An April 2021 survey by the Centers for Disease Control and Prevention (CDC) cited significant increases in respondents showing symptoms of anxiety disorders. Healthcare workers have reported high rates of post-traumatic stress disorder (PTSD) during the pandemic—a February study of 1,000 frontline workers reported that nearly one-quarter showed likely signs of the disorder. In contrast, only 6.8 per cent of the general population ever experiences PTSD in their lifetime, according to National Institute of Mental Health estimates. Long story short, mental health conditions are on the rise due to the COVID-19 pandemic, among many other factors.
The toxic stress of lockdown and the constant uncertainty of the past year created conditions for widespread anxiety, which, for many, have just been added on top of already existing reasons. As virtual reality technology improved over the years and headsets became more affordable, academics started seeing its potential in helping to treat PTSD. Can VR exposure therapy really treat people dealing with trauma by making them relive it?
Although recreational VR headset sales to the general public have grown during the pandemic, the technology has yet to fully enter the medical mainstream. Experts who study VR therapy argue that’s about to change as clinicians look for effective and accessible ways to treat anxiety disorders.
Many VR therapies build on a somewhat divisive therapeutic technique called ‘prolonged exposure’, developed by Edna B. Foa, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine. Prolonged exposure is a cognitive intervention therapy—patients first describe a traumatic event to a therapist, in great detail and in the present tense, and then confront triggers of the traumatic event in the real world.
“While some experts have worried the practice might overwhelm or re-traumatise patients, prolonged exposure is now widely accepted as an effective tool to treat chronic PTSD,” writes The New York Times. With ‘practice’, patients become desensitised to their memories and end up proving to themselves that their thoughts can be safe. If you overcome something in VR, you basically overcome it in real life too.
For now, direct-to-consumer virtual reality therapy products remain rare, and only a few are covered by insurance in the US. Looking into whether the technology truly works and what patients who’ve tested it have to say, The New York Times spoke to US veteran Chris Merkle who, after years spent struggling with the invasive symptoms of PTSD, decided to give VR exposure therapy a try.
Understandably, building up the courage in order to agree to try a virtual reality simulation that would mimic his days in combat took Merkle some time. “I was like, you want to put me in a virtual world, reliving my worst days, my worst nightmares?” he told The New York Times. Months later, after his symptoms intensified and he felt desperate for a solution, he finally agreed.
At a Department of Veterans Affairs hospital in Long Beach, California, Merkle strapped into a headset and sank into the past. The details in the simulation were extremely precise, he said: the military-issue truck, the weight of the model gun in his hand, the dark swath of sand in the night. He narrated one particularly troubling incident out loud to a clinician, who adjusted the simulation as he spoke. “I was seeing that person shooting at me, that I hadn’t thought about in 10-plus years,” Merkle said. He was terrified. But when he took the goggles off, he said, the sense of accomplishment became its own form of comfort. Confronting the past in VR proved to him that he could survive revisiting his memories.
After about seven runs through the simulation, Merkle started uncovering fragments of memory his mind had blacked out, which is a common response to trauma. The treatment was working—he was less scared of his memories, and therefore less scared of himself. “He was getting better,” writes The New York Times.
Although VR exposure therapy should not be seen as a miracle solution, for some patients, it offers convenience and can immerse them in scenes that would be hard to replicate in real life. While a significant amount of funding on virtual reality’s therapeutic potential has focused on military veterans, researchers are ready to start treating civilian trauma.
During the pandemic, Johns Hopkins researchers have used the technology to reduce stress and burnout in medical workers. In one unpublished study, 50 nurses from a COVID-19 ward tested virtual reality mindfulness exercises (guided meditations beside animated fields and waterfalls) and all but one participant reported reduced stress levels.
In the UK, the NHS announced in March 2020 that it will offer a new virtual reality treatment for patients with social anxiety. Meanwhile, researchers are also testing whether they can alleviate childhood social anxiety with virtual reality programmes, one of which uses animated AI bullies that growl things like “give me your lunch money.” Virtual reality also looks promising for treating phobias. As more people grapple with the pandemic’s aftermath, it certainly looks like VR therapy might be needed for civilians ASAP.
The US army has faced a growing problem in its rank for decades now. According to Pentagon data, between 2014 and 2019, the suicide rate for active-duty troops rose from 20.4 to 25.9 suicides per 100,000. In 2019, there were 7,825 reports of sexual assault involving service members as victims, according to The New York Times. In the last three months of 2020, suicides among National Guard troops nearly tripled to 39 from 14 over the same period the prior year.
But how do you prevent militaries from committing suicide or sexually assaulting each other? You train members of the US army to intervene whenever they see alarming signs. Which tools do you use for this very specific type of training? Virtual reality (VR) headsets. At least, that’s what the Air Force is testing at the moment.
Years of prevention training—often in the form of somnolence-inducing PowerPoint presentations—have done little to reduce the rates of either problem. Whether the VR model can ultimately do better remains an open question, but military officials are encouraged by the early self-reported responses to the training.
So far, over 1,000 Air Force personnel have participated in the training, reports The New York Times. 97 per cent of those who tried it would recommend it, and trainees reported an increase in the likelihood to intervene with a person in crisis, Air Force officials added. Among those ages 18 to 25—a generation more used to interactive virtual experiences make up the majority of new recruits—the impact increased sevenfold. Officials intend to train at least 10,000 airmen with the programme this year.
The VR programme is based on the fact that intervention by bystanders has been approved by experts as one of the few effective tactics for both problems. If they witness harassment in a bar, for instance, or alarming messages on social media representing a suicide threat, then they’ll know how to approach those problems tactfully.
The programme places airmen in related scenarios with photo-realistic actors and coaching on which responses would be constructive and which may not. “You are an active participant. You have to be ready. I think that it is going to help airmen retain and remember knowledge,” said Carmen Schott, the sexual assault prevention and response programme manager for the Air Force’s Air Mobility Command. He continued, telling The New York Times: “We don’t want people to feel judged. They may not make perfect decisions, but they will learn skills.”
In the military, many barriers can get in the way of people trying to intervene—especially against someone of a higher rank. As of now, airmen going through the programme have only been interacting with suicidal virtual colleagues via their headsets. Another bystander programme, which will roll out in July, will place the users in a bar, watching a scene of sexual harassment unfold.
But this VR programme is not the only educational tool with more of a hands-on approach. Gamification seems to also play a crucial part in successful and impactful teaching. With the growing use of computer-based therapy in mental health and promising results seen in the use of gamification in psychotherapy, the push to gamify sex education is part of a broader movement—deploying video games to target health issues ranging from depression to tobacco use.