Depressed people can see negativity everywhere, even a passing glance from a stranger can be taken as disapproval. Researchers, using VR goggles, are aiming to let sufferers deal with their distressing thoughts rationally.Peopleimages
Two things surprised me when I faced Shane Warne's devilish googly on centre pitch at a packed MCG.
The first was that I lobbed the chisel-jawed celeb for six. The second was that, when the crowd stood up and roared approval, I turned to them and waved my bat in appreciation.
The virtual crowd that is.
I was, of course, dispatching Warney in an immersive virtual reality (VR) cricket game. But I had never expected it to be so lifelike I'd be hoodwinked into thinking those adoring fans were real.
Forget gamers. Mental health could be the real beneficiary of VR. Dr Greg Wadley, lecturer in the Department of Computing and Information Systems at The University of Melbourne along with his team from left to right, Ben Loveridge, Anchalee Laiprasert, Yunhan Li, and Associate Professor Reeva Lederman in the virtual reality room.Jesse Marlow
Until now, the gamer generation has pretty much had dibs on VR, but recent quantum leaps have made the technology so real that gamers may have to start sharing their coveted space with some rather tech-savvy mental health folk.
New studies under way at Orygen, The National Centre of Excellence in Youth Mental Health in Melbourne, and at King's College London, are harnessing dramatic improvements in VR to literally retool the treatment of depression and psychosis. The promise is that commercially available headsets such as the Oculus Rift and the HTC Vive will become fixtures in the consulting room, helping young patients to relive experiences that trigger mental health crises and to deal with them.
"The systems of five or 10 years ago were expensive and not particularly high quality," said Dr Greg Wadley, a lecturer in the School of Computing and Information Systems at the University of Melbourne and a researcher on the Orygen study.
"Now we've got these affordable, very high quality, very immersive systems. We think those systems have crossed a threshold, and that they're now a plausible technology to be used in a youth mental health clinic," said Wadley.
The study, which will take place at the Orygen centre in Parkville and recruit people aged 15-25, will use the HTC Vive kit. "It's very real, it's extraordinary. Everyone I've seen try it has a 'wow' moment where they think it's the most amazing thing they've ever done," said Wadley
Does this scene make you nervous? For many people, public transport is a source of anxiety leading to depression. Now, research using virtual reality goggles may change that. This scene is courtesy of Oxford University researcher Professor Daniel Freeman who has created a "virtual train". Oxford Cognitive Approaches to Psychosis, University of Oxford.
Psychologists have used VR for nearly two decades as a treatment for spider phobia, fear of flying and post-traumatic stress, where controlled exposure to a feared situation helps put a lid on the fear. But VR as therapy for depression and psychosis is only just beginning. And the bespoke virtual world created by the Orygen researchers will have some very high-tech tweaks.
In depression, negativity can be so pervasive that even a passing glance from a stranger can be taken as disapproval and a reason for self-loathing. One of the most effective treatments is mindfulness-based cognitive therapy, which teaches people not to engage with the negative thoughts, but to simply watch them.
My own doctoral research and subsequent book on depression taught me just how powerful mindfulness can be for a disorder where even the most absurd pessimism feels real. The key is to adopt a sceptical mindset that greets thoughts not as bearers of bad news, but more like habitual liars who should be watched at a respectful distance.
Fancy a drink? One of Lucia Valmaggia studies uses Twitter to recruit people with a spectrum of risk for paranoia and invites them for a virtual night out in a swank British bar. Virtualware for the KCL VR Lab
But how, precisely, do you watch a thought?
In the study, participants will enter a virtual world where avatars do things designed to trigger classic depressive thinking, such as "the dismissive glance".
But instead of being consumed by self-hatred, participants will select their thought from a pop-up menu, perhaps "they don't like me", and have it enter the virtual world in a bubble.
The researchers think visualising thoughts in such a tangible way – written in a bubble – could be a game-changer for young people with depression – mindfulness "the idea" will, so to speak, get its very own TV show.
Associate Professor Mario Alvarez says people are very good at remembering scenes, but not so good at remembering abstract concepts.
"The core thing about mindfulness is that you are able to observe your thoughts in a non-judgmental way so you don't engage with them or get swept away by them," said Associate Professor Mario Alvarez, head of E-Health at Orygen and a researcher on the study.
"For young people, it is actually quite hard to understand that by observing your thoughts without reacting to them they can slowly fade away. That's one thing we can clearly illustrate with virtual reality," he said.
Alvarez is being literal. The aim is to use biofeedback to reward mindfulness with a television-style fade-out that dissolves those negative thought bubbles. And the technology to do that is here.
In a project called PsychicVR, MIT Media Lab uses a nifty headband called MUSE to monitor the brainwaves of people doing mindful meditation while they're in virtual reality. The EEG senses when the lotus sitter gets more focused and rewards them with superhero powers, including levitating over a meadow and seeing through walls.
Oxford University's Professor Daniel Freeman, of Oxford University, found people with paranoia who were gradually exposed to more passengers on a "virtual train" had a reduced sense of threat. Oxford Cognitive Approaches to Psychosis, University of Oxford.
Banishing the gloom
If the Orygen team is successful, young people could soon be wielding their own special powers over depressive thoughts.
If it all sounds a bit gimmicky there are good reasons visualising gloomy thoughts in VR could have a leg up on traditional talking therapy for young people.
"We are very good at remembering scenes, but not so good at remembering abstract concepts," said Alvarez, referencing the eye-glaze that will develop in many depressed adolescents getting their first explanation of mindfulness.
The superiority of visual recall is, Alvarez points out, why memory champions can learn the order of an entire deck of cards by visualising them, often reimagined as celebrities doing very odd things, in a suite of rooms known as a "memory palace".
"We think that being able to illustrate the process of mindfulness will make it easier for young people to remember," he said. "Also, we are going to be able to make abstract concepts like 'you are not your thoughts' much more concrete."
Using VR to make the abstract concrete is something that also pre-occupies Dr Lucia Valmaggia, a clinical psychologist and head of the Virtual Reality Lab at King's College London, who is researching another key disorder in youth mental health. Psychosis can be caused by severe stress, drugs, and bipolar disorder, and frequently manifests as paranoia.
And thinking that "everyone is out to get me" can easily cascade into a disabling fear of public places.
"If you come to see me and you've just experienced a first episode of psychosis you might find it very difficult to take public transport to go back to go school," said Valmaggia.
"I might ask, 'well what happens?' and you say 'I don't know I just get scared'. It can be very difficult for you to access what you thought and how you felt because you're sitting in my consulting room," she said.
In Valmaggia's practice the next step could be for the patient to strap on the VR goggles. "If I put you in the tube or in the tram or in the bus you can tell me as it happens what you are looking at and what you are noticing in your body," said Valmaggia.
With VR, clinicians can watch paranoia unfold in real time, something previously possible only if they went with patients to the site of their real-world fear, often hopelessly impractical.
Now Valmaggia is developing a formal tool to measure paranoia in VR. One of her studies uses Twitter to recruit people with a spectrum of risk for paranoia and invites them for a virtual night out in a swanky British bar.
Some of the pub's virtual patrons are programmed to unsettle participants by doing potentially galling things such as laughing then looking away. To see just how upset participants get, Valmaggia monitors their heart rate and has them report how they feel on scales that appear in the virtual bar.
"We found that, like life in general, people prone to paranoia are more likely to interpret these ambiguous situations as directed at them and they trigger distress," said Valmaggia. "They are more likely to think 'they were laughing about me,' " she said.
But Valmaggia is also using VR as a treatment. She might, for example, get the person hobbled by a fear of public transport to take a ride on a virtual London bus.
"I can talk to you about how realistic it is that people on the bus are going to attack you," she said. "And, say you are someone with a lot of avoidance who just looks down all the time. I can ask you not to do that, to check the world around you and disprove whatever beliefs you have about what is going on."
Evidence is starting to gather behind this approach.
A 2016 study, led by Oxford University's Professor Daniel Freeman, found people with paranoia who were gradually exposed to more passengers on a virtual train had a reduced sense of threat. Importantly, that feeling of safety carried over into the real world.
Overall, however, the technology is evolving and the evidence is mixed. Freeman has just published the first review of every study that has used VR in mental health – that's 285 studies over 25 years. He found a preponderance of poor methods, large gaps in the research and, to date, evidence that its effectiveness was highest for anxiety disorders.
But in a March op-ed for The Guardian, Freeman is upbeat, and may well channel the thoughts of other VR researchers when he writes, "Many have said that VR is a technology in search of a purpose. In mental health, it may just have found one."