Mental illness has finally come out of the shadows. Once shrouded in stigma, as a society we’re gradually getting used to the idea that psychological problems are a normal part of life and that those affected have the same right to treatment as they would if they were suffering from sciatica or pneumonia.
But though mental illness is common – a quarter of us are likely to experience a problem over the next 12 months – there’s a big problem when it comes to access to treatment. We’re not short of effective, evidence-based psychological therapies. What we lack is the skilled clinicians to deliver them.
The ramifications from this ocean of distress aren’t merely personal; the socio-economic consequences are profound. Nearly half of all ill health in working age adults in the UK is psychological. Mental illness costs the UK economy £28 billion every year — and that’s excluding NHS costs.
The Success of OxfordVR’s Fear of Heights Application
Can VR help overcome this bottleneck? The clinical trial of OxfordVR’s fear of heights application – the first ever automated VR treatment for a psychological disorder – suggests that it can.
Instead of a real-life therapist, a computer-generated avatar – named Nic – guided users through a cognitive programme designed to help them overcome their fear of heights. Trial participants had lived with their fear for, on average, thirty years. Yet after just four or five 30-minute VR sessions, their fear had reduced on average by two thirds – which is better than one would expect from first-rate in-person therapy.
Let’s look a little closer at the excellent results that were produced and some further details on the trial itself. We conducted one of the largest randomised controlled trials of fear of heights treatments, the trail consisted of gathering one hundred people with a fear of heights and offering some sufferers VR therapy and others no treatment and then comparing the two datasets. The VR group spent two hours in VR over five treatment sessions and generally, the results were successful with all participants in the VR group showing a reduction in fear of heights (with an average reduction of 68%). Half of the VR group saw average reduction rate of over 75%. This is a relatively inexpensive treatment which users respond positively to, VR allows users to directly interact and confront their fear of heights in the safe space of the virtual world.
Richard’s Case Study below exemplifies the incredibly high potential of virtual reality’s use for the treatment of mental illness.
The Uses of Virtual Reality to Treat Psychosis
The challenge now is to move beyond treatments for phobias. How can VR help patients with the most severe forms of mental illness?
gameChange, a £4 million project funded by the UK National Institute of Health Research, is designed to tackle precisely this challenge. Led by the University of Oxford and Oxford Health NHS Foundation Trust and including partners such as the Royal College of Art, NIHR MindTech, Oxford VR, and several NHS mental health trusts, gameChange aims to help people with psychosis re-engage with everyday activities. The involvement in the project of the McPin Foundation means that people with lived experience of psychosis have been central to the design process, which has involved many hundreds of hours of patient feedback.
The issue is an urgent one: all too often, individuals with psychosis find day-to-day life so anxiety-provoking that they simply withdraw from the outside world. Menial everyday tasks — getting on a bus, doing the shopping, speaking to other people — become extremely challenging. Work and home life suffer. And mental and physical health deteriorate.
Psychological therapy can make a significant difference. But it needs to be the right kind of therapy. What works best is active coaching in the situations that trouble people, helping patients move beyond their fears. However, this is easier said than done. It requires skilled therapists with the time to get out and about with patients. And patients often find the idea frightening. The result is that a potentially powerful treatment is seldom actually delivered.
gameChange and the Future of Therapeutic Treatments for Severe Forms of Mental Illness
VR, of course, is perfect for this kind of therapy. Over six half-hour sessions, gameChange users will learn to overcome their anxiety in sophisticated simulations of the situations they find stressful. We do this in a graded way, so patients aren’t presented with activities they really can’t handle. With Nic’s guidance they’ll learn that, contrary to their fears, they are safe and they can cope. In effect, the treatment is automated, making it a low-cost yet effective complement to existing care.
Patients find it easier to do this work in the virtual world – and they enjoy using our VR applications. As one of gameChange’s pilot study patients commented: “It’s an incredible experience.” But though VR scenarios are clearly artificial, research suggests that the benefits will transfer to the real world.
gameChange will be tested later this year in a large multi-centre clinical trial in NHS trusts across England. All being well, patients across the NHS will in time have access to the treatment. This will mean a huge expansion in the number of psychosis patients able to benefit from evidence-based psychological therapy. More generally, it will signal VR’s value for treating severe mental illness: a game changer indeed.