“We are Alfred” is a virtual reality program created by Embodied Labs to allow medical students to feel what it is like to be 74. The program allows them to experience both audio and visual programs. This, very much like my own OpticalSim, raises awareness for impairments, except in this case it is degenerative impairments.
“We Are Alfred” uses a virtual reality headset, headphones and a hand-tracking device to immerse users in live-action story from the perspective of the 74-year-old man named Alfred. The story consists of six, seven-minute scenes that span from a spilling wine to waiting in a doctor’s office all as Alfred, who has audio and visual impairments.
In a Scene called “Happy Birthday Song,” the user sees a large, dark patch in the middle of the screen, which is designed to resemble macular degeneration — the leading cause of vision loss for those 55 and older. The incurable disease affects more than 10 million Americans, which is more than cataracts and glaucoma combined.
This is exactly how I wanted my experience to be, but with more common visual impairments such as cateracts and lazy eye.
“We wanted something that was as accurate to the experience of somebody discovering that they have an impairment, their family confronting them about it and then them having to go act upon that discovery,”
Another story within the simulation called “Taking the Cognitive Test” deals with the disconnect that sometimes occurs between a young doctor and an elderly patient. In this scene, Alfred (and the viewer) struggles with the test, not because there’s something wrong with Alfred’s cognitive abilities, but because he can’t really hear what the doctor is asking him to do.
“I don’t remember what I’m supposed to do,” said one user after this scene in the below video. “I couldn’t really hear and I couldn’t see the test when he was describing it, so now I don’t really remember what I’m supposed to do.” If the user has to ask what they need to do, you can tell that the simulation is working.
The team at Embodied Labs decided to create “We Are Alfred” due to the increase in population over the age of 64. According to the Administration for Community Living, in 2014, the percentage of Americans 65 and older accounted for about 15 percent of the population. By 2040, they estimate that that number will jump to about 25 percent.
The average medical student, on the other hand, is 24 years old.
Embodied Labs wants to simply bridge that gap.
“The project is focusing on comfort,” Eric Swirsky, a faculty adviser on the project and clinical assistant professor of biomedical and health information sciences told UIC. “It’s not curing, it’s not curative, it’s not even treatment-oriented. It’s about comforting and understanding where the patient is so that you can be with him.”
Inspiration for my Project
I have found that many of those with Lazy Eye are children, and this is usually fixed easily by wearing a patch. I think I am going to move more towards creating my project around cataracts, and the build up of it over weeks. I really like the first person idea especially with the hand sensors which make you feel even more a part of the virtual environment and will implement it in my own world.
I really like this idea and that people were struggling with some of the tasks as this is the reaction I wanted with my own work. I feel that people remember things better and will talk more about an experience rather than another form such as a leaflet.
Recently Virtual Reality has been used to help teach and treat others. Virtual Reality is beginning to be used not only to teach surgery to new medical professionals, but is also used for therapy.
Home-based systems will soon be used to take standard procedures from inside clinical environments into the comfort of the patients home. By doing so, patients have the opportunity to work through after-care and therapy at their own pace, rather than being limited to appointment times. This relates a lot to the work VividVision are doing as they allow for the treatment of lazy eye to be done in the homes of patients.
The demand for VR group therapy sessions is already evident, with 52 per cent of consumers expressing a readiness to try virtual reality for group rehabilitation. By doing so, the sessions can provide a chance for those who are anxious and uncomfortable in traditional group therapy sessions to feel safe with anonymous avatars hosting and participating within the session. If VR were to be implemented in this nature, the more traditional face-to-face therapy sessions could begin to drop, taking pressure of this area of the healthcare service.
If the NHS were to take on VR as a means of therapy in the future they could save thousands, people would be hospitalised for less time also freeing up doctors and nurses.
Virtual Reality Therapy and Mental Illness
Psychological conditions and mental health disorders affect our daily lives, and cost an estimated $467 billion in the U.S. in lost productivity and medical expenses ($2.5 trillion globally).
For many disorders, there are highly effective treatments that don’t require drugs. But many doctors still tend to over-prescribe medications that are either not effective, have disturbing side effects or are completely unnecessary.
Can virtual reality become a global mental health treatment platform?
With the advent of affordable mobile VR headsets, there is a new opportunity to apply telemedicine to decentralize mental health treatment, reaching more patients and improving lives around the world.
A key challenge today is the lack of clinical evidence and data to support if and how VR can be used to administer effective treatment both in the clinic (expanded use) and remotely. Companies wishing to penetrate this market will need to conduct well-designed, randomized, controlled, properly powered clinical studies in order to change or influence treatment paradigms. There will undoubtedly be a flood of VR apps in the coming months and years attempting to solve these mental health issues.
For many disorders, there are highly effective treatments that don’t require drugs.
Some examples might include remote teletherapy by qualified practitioners who use VR as a supplementary tool, in-clinic VR therapy, virtual therapists created using artificial intelligence or patient-directed VR therapy in the absence of a professional therapist. It remains to be seen which options can deliver real, effective and sustaining treatment to mental health patients across the world, or even people with no diagnosable disorder who want to reduce generalized stress and anxiety in their lives.
Cognitive behavioral therapy and exposure therapy
Briefly, CBT is a psychotherapeutic treatment administered by a therapist trained in mental health disorders and specifically in CBT. Patients typically attend a limited number of sessions that focus on a specific problem, helping the patient identify, recognize and change disturbing thought patterns and feelings that are leading to negative or destructive beliefs and behaviors.
For example, if a person spends a lot of time thinking about plane crashes and accidents, they might avoid air travel. Or if they worry about how others perceive them in public, they may avoid social situations and become isolated, leading to depression and other issues. CBT can be thought of as a set of tools one can use to overcome these limitations, providing a way to cope with their thoughts and feelings effectively. Virtual reality is now convincing enough to simulate many of these anxiety-inducing stimuli, and is a safe, controllable and effective way to conduct various types of and CBT.
Treating PTSD using virtual reality
Virtual reality has been used fairly extensively to deliver prolonged exposure therapy (PET) for PTSD since the 1990s, mostly for the treatment of soldiers and war veterans. Dr. Albert “Skip” Rizzo, director of Medical Virtual Reality at the Institute for Creative Technology at the University of Southern California, is a leader in this field. His application, called Bravemind, was developed in partnership with Virtually Better, who sells the product to institutions around the world
Screenshot from the Bravemind Simulation
The Canadian government purchased two copies of this software in 2014 for $17,000 each. The system consists of various components, such as the VR environment, which is controllable and customizable, a vibrotactile platform, which delivers sensations associated with explosions and firefights and even a scent machine, which can emit smells like diesel fuel, garbage and gunpowder at specific times during the simulation to increase immersion. There have been a number of clinical studies (completed and ongoing) that investigate the safety and effectiveness of Bravemind.
Virtual Reality or Medication?
A recently published study found that the VR therapy alone was as good as a combination of drug therapy and VR therapy. In fact, one of the drugs studied led to a worse outcome for patients. This shows how viable it is as a type of therapy in the future. Military funding has allowed rigorous studies to be conducted. However, smaller private companies developing VR therapy applications with limited budgets must still demonstrate clinical efficacy if they hope to penetrate this market. I have spoken with one such company operating in the Netherlands who is attempting to tackle PTSD in a different, but scientifically based, way.
Virtual Reality and EMDR
Beyond Care is working on a VR software solution for PTSD based on the principle of eye movement desensitization and reprocessing (EMDR). EMDR works by having a patient recall a traumatic memory, then having the patient follow a moving object with their eyes only at the same time. The dual task of memory recall plus eye movement taxes the working memory, causing the traumatic memory to become less clear and vivid.
Eventually, after repeating this process, the memory permanently loses its ability to trigger such intense emotional responses. After a successful pilot study, Beyond Care is now coordinating a patient trial in partnership with a Dutch University and a company specializing in delivering specialized psychological treatment over the Internet. The results of this study will determine if the new VR desensitization and reprocessing therapy, called Beyond Care PTSD, works and, more interestingly, whether it can be successfully delivered virtually, under the semi-supervision of a therapist.
Treating phobias and anxiety disorders using virtual reality
Similar to PTSD, VR therapy has for many years been used in clinics for the treatment of phobias and other anxiety disorders. Anxiety disorders affect at least 40 million people in the U.S. and cost the country $42 billion per year. Because of the vast number of patients afflicted by some form of anxiety disorder, decentralization of treatment through telemedicine or self-guided therapy could make a huge difference.
There are already a lot of VR programmes already for Anxiety Disorders, these are shown below:
The Virtual Reality Medical Center has a system for treating those afraid of flying. It includes software and hardware, complete with airplane seats and a subwoofer system to mimic the sights, sounds and feeling of flying.
Virtually Better also has software to treat fears such as flying, heights, public speaking and storms. This company has partnered with leading academic institutions, research and treatment facilities to undertake new R&D projects concerning childhood anxiety and childhood social phobias.
Psious is a company in Spain that offers a clinical toolkit for therapists to administer and control VRET to treat patients with phobias; it includes VR hardware, a customizable software platform and biofeedback devices.
VirtualRet is another tool for psychologists and therapists to help evaluate and treat phobias such as public speaking, flying, heights, blood and public places. They provide a range of virtual environments, hardware and parallel services.
A company from Sweden called Mimerse is developing gamified psychological treatment tools for VR for the mass market in partnership with the Swedish Government and Stockholm University. Their first game, “Itsy,” is focused on treating arachnophobia without involvement from a real-world therapist. Coinciding with the game’s release on the Gear VR app store, a randomized controlled study is being conducted comparing VRET using Itsy versus real-world exposure therapy. Because the majority of phobia sufferers don’t receive professional treatment, mass market games like Itsy could offer immense value for individuals globally.
Virtual reality for stress relief and meditation
Whether or not a person suffers from a specific diagnosable mental health condition, most of us experience varying levels of stress and anxiety during our lives. Meditation is a great way for anyone to improve their mood and induce a state of relaxation. While meditation and relaxation may not be the sole treatment for any particular diagnosable condition, the general overall health benefits are thought to be positive for anyone, healthy or otherwise.
In addition to their work on phobias, Psious and VirtualRet also have solutions for generalized anxiety and relaxation. Another company developed DEEP, a unique meditative VR game where the user explores a strange and beautiful underwater world. The unique part is that the game is completely controlled through breathing (biofeedback). Correct breathing techniques are central to meditation and relaxation, and with the custom DEEP controller the user’s breathing coincides with what is seen in the virtual environment and controls how the user moves through it. There was also an interesting TED talk on DEEP which I have linked below.
The market for improving mental health through the use of VR has been well established based on decades of scientific research.
Bringing light to mental darkness
The market for improving mental health through the use of VR has been well established based on decades of scientific research. However, this market is still in some ways in its infancy as the technology to date has not been advanced enough to allow massive patient access across the world. We can see the majority of companies developing tools used by therapists to help treat patients in person. Hopefully soon we will see therapies that can be done at home safely with VR.
In a few years’ time there should be a lot more data available from clinical studies to properly evaluate these new treatment modalities in different psychiatric conditions. Until then, we are bound to see an explosion of apps making all sorts of different claims — some supported by data and some yet to be validated.
These personas are fictional, but help in showing my products intended users. This will allow me to put some faces to the audience, I have decided to use both students for my personas, but from different stages in education.
Personas are a good starting point for me and my work because it helps me to focus more on who my target audience are. It would be beneficial for me to get more feedback from real people so I can see the advantages and disadvantages of my product.
So that I keep on track with my project and don’t run out of time, I need to make sure that I have good time management. I created a Gantt chart so that I know how long I have to do each individual task, this will help me keep on track with my project in the long run.
Chris Milk uses innovative technologies to make personal, interactive, human stories. VR is the last medium for storytelling, he says, because it closes the gap between audience and storyteller. To illustrate, he brought the TED audience together in the world’s largest collective VR experience. You can take part with the audience by getting a Google Cardboard and downloading the experience at with.in/TED.
I found this talk really interesting for my project because it shows how VR can show not only simulations but is also a unique path into the emotions, senses and body. It implies you can connect with a user more intimately with Virtual Reality over another medium, and so making it easier to empathise with the users.
Chris says that VR can make anyone feel local, and unlike film you have to guide the users attention using sound.
One of the most interesting pieces of Milk’s was “Clouds over Sidra”. This is a documentary style VR experience based in a refugee camp. This gives us a look into the daily life of a schoolchild, which is along the lines of what I wanted to do but with someone with visual impairment. Milk says that “VR can make anywhere feel local”, and in this film you can see how this is possible. By taking the view of a 12 year old girl you really emphasise and feel for her and what she is going through.
