Tackling Mental Illness with VR

Expertise from business, research and clinical practice

The use of virtual reality (VR) in mental health care opens up new dimensions in diagnostics, therapy and prevention. As an immersive technology, VR makes it possible to create computer-generated environments in which patients can have realistic experiences – in a controlled, safe and therapeutically targeted manner. VR is proving to be a promising tool for supporting traditional therapy methods, particularly for mental illnesses such as anxiety disorders, post-traumatic stress disorder (PTSD), depression and specific phobias. VR therapy offers a high degree of individualisation and adaptability. It allows therapists to simulate specific triggers or anxiety-inducing situations in a targeted manner and work through them together with patients – a central component of behavioural exposure therapy.

We spoke to three experts for the Virtual Reality Technology Hub to explore the opportunities and challenges involved in treating mental illness. Daniela Schumacher is the founder and chief executive officer of PsyCurio. PsyCurio is an innovative virtual reality software that enables sustainable therapeutic success for various mental illnesses. Treatment in a photorealistic environment promotes lasting motivation through the targeted use of game-based elements. In addition, seamless real-time evaluation of physiological data allows conclusions to be drawn about the emotional state of patients at any time, so that ongoing treatments can also be effectively adjusted. Robert Hrynyschyn works as a research assistant in the Health Education Research Group at the Institute of Health and Nursing Sciences at Charité – Universitätsmedizin Berlin. His research focuses on digital public health and virtual reality in prevention and health promotion. He is currently working on the development and evaluation of a VR application for alcohol prevention among young people. Dr Kyra Kannen conducts research at the Centre for Assistive Technologies (ZAT) Rhein-Ruhr. As a trained psychologist, she moved to Rhine-Waal University of Applied Sciences as a postdoctoral researcher after many years at Bonn University Hospital. ZAT Rhein-Ruhr is a joint research project between Rhine-Waal University of Applied Sciences, Niederrhein University, Bonn-Rhein-Sieg University and the University of Duisburg-Essen. Prof. Dr. Stefan Heinemann, professor of ethics and spokesperson for the Ethics Ellipse Smart Hospital at Essen University Hospital, also answered a few questions. He was already involved in the VR hub for training health professionals in virtual worlds.

What excites you about virtual reality?

Daniela Schumacher: Virtual reality can put people in situations that feel real, but are still controlled and safe. This is a huge advantage, especially in therapy, for example for treating anxiety.

Robert Hrynyschyn: As the name “virtual reality” suggests, this technology allows you to immerse yourself in virtual worlds that you don’t normally experience on a regular basis, such as a safari or, even more rarely, a walk on the moon. That’s why I find it fascinating that VR enables people to experience situations and understand them in a realistic way. VR is also interesting for our research area of digital prevention and health promotion, as it allows us to understand people’s behaviour in realistic worlds.

Dr. Kyra Kannen: Virtual reality makes it possible to simulate complex everyday situations in a controlled, flexible and repeatable manner. In psychiatry, this creates new ways of supporting therapeutic processes under realistic conditions. I find the potential to use VR to design laboratory conditions that are much closer to the everyday experiences of patients particularly fascinating – it’s a valuable bridge between research and practice.

What virtual reality solutions do you offer, use or research for health promotion or therapy?

Daniela Schumacher: We have developed software that is specifically used for mental illnesses such as anxiety disorders, affective disorders, addictions or PTSD. This software is used with VR headsets so that users can practise in controlled scenarios, such as speaking in front of groups or coping with social situations. The application makes it possible to tailor these exercises to the specific needs of the patient.

Robert Hrynyschyn: At the Institute of Health and Nursing Science at Charité – Universitätsmedizin Berlin, we are conducting research into a virtual simulation for alcohol prevention among young people in Germany. Various studies show that binge drinking is particularly common among 15- to 18-year-olds. At this age, young people are also particularly exposed to peer pressure situations that encourage the consumption of alcohol and other substances. Our goal was therefore to develop a digital prevention programme specifically for this age group. It aims to teach young people skills for dealing with social pressure and prepare them for ‘real-life situations’. Since traditional prevention programmes often require considerable time and human resources, we want to create a virtual but realistic learning environment. VR combines these characteristics particularly well.

Dr. Kyra Kannen: During my PhD at Bonn University Hospital, I was part of the Virtual Reality Therapy and Medical Technology working group, where we developed VR settings for investigating attention processes in ADHD. I then worked on the BMBF-funded project ReliVR – Using Virtual Reality to Combat Depression, which researched the use of VR in the treatment of depression. I am currently working at the Rhine-Ruhr Centre for Assistive Technologies at Rhine-Waal University of Applied Sciences, where VR is primarily used for simulation training in clinical education. At present, our focus is not on psychiatric applications – but I continue to observe the field with great interest.

How do patients benefit from these VR solutions?

Daniela Schumacher: Patients can try out new behaviours in controlled environments. This makes it easier for them to overcome fears, build self-confidence and make progress. Many experience success more quickly and are more motivated to continue working.

Robert Hrynyschyn: Currently, there are only a few VR solutions in the field of addiction prevention that are explicitly aimed at young people. However, VR has great potential in this area. Our studies show that young people are very interested in VR technology. In addition, due to its immersive nature, VR can create real-life situations and thus simulate risky situations, e.g. a house party, which are suitable for practising health-promoting behaviours.

Dr. Kyra Kannen: In our systematic review published in 2022, ‘Virtual Reality in the Diagnosis and Therapy of Mental Disorders: A Systematic Review’ (https://doi.org/10.1016/j.cpr.2022. 102213), we screened a total of 9315 studies and identified the most promising results in the areas of anxiety disorders, PTSD and addiction. In VR exposure therapy in particular, we found convincing evidence of positive therapeutic effects, suggesting that these approaches will increasingly find their place in regular patient care and, of course, have already done so to some extent. However, there are also many other innovative VR approaches that are promising but not yet mature enough for widespread clinical application. Overall, however, it is clear that VR gives patients the opportunity to interact with realistic stimuli in a safe and controlled environment, which can increase the effectiveness of therapies.

What special considerations need to be taken into account when patients use VR?

Daniela Schumacher: It is important that patients are given a thorough introduction at the outset so that they feel confident. If they feel uncomfortable or overwhelmed, users have control at all times and can withdraw from the situation. The level of stress can be easily adjusted and adapted to the needs of the patient.

Robert Hrynyschyn: VR can unleash its potential through three factors: virtuality, immersion and interactivity. In order to develop a sustainable VR solution, the focus should be on the users. Developing the VR solution together with the users results in better technological solutions. If their interests are not taken into account sufficiently, the world simulated by VR can be perceived as unrealistic. This usually means that the potential of virtuality, immersion and interactivity is not used optimally in the interests of users. These special requirements are what make the development of VR solutions so complicated: on the one hand, the virtual world must be perceived as realistic and immersive, and on the other hand, users must feel that they can interact with this world.

Dr. Kyra Kannen: Patients experience VR applications very differently – while some cope well with them, for others it can be an unfamiliar or even stressful experience. Physical side effects such as nausea (cyber sickness) should be systematically taken into account during the development and testing phase. From my own experience – both as a study leader and as a test subject – I know how important a sensitive introduction and therapeutic support are. In my opinion, VR should therefore never be used in isolation, but always embedded in a professionally supervised setting. It is also crucial to involve the respective target group in the development of the VR application at an early stage.

What special skills do health professionals need to use VR in therapy?

Daniela Schumacher: Health professionals do not need any special skills to use VR in therapy. They can continue to use their usual methods, but implement and supplement them in a digital way. Technically, VR is easy to use, comparable to a computer game.

Robert Hrynyschyn: The skills required to use and apply VR are comparable to those required for other technologies. On the one hand, an open-minded attitude towards technology is necessary so that new digital solutions such as VR are not perceived as obstructive or disruptive. At the same time, developers must create solutions that offer real added value for users and prevention workers and address a problem in practice. VR is not currently a standalone application, but should be used in conjunction with other activities. This increases the complexity that practitioners (e.g. prevention workers) are exposed to. To enable successful implementation, VR solutions should be oriented towards practice and not the other way around. To this end, users and prevention workers should be more closely involved in the development of VR solutions.

Dr. Kyra Kannen: In addition to a basic technical understanding, therapists need above all the ability to integrate VR into the therapeutic process in a targeted manner. It is also important to have good observational skills during use and sensitivity in dealing with possible stress reactions.

Prof. Dr. Stefan Heinemann:For the effective use of VR, health professionals need both technical and methodological skills and, in my opinion, a basic understanding of ethics. This includes a fundamental understanding of how VR systems work and how to operate them, as well as the ability to integrate this technology into everyday work in a targeted manner – and even to transfer it to areas where new technologies promise benefits. Critical thinking and problem-solving skills are also required to evaluate the results of VR simulations and transfer them to real-life care situations. Pedagogical skills also play an important role, especially when using VR in patient education or training programmes. In addition, social skills such as empathy and strong communication skills are essential in order to support and motivate patients who may not initially be enthusiastic about using VR. Last but not least, working with VR requires openness to digital innovations and a willingness to engage in continuous professional development in order to keep pace with technological developments, insofar as this still seems feasible. Ethics is – I can’t change that – once again an issue here. This is because VR, especially in a medical context, is a morally ambiguous challenge for identities and relationships.

What risks should be considered when using VR?

Daniela Schumacher: One risk associated with the use of VR is that some people may experience dizziness or nausea, known as motion sickness. However, this is very rare. Motion sickness was minimised during the development of our software through a special software development. In addition, it must be ensured that the user cannot trip over cables or similar objects in the room while using VR.

Robert Hrynyschyn: Cyber sickness can occur when using VR. This usually manifests itself in dizziness, headaches or eye strain. The severity and frequency of the symptoms often depend on the design of the application, e.g. the height of the camera when recording a real situation. This could be taken into account during development, as users will otherwise avoid VR solutions.

Dr. Kyra Kannen: Like any therapeutic method, VR applications must be carefully tested before being used in the field (e.g. on a technical, ethical and psychological level) . Issues of privacy and data security in virtual space must also be considered before responsible use is possible.

Prof. Dr. Stefan Heinemann:There are several risks associated with the use of VR, covering technological, psychological and ethical dimensions. Technological risks arise from the possibility of hardware malfunctions or software failures that can impair the effectiveness of the application, but these should be regulated by a well-established IT system. Psychological risks include the possibility of users becoming overwhelmed or disoriented, as VR offers intense sensory experiences that can cause side effects such as nausea, dizziness or ‘cyber sickness’ in sensitive individuals, which can then become a medical problem in themselves. There is also the risk of psychological stress from overly realistic scenarios that could trigger anxiety or stress. Ethical risks arise from the improper handling of sensitive patient data that could be used in VR scenarios, as well as from potential dependence on the technology, which could interfere with personal interaction between patients and professionals. The latter appears to be more profound than data protection. Clear guidelines, training and technical standards are necessary to minimise these risks.

Further information on this topic

ATLAS features additional articles and science digests on virtual reality in healthcare. Read, for example, how virtual reality is revolutionisingnursing education.

Check out the other technology hubs on exciting topics.