiology textbook; in onboarding and training manuals for new direct care hires; in a senior’s list of medications; in a breakdown of the pros and cons of dialysis modalities; in the definition of empathy; and in the list of symptoms of alcohol abuse, PTSD or depression. Despite the processing limitations, developmental changes, and susceptibility to stress and anxiety in this system, much of our traditional training relies almost exclusively on this system. This explains why so much training is ineffective and time-consuming.
The 𝙗𝙚𝙝𝙖𝙫𝙞𝙤𝙧𝙖𝙡 𝙨𝙮𝙨𝙩𝙚𝙢 in the brain has evolved to learn motor skills (Figure 2). This is an amazing system and one that builds the “muscle memory” needed to achieve goals. The detailed processing characteristics of this system are fascinating but beyond the scope of this report. Suffice it to say that the critical brain structure for behavioral learning is the striatum, and processing in the striatum is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback. Behaviors that are rewarded in real-time are more likely to occur again, and behaviors that are punished in real-time are less likely to occur again. This system links rich experiential contexts (represented by the experiential learning system) with the appropriate behavioral responses. It is one thing to know “what” to do (cognitive information), but it is completely different (and mediated by different systems in the brain) to know “how” to do it (behavior). For example, you might want to train a nurse to care and maintain a central line, a surgeon to perform heart surgery, a senior care worker to “show” empathy verbally and non-verbally and to see the signs of sundowning, an addict not to “use”, a veteran not to get anxious in situations that remind them of combat, or cancer survivor to use relaxation and mindfulness techniques as alternatives to manage pain.
The 𝙚𝙢𝙤𝙩𝙞𝙤𝙣𝙖𝙡 𝙡𝙚𝙖𝙧𝙣𝙞𝙣𝙜 𝙨𝙮𝙨𝙩𝙚𝙢 in the brain has evolved to provide rich motivational and emotional context and to train situational awareness (Figure 2). Situational awareness is about nuance, but nuance that is vital to success. Whereas one can have all of the facts and figures available, and can have a strong behavioral repertoire, in the end one has to extract the appropriate information and engage the appropriate behavior in each distinct situation. One needs to know what to do, and when. The critical brain regions are the amygdala and other limbic structures. Emotional learning and situational awareness are critically important in healthcare. Healthcare workers must know how to respond quickly and accurately under high stress conditions, and when time is of the essence. The frontline senior care worker must know how to diffuse a contentious situation, at the same time knowing how to show sincere empathy toward a senior who is sundowning. Mental health professionals must have a deep and intimate understanding of a broad range of mental health conditions (e.g., addiction, PTSD, depression, and anxiety) and at the same time know how to “read” a situation and do the right thing.
Although each of the four learning systems in the brain are distinct, they all reside within the same brain with massive, dependent interconnections. In nearly all healthcare situations information needs to be stored and retained (cognitive), motor skills must be perfected (behavior), situational awareness must be strong (emotional), and all of these must be present within the relevant work context (experiential). In other words, ideally all four learning and performance systems in the brain should be activated 𝙞𝙣 𝙨𝙮𝙣𝙘𝙝𝙧𝙤𝙣𝙮. This is the power of virtual reality in healthcare — one experience at a time.
𝗣𝗮𝗿𝘁 𝗧𝘄𝗼: Patient Education and Healthcare Professional Training
The goal of all hospital administrators and medical personnel is to provide the highest quality of care that results in the best possible health outcomes for their patients. Increasingly, this drive for value also means improving a now-measurable patient experience. Ensuring healthcare providers are highly-trained and competent in all critical aspects of their given domains will surely increase qualitative measures of patient satisfaction, but this is only one part of the equation. Crucially, experience itself centers around a patient’s understanding and familiarization with the upcoming medical treatments and procedures.
Satisfied patients understand their medical needs and upcoming medical procedures because their healthcare provider offers high-quality education and training tools. Healthcare providers with satisfied patients are the providers who know how to impart knowledge effectively on patients, and critically have the people skills needed to put patients at ease throughout their care journey. Without high-quality education and training, patients feel ill-informed and lack confidence, all of which breeds stress, anxiety, and mental and physical discomfort before, during, and after the point of care.
Unfortunately, the overwhelming majority of both patient education and provider training is done through reading text, viewing PowerPoint presentations, or watching videos. As our neuroscience review suggests, these load only on the 𝙘𝙤𝙜𝙣𝙞𝙩𝙞𝙫𝙚 𝙨𝙠𝙞𝙡𝙡𝙨 𝙡𝙚𝙖𝙧𝙣𝙞𝙣𝙜 𝙨𝙮𝙨𝙩𝙚𝙢 in the brain when a better approach would be to broadly engage experiential, cognitive, emotional and behavioral learning systems in the brain in synchrony. While some hands-on simulation training is provided — such as when a patient needs to care for a new medical device like a colostomy bag, or a surgeon learns to conduct a specific surgical procedure — this training is often time intensive, costly, inconsistent, location-dependent and unable to scale. More of it would be valuable, both in terms of availability and bandwidth, but rarely fits in the budget or infrastructure.
Patient and healthcare provider education and training is ripe for the application of modern technologies such as VR that broadly engages multiple learning systems in the brain in synchrony. Patients will get the high-quality experiences that they so desperately need to feel informed, confident and to reduce stress and anxiety. Healthcare providers will also get the high-quality experience that they need to feel better informed, and to obtain enhanced people and communication skills.
𝗙𝗼𝗿 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻
Suppose you are diagnosed with cancer of the large intestine and you need surgery to remove part of it. Ultimately, you will be fitted with a colostomy bag. You can read documents and watch videos outlining the surgical procedure, the pre-operative preparation and post-operative recovery, and the steps to follow to care for the colostomy bag. This entire sequence is processed purely by the 𝙘𝙤𝙜𝙣𝙞𝙩𝙞𝙫𝙚 𝙨𝙮𝙨𝙩𝙚𝙢 in the brain. Instead, imagine an interactive storytelling approach using virtual reality. Suppose that a 360 VR experience was created in which you meet a colon cancer survivor who has been using a colostomy bag for years. The patient, along with a nurse, walks you through the hospital, showing you the patient waiting rooms, touring the operating rooms, and even a typical recovery room. Then, the patient talks you through the procedure from firsthand experience, the whole time emphasizing that she has walked in your shoes while dispelling myths and pointing out a few tricky parts of caring for a colostomy bag. Following your surgery, you might get a new VR experience that shows you how to care and maintain the colostomy bag at home with the same patient as your guide. Through a combination of first- and third-person perspectives, you begin to feel more confident and less anxious now that you are familiarized with aspects of what to expect during the course of your treatment and care.
As a second example, suppose you are a patient with chronic kidney disease (CKD) and end-stage renal disease (ESRD) who has been on dialysis for several months. You have met a few patients at the dialysis center who have switched to a home dialysis modality, so you want to learn more about it the next time you talk to your nephrologist. Though you have read some of the materials and watched a few videos, you still don’t feel like you have enough information to make a confident decision — it’s a big change. Now let’s consider an interactive storytelling approach with virtual reality. Suppose that a 360 VR experience was created in which you experience in-clinic and in-home dialysis from a first-person perspective (i.e., that of the patient) and a third-person perspective (i.e., that of a loved one or friend). While immersed in this experience, a narrative unfolds for you that describes the relevant steps involved in this new modality while the patient is experiencing them, and also includes a narrative regarding the decision making process and factors to consider when discussing this choice with your care team. At the end of the day, this is an important decision, and one that patients ought to be able to make confidently, which only comes through a deeper understanding of what to expect.
In both the colon and kidney care examples, the interactive, immersive VR experience broadly engages multiple systems in the brain. You feel like you are there and you feel like you are gaining the requisite experience to get through whatever’s next, to make the right decision for yourself, and to live a good life. You are satisfied; you are confident; and you are less stressed.
𝗙𝗼𝗿 𝗛𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗣𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀
The VR applications for healthcare providers are many. Suppose you are a medical student faced with the problem of learning the anatomy and physiology of the human body. The human body is a 3-dimensional structure that functions as a dynamic system. Unfortunately, most traditional medical visualization tools are textbooks or slide shows that are filled with 2D static images. Thus, the learner must convert a series of 2D static images into a 3D dynamic mental representation in the brain that accurately reflects the human form. This relies exclusively on the cognitive processing system in the brain, is very challenging and is fraught with the potential for error. Now consider a VR solution where a 3-dimensional, dynamic representation of the human body appears in front of you. You can walk around the body and can rotate it so that you can see it from all angles. You can select a skeletal view and when you touch a bone its name appears. In this case, you have a highly accurate 3-dimensional dynamic VR visualization tool that is intuitive and facilitates the development of a highly accurate 3-dimensional dynamic representation in the learner’s brain. Those resources can be used to learn the names of the bones, muscles, arteries, etc., but with a rich visual mental representation upon which to attach them.
The same logic holds for procedures such as caring and maintaining a central line. The most common approach to central line care and maintenance training is to have learners read documents describing in detail all of the required steps. Again, this focuses exclusively on the cognitive processing system and is error prone. Now imagine going in VR and being transported into an immersive setting in which you are watching someone care and maintain a central line in a virtual world in real-time from either a first-person or third-person view.
The cognitive load is instantaneously reduced and visual representation areas in the brain are engaged. Learning will be enhanced, quicker and more robust.
People skills and empathy are what set a healthcare organization apart from the rest. These skills are hard to train with traditional approaches, but VR offers an excellent medium. The ability to “walk a mile in a patient’s shoes” can not be overstated. Imagine a nurse-in-training donning a VR headset and “walking a mile in the shoes of a patient”. They can obtain a first-person virtual experience of the stress and anxiety that a patient feels when someone is explaining a procedure to them and they don’t understand all of the jargon and terminology. They can experience what it is like to be a patient interacting and communicating with an empathetic nurse and with a nurse who shows little empathy.
Analogously, a nurse-in-training might be transported into the middle of a busy emergency room and shadow a seasoned nurse explaining a patient’s condition to their distraught spouse. Using voice-over, the seasoned nurse might explain how they are showing empathy to sooth the concerns of the spouse. The nurse-in-training is in the situation and can feel the emotions. They can combine the information provided by the seasoned nurse with the behaviors they are observing, all within an emotion-laden, realistic experience. This engages multiple learning systems 𝙞𝙣 𝙨𝙮𝙣𝙘𝙝𝙧𝙤𝙣𝙮 and will build empathy quickly and effectively.
𝗦𝗶𝘁𝘂𝗮𝘁𝗶𝗼𝗻𝗮𝗹 𝗮𝘄𝗮𝗿𝗲𝗻𝗲𝘀𝘀 is also effectively trained in VR. Because VR training platforms allow the learner to obtain extensive practice, a broad range of situations can be trained. Situations that the medical personnel will experience on a day-to-day basis can be trained, but other, extreme conditions can also be trained. These come in many forms. For example, common situations can be trained, but under time sensitive conditions, or with sub-optimal equipment or in sub-optimal environments. Imagine the EMT who must deliver a baby in the back of the ambulance, without some critical piece of equipment and with a mother whose blood pressure is dangerously low.
Patient and healthcare provider education and training is ripe for the introduction of interactive, immersive virtual reality education and training technologies to complement existing training tools and to build satisfaction, confidence, empathy and situational awareness. These tools educate and train through experience.
Put plainly: VR builds critical knowledge and expertise — one experience at a time.
𝗣𝗮𝗿𝘁 𝗧𝗵𝗿𝗲𝗲: Preparing The Senior Care Workforce
By 2030, 25% of Americans will be 65 or older by 2030 (U.S. Census). Approximately 90% of baby boomers aim to age-in-place, but these numbers drop when physical and mental deterioration sets in. In a recent LeadingAge survey, 40% of baby boomers said they wanted to live somewhere other than the place they currently call home if they had a physical disability impacting their day-to-day lives, and 70% want to be in a staffed senior care facility if they have dementia and need help with daily activities. These statistics suggest a growing need for senior care professionals, with the direct care workforce expected to grow from 4.4 million to 5.8 million--an increase of 30%-- from 2016 to 2026. This places a heavy burden on staffed senior care facilities to 𝗿𝗲𝗰𝗿𝘂𝗶𝘁, 𝗼𝗻𝗯𝗼𝗮𝗿𝗱 and 𝘁𝗿𝗮𝗶𝗻 direct care workers to meet the complex needs of seniors.
Unfortunately, high-quality education and training can be difficult to find, harder still to replicate, and in too many cases, minimal and often ineffective training is provided. When training is made available, it usually comes in the form of textbooks, training manuals, or classroom-based instruction that engage only the cognitive skills learning system in the brain. A more effective approach would be to broadly engage experiential, cognitive, emotional and behavioral learning systems in the brain in synchrony.
The question becomes: how can we do that in a way that is at once complementary to existing methods, while also more consistent, accessible, scalable and available on-demand?
Senior care education and training are ripe for the application of modern technologies like virtual reality (VR), which broadly engages multiple learning systems in the brain in synchrony by transporting learners into realistic situations. What better way to understand how a candidate might react in a challenging scenario; or to help guide new and experienced hires through the rigors of caregiving? VR can be fruitfully applied at every stage of the caregiver’s journey: from recruitment to onboarding and continuous training for the direct care workforce.
VR can be used to enhance frontline senior care recruiting efforts for the direct care workforce, from certified nursing assistants (CNAs) to non-clinical home health aides and the myriad roles in between. With turnover rates ranging from 45 – 65%, giving potential recruits a better understanding of the nature of the job through VR experiences would be advantageous. Imagine having a recruit put on a VR headset and experience a “Day in the Life of Caregiving” where they watch the rules being followed or broken — along with the consequences for each path taken.
Users might shadow a seasoned professional who is mitigating a fall, or experience the many challenges associated with memory loss. They might also have VR experiences that emphasize communication, responsiveness, and empathy by allowing the recruit to “walk a mile in a senior’s shoes”. Learners can obtain a first-person virtual experience with an apathetic or non-communicative frontline worker, or obtain a first-person virtual experience of the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes.
These “walk a mile in my shoes” experiences are visceral. They engage emotional and experiential learning centers in the brain that quickly and effectively build empathy. Recruits who are not “cut out” for this kind of work will choose a different line of work, or perhaps will not be hired in the first place. Those who are ultimately hired will have a better understanding of what to expect and show higher levels of confidence. The hiring professional can rest assured that the frontline worker is prepared and that the residents will receive excellent care.
Research suggests that new hires decide whether to stay at a job long-term within a few weeks of being hired. Studies show that effective onboarding can improve retention rates by 52 percent, time to productivity by 60 percent, and overall satisfaction by 53 percent. Imagine using the “Day in the Life of Senior Care” VR experience during the onboarding process.
This can begin with a virtual tour of the facility to familiarize the learner, through experience, with the layout of the facility. During the virtual tour, standard operating procedures that are most relevant in a given location can be described by the CNA tour guide. During the tour the new recruit can witness a challenging situation between two residents or between a resident and a CNA. The recruit can observe as a seasoned CNA diffuses the situation, then offers the recruit tricks and tips on how to mitigate similar situations that they might face. The new recruit can even experience an emergency situation and observe the seasoned CNA follow the emergency protocols in a calm and methodical manner.
This “Day in the Life” experience could be followed by VR experiences focused on communication, responsiveness, and empathy. A series of VR experiences focused on dementia and memory care, sundowning, and physical changes associated with normal aging could follow. All of this training can be accomplished in a familiar, safe environment for the learner, which not only results in better prepared hires, but also goes a long way towards demonstrating an organization’s commitment to its employees.
Once the onboarding process is complete, the next step is to initiate an ongoing education and training program. The brain is hardwired to forget so ongoing training is needed to “train for retention”. VR, as a complement to an existing Learning Management System (should one be in place), provides the perfect tool for this. Ongoing training around the many physical, emotional and cognitive changes associated with normal aging is in order. Continued training on the important people skills needed to ensure that staff are responsive to residents, communicate effectively, and show the empathy required to provide the best care is in order. Finally, training on medical procedures such as proper care for a tracheostomy tube, drain, or central line are trained effectively with VR.
The senior care industry is ripe for the introduction of immersive, VR education and training technologies to complement existing training tools and to facilitate recruitment, onboarding, and continuous training. These tools educate and train through experience. Put plainly: VR builds knowledge and expertise — one experience at a time.
𝗣𝗮𝗿𝘁 𝗙𝗼𝘂𝗿: Mental Health, Therapy, and Addiction
Mental health issues are a serious problem in the United States. Over $200 billion in lost earnings per year are due to mental illness, with depression as the leading cause of disability in the U.S. among those ages 15 – 44. Depression is one of the top 3 workplace issues, along with family crisis and generalized stress. These problems are intensified in our many military veterans. Twenty-two military veterans lose their lives to suicide every day, and the rate of PTSD is 15 times higher among veterans than civilians. Most importantly, and tragically, the overwhelming majority of civilians and military veterans do not receive the treatment and therapy that they need.
Substance abuse and addiction are also a serious problem in the U.S, and often co-occur with mental health disorders. The National Institute on Drug Abuse reports that drug and alcohol abuse costs the U.S. economy approximately $600 billion in healthcare, criminal justice, legal and lost workplace productivity every year. There has been a recent upsurge in the prevalence of opioid addiction that has reached epidemic levels, and is of grave concern. Alcohol abuse has been and continues to be a major problem in the U.S. Although drug and alcohol rehabilitation are often successful at getting an addict “clean”, recidivism rates are high and relapse is the norm.
We strongly believe that anyone suffering from mental health disorders or addiction should seek professional help from medical professionals and mental health experts. At the same time, we believe that tools like VR show great promise as tools for mitigating mental health problems, facilitating therapy, and for “unlearning” addictive behaviors.
𝗠𝗲𝗻𝘁𝗮𝗹 𝗛𝗲𝗮𝗹𝘁𝗵 𝗮𝗻𝗱 𝗧𝗵𝗲𝗿𝗮𝗽𝘆
Psychological therapy, often supplemented with pharmaceuticals, is highly effective at reducing symptoms for most patients. One study shows that 80% of those treated for depression show an improvement in symptoms within 4 – 6 weeks of starting treatment. We believe, and a growing body of research suggests that VR can complement therapy in many positive ways. From a logistics standpoint, at most therapy sessions occur once a day, most likely for an hour. More often therapy occurs once a week or so. VR is available 24/7. If one is feeling depressed or anxious, they can don a VR headset and be transported to their favorite beach or to a forest landscape with soothing music in the background. Or one can visit Paris, the Great Wall of China, or even a galaxy far far away. Many mental health disorders are associated with feelings of isolation. With VR one can visit with friends and family in real time in virtual spaces, and feel that connection.
Applications of VR for PTSD and anxiety disorders are growing as well. In these cases, and most likely under the watchful eye of a mental health professional, a PTSD patient can be slowly habituated to anxiety and stress provoking environments but within VR. The “unlearning” of perseverative behaviors like rumination, anxiety and stress require multiple exposures to anxiety provoking situations. VR offers a perfect tool to address the need for multiple exposures because it is available 24/7 in almost any location. The number of mindfulness, relaxation, and mediation related VR experiences is growing. We fully expect the mental health community to embrace and continue to leverage these technologies in the coming years.
A typical 30- to 60-day inpatient rehabilitation program can cost anywhere from $12,000 - $60,000. Unfortunately, although addicts are often successful at avoiding destructive behaviors while in rehabilitation, and despite the best efforts of those in the health care system, relapse rates following drug rehabilitation remain high. From a psychological and neuroscience perspective, it is as if rehabilitation causes the abusing behavior to disappear but only temporarily. Once out of rehabilitation and back in society, the abusing behaviors return. The rehabilitation process temporarily suspends the bad behavior but does not induce true unlearning of the abusing behavior.
Although a detailed discussion of this topic is beyond the scope of this report, suffice it to say that the real culprit is context. The reappearance of addictive behavior once back home that a rehabilitation program was designed to eliminate (and did successfully eliminate within the rehabilitation context) suggests that the intervention did not induce true unlearning, but rather induced context-specific unlearning. The idea is that the rehabilitation center serves as a new environmental context, which causes new learning, rather than unlearning of the previously acquired addictive behavior. As a result, the addictive behavior reappears when the “rehabilitated” addict re-enters their original addictive environment.
Virtual reality offers a great tool for addressing this problem because with VR you can put the user in any context that you like. Imagine incorporating VR into the rehabilitation process by transporting an addict into a virtual environment that shares many of the contextual cues associated with their typical “using” environment. Now imagine incorporating some of the behavioral extinction or unlearning procedures, commonly utilized during rehabilitation, into this virtual environment. Since the addict is in a virtual environment that is similar in context to their “using” environment, true unlearning of the addictive behaviors within this virtual “using” context could take place. By incorporating VR environments that share many contextual cues with the using environment into the rehabilitation setting, true unlearning is more likely to occur. Unlearning requires many exposures, but VR offers a perfect tool to address this need as it is available 24/7.
The areas of mental health, therapy and addiction are ripe for the introduction of immersive, VR technologies to complement existing tools and to facilitate recovery from mental health disorders and addiction — one experience at a time.
𝗣𝗮𝗿𝘁 𝗙𝗶𝘃𝗲: Pain Management and Future Directions
Pain presents itself in various forms, some of which you might already be familiar with. And while there are several classifications and levels of intensity, separating pain by duration leads us to two types: acute and chronic pain. Acute pain is often managed with mild numbing agents, aspirin, ibuprofen, or as you likely have experienced, we simply “grin and bear it”. Chronic pain, which usually lasts longer than six months, is dealt with pharmacologically, and often with opiates.
Given the major crisis of opioid addiction in America, alternatives are desperately needed for managing chronic pain. Although the “grin and bear it” approach may be acceptable for some, pediatric medical professionals are turning to non-pharmacological alternatives to pain management for children. With nearly all children receiving immunizations from an early age, alternatives that can mitigate the pain would be advantageous for reducing the pain and anxiety associated with pediatrician doctor visits (or for adults with especially low tolerance to pain). Fortunately, non-pharmacological alternatives for pain management are on the rise.
VR offers a great tool for addressing problems of acute and chronic pain management by putting patients in a rewarding virtual context that distracts them from the pain. Significant progress has been made on a number of fronts worth highlighting here.
With respect to acute pain management in children, especially around immunizations and venipuncture, much progress has been made. New VR solutions are being launched on almost a weekly basis, with many of these showing great promise. Some of the most exciting applications actually transport the child into a virtual world where they can play a highly-interactive game. The nurse running the virtual therapy has a display screen so that she has a shared view with the child in real-time. At a point of maximum distraction for the child – often built into the game narrative intentionally – the nurse inserts the needle. Although anecdotal, many children report no feeling of pain or only a minor irritant that quickly recedes.
Solutions that address the more challenging problem of chronic pain, such as those involving back pain, cancer recovery and rehabilitation, or for burn victims during dressing changes continue to be explored and tested. Despite significant challenges, progress is being made. Patients have been able to reduce, and in some cases cease completely, their reliance on addictive drugs like opioids. Applications for pregnant women while in labor are being explored to reduce the need for and reliance on epidurals.
Pain management is an exciting area that is ripe for the application of immersive, VR technologies. Solutions for acute pain in children, and for chronic pain sufferers of all types are growing in prevalence and are easing people’s pain — one experience at a time.
𝗦𝘂𝗺𝗺𝗮𝗿𝘆 𝗮𝗻𝗱 𝗙𝘂𝘁𝘂𝗿𝗲 𝗗𝗶𝗿𝗲𝗰𝘁𝗶𝗼𝗻𝘀
The use of VR technology in all aspects of healthcare is increasing. In this report we outline four use cases that have grown significantly in the last several years. In all cases, the success of VR can be attributed to the way in which it engages the user’s brain. The success of VR applications in patient education and healthcare provider training, senior care and caregiver support, and mental health, therapy, and addiction are all grounded in the fact that VR broadly engages experiential, emotional, cognitive and behavioral learning systems in the brain in synchrony. The majority of other tools and technologies recruit only cognitive systems in the brain, and are thus much less effective. In pain management, VR has the capacity to transport an individual from the pain that they are experiencing to another place where they do not experience the pain. Whether activation in pain centers is reduced, or whether the user is simply being distracted, the outcome is a reduction in pain.
The future of VR in healthcare is bright. Although not discussed in detail in this report, one of the biggest advantages of VR is the ability to collect a broad set of data quickly and efficiently. Whether subjective ratings of satisfaction and confidence, or objective tests of one’s knowledge or ability to make the right decision, data collection is straightforward and simple. Other measures like eye gaze patterns can also be examined. Because eye gaze and eye fixation provide a window onto attentional processes, at a minimum these can be used, along with subjective and objective measures to optimize VR content.
As other technologies come on line such as real-time and natural haptic interactions, olfactory cues, and AI-driven real-time voice and facial recognition, the use cases for VR will grow. We are especially excited about advances in medical device training, surgical training, and communication, and empathy training.
The future of VR in healthcare is bright, and we look forward to being a part of this future – one experience at a time.