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Could virtual reality be the next frontier for treating depression?

A new study, published in the British Journal of Psychiatry Open on Monday, suggests that VR therapy could reduce depressive symptoms by boosting feelings of self-compassion and alleviating self-criticism. 

"Self-compassion is important in soothing feelings of distress, and without it distress can escalate and become unbearable," Dr. Chris Brewin, a professor of health psychology at University College London and the study's lead author, told The Huffington Post in an email. "We now know that many patients with depression and other disorders have real problems in being compassionate towards themselves, although they are often very good at being compassionate to others."

For the preliminary study, 15 adults with depression underwent three sessions of virtual reality therapy, which had previously been tested on healthy volunteers. 

In the virtual reality sessions, the patients wore a virtual reality headset which allowed them to see from the perspective of a life-size avatar. To create the illusion that the avatar was their own body -- an experience known in VR as "embodiment" -- the patients were able to see the body moving in a mirror the exact same way that they were moving. 

While "embodied," the participants underwent eight-minute sessions, during which they were told to express compassion toward an avatar of a distressed child. As the patient spoke kindly towards the child, the child calmed down and gradually stopped crying. Next, the patients were embodied in the child's figure, and then listened to the avatar of their adult selves expressing compassion towards them.

The patients underwent three weekly sessions of this virtual reality exercise. Then, one month after the therapy, the patients answered questions about their moods and mental health. Nine of the patients reported reduced depression symptoms, and four experienced a significant drop in the severity of their symptoms. Some of the patients said that they were less self-critical in real-life situations after undergoing the therapy. 

“By comforting the child and then hearing their own words back, patients are indirectly giving themselves compassion," Brewin said in a statement. "The aim was to teach patients to be more compassionate towards themselves and less self-critical, and we saw promising results."

Excessive self-criticism is often a central component of depression, and VR-based therapies may be uniquely equipped to target this aspect of the illness. 

"We think the responses people have to the [virtual reality] scenario are automatic and may bypass resistance to experiencing self-compassion, or to accepting compassion from a therapist," Brewin said. "VR can also be accessed remotely and may be useful for people who don't want to see a therapist or feel too ashamed to do this."

The study's sample size was small and there was no control group, so the findings are very preliminary. Still, they offer reason for optimism and directions for future research.  

"Virtual reality can offer new types of therapeutic experience that are potentially very powerful through the process of embodiment in avatars," Brewin said. He noted, however, "We also need to develop the technique further based on what our initial patient sample have told us."

 

Image credit: huffingtonpost.in

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Personalised smartphone applications and wearable technologies that are attuned to the user's state of mind are offering customised ways of helping people cope with mental illness.

The rising incidence of  places great strain on  systems and societies around the world. In the EU,  are already estimated to cost the economy €798 billion a year – a figure that is expected to double by 2030.

Given the prevalence of , some researchers seeking alternative ways to treat the more common conditions are turning to technology to help.

While there has been a boom in self-help and digital wellness apps on smartphones and tablets promising support for mental health issues, much of the data they generate needs to be first interpreted by  before it can be used in an effective recovery programme.

'Most existing apps stop with the data – it's not part of a programme of interventions you can take,' said Professor Corina Sas, a researcher in human-computer interaction at Lancaster University in the UK. 'At present, data capture is very disconnected with the high-level-type thinking we make in terms of emotional processing.'

To tackle this, Prof. Sas and her colleagues are attempting to create more intelligent, interactive technologies that harness information about the emotional states of users over time to automatically offer tailored advice on dealing with mental health issues.

Through the AffecTech project, they are developing a personalised, low-cost toolkit using a range of technologies for individuals with 'affective' health conditions like depression, anxiety and bipolar disorder. They aim to support people with mild to modern conditions—some of whom may not visit a doctor, but could benefit from this technology.

'The idea is to support people in capturing emotional responses, but then to use new types of interactive technologies that can help people make sense of this,' said Prof. Sas, who is the principal investigator for AffecTech.

The project began at the start of 2017 and involves a consortium of universities, health and tech organisations. It is currently exploring different devices and technologies to help track patients' emotions and then suggest ways for people to manage their issues. These include using apps in conjunction with sensors on mobile phones, smart watches or other wearable devices, along with artificial intelligence (AI) and virtual reality technology.

Emotional management

'My vision is that we build a toolbox of interfaces involving different types of technology,' said Prof. Sas. After interpreting a user's emotional state using technologies such as AI, the system would then offer relevant therapeutic activities to help the individual manage their condition.

One approach, she says, could be to use wearable cameras to allow users to record events taking place when they are in a particular emotional state, which they could later watch to help them understand the factors that may trigger positive and negative emotions.

The team has also tested prototypes of wrist-worn, colour-changing biosensors that help users track their own emotions.

Another idea stems from colouring in intricate mandala patterns, which some research has shown to reduce anxiety and is growing in popularity through the sale of adult colouring books. 'Imagine a cube on which you move your finger and start colouring in patterns,' said Prof. Sas.

She describes this type of emotional management as a 'paradigm shift' that could not only have long-term mental health benefits for patients, but also lead to major cost savings for health services.

The project, which includes the Leeds NHS Trust as a member, is also seeking to test the technologies with users recruited through national health services, charities and other communities.

But while  can be used to help patients manage their emotional state, it can often lack a key element that personal contact with health professionals can provide – empathy. To address this, some researchers are using advances in AI to offer patients support on chat-based apps.

Chat app

The Shim project, run by a team of psychologists, researchers, writers, engineers and designers, is combining techniques from cognitive behavioural therapy – a talking therapy commonly used to treat people with mental health issues – with human-like support on a mobile-based chat app.

The system uses AI to spot language patterns and keywords to create personalised text-based conversations that help to shift the user's mental perspective when they report a negative thought.

Dr. Kien Hoa Ly, a researcher in behavioural sciences and learning at Linköping University in Sweden and chief executive of the project's company Hello Shim, explained that the app uses positive psychology to help a user reflect more optimistically on their own life.

'In the everyday interaction, we are using positive psychology to make the user reflect upon positive things in life, experiences and what the user is grateful for,' said Dr. Ly. 'We are building a mental map of every user and their inputs. As a user talks to Shim it grows, which makes Shim remember more things and ask more questions.'

The app might ask the user, for example, how they felt when they were doing an activity they enjoy such as hiking in the mountains, getting them to reflect on positive emotions.

This use of empathy differentiates the app from other  apps, says Dr. Ly. 'Our mission is to build the world's best data model and predictive tools to help people improve their wellbeing,' he said. 'We do this by understanding what specific reply from Shim is most likely to be helpful given a negative thought from a specific user.'

The company is also experimenting with social features, such as sharing positive thoughts with friends and family.

Since launching on Apple mobile devices in Sweden last November, Shim has been downloaded 10,000 times. The company hopes to launch the app in the US later this year.

A pilot study published last year showed that participants who talked to Shim reported a higher level of emotional wellbeing and lower stress levels than a control group after using the app for two weeks. Shim is now planning a larger study, which may involve collaborating with several US universities.

'In the future, we will see a world where you pick up your phone when you are feeling down to get emotional support in the moment,' Dr. Ly said.


 

Image credit: medicalxpress.com

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Sometimes, your best therapist is yourself—or at least a CGI avatar of yourself. A new study published by the Royal College of Psychiatrists found that virtual reality (VR) therapy can serve as a possible solution for treating depressed patients by encouraging self-appraisal and compassion.

The experiment is designed to target depressed people’s tendency to self-criticize. A major symptom of depression is that people are not able to hold themselves in high regard, and consequently blame and punish themselves for any behavior or action they perceive to have a negative effect. In order to alleviate this tendency, patients are encouraged to practice self-compassion.

“Self-compassion is important in soothing feelings of distress, and without it distress can escalate and become unbearable,” Dr. Chris Brewin, a psychology professor and the study's lead author, told The Huffington Post. “We now know that many patients with depression and other disorders have real problems in being compassionate towards themselves, although they are often very good at being compassionate to others.”

In the experiment, 15 adult subjects with depression participated in three weekly therapy sessions in which they alternated between playing the role of therapist and that of patient. After donning a VR headset and body motion sensors, each subject played an adult who expresses compassion and affirmations to a distressed child. Then, the subject switched to take the place of the child and heard the same words, now expressed to them, in their own voice.

A month after the subjects completed the three-week program, they answered a questionnaire that asked them about their mental health. Nine of the subjects reported a decrease in depression symptoms while four reported significant improvement.

This is only a preliminary step; the sample size in the study was small and there are many other techniques to be tested, but the experiment lays the groundwork for a future in which therapeutic VR could be a viable alternative to in-person therapy options.

 

Image credit: good.is

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SINGAPORE - Students at some secondary schools will have a chance to use virtual reality (VR) to understand what it is like to have depression.

By donning a VR headset, they will take on the persona of a virtual character - a girl who suffers from depression - and listen to her inner thoughts like their own.

After the two-minute session, the students will discuss the scenario and how they feel.

The one-time sessions, to be conducted by staff from Touch Community Services, are part of a programme called Do You M.I.N.D.? that teaches secondary school students about mental health through games and classroom learning.

Started by the charitable organisation in October last year, Do You M.I.N.D.? has reached out to about 900 students from eight secondary schools so far.

Besides the VR sessions, Touch also launched a mental health-themed train at HarbourFront MRT station on Tuesday (Oct 30) to promote public awareness and education on mental health.

 
On the interior of the train is information on the four common mental health conditions among youth that the organisation sees - depression, self-harm, anxiety and eating disorders. There is also information on coping methods and short stories from people who have these conditions.
 
The train is scheduled to run for 18 hours daily until the end of November on the North East Line. The campaign is expected to reach some 840,000 commuters.
 

Touch chief executive officer James Tan said the organisation decided to use VR to educate students on mental health as that method has been shown by research to be more effective than some other learning methods.

Research in January last year from the National Training Laboratory, a non-profit organisation which deals with applied behavioural science, showed that VR training yielded a 75 per cent retention rate, compared to a 5 per cent and a 10 per cent rate for lecture-style learning and reading respectively, he added.

Besides educational programmes in schools, Touch also provides counselling and therapy, as well as a peer support group programme for youths at risk, or those who have mental health conditions.

Mayor of North East District Desmond Choo, who was guest of honour at the launch, said that awareness of mental health still needs to be promoted because of misconceptions.

"I think there is still a general lack of awareness of what is depression and anxiety," he added.

"To many people, it is just a temporary thing that you can snap out of. But for somebody facing this, it is a real medical condition."

 

Image credit: straitstimes.com

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Telling a depressed person to suck it up, is about as effective as telling a patient on dialysis to grow an extra pair of kidneys. In an effort to help boost self-confidence among depressed people, researchers have developed a virtual reality therapy that encourages patients to be less harsh on themselves, which could help thwart future depressive episodes.

The recent study was published in the British Journal of Psychiatry Open and funded by the Medical Research Council.

Researchers from University College London, which worked alongside the ICREA-University of Barcelona, have conjectured for years that virtual therapy may be able to help treat mental health problems.

 

An out-of-body experience

 

The researchers tried the therapy on 15 patients with depression, aged 23 to 61 years. Ten were men and five were women. Ten of the patients were taking anti-depressants during the study; seven were receiving psychological therapy, while seven others were awaiting such therapy; and one had finished one course of therapy.

The treatment consisted of a technique referred to as “embodiment,” where patients wear a virtual reality headset that allows them to see the world from the perspective of a virtual body, otherwise know as an avatar. Participants were asked to mentally identify with the avatar, which was an exact replica of each patient’s body.

They then noticed a different avatar of a small child that was crying. They were asked to interact kindly with the child in an effort to comfort and console them. Patients asked the child to remember a time when it was happy and think of someone who loved them.

At this point in the experiment, the roles were switched. The scientists changed the headset so that the patient was embodied as the small avatar child, which mimicked the patient’s body movements. The patients then heard the exact phrases they said to the child, said back to them, in their own voice, by the adult avatar.

 

Patients report a heightened sense of self-respect

 

When the patients reported back a month later, the results were encouraging. Nine of the patients reported that their symptoms of depression and self-criticism had decreased. Among four of these patients, the decrease was medically significant.

Other patients claimed to have more self-compassion. Reports of the therapy overall were positive. Repeated sessions seemed to heighten the experience. However, some of the test subjects reported no changes.

According to lead author of the study, Prof. Chris Brewin, “People who struggle with anxiety and depression can be excessively self-critical when things go wrong in their lives. In this study, by comforting the child and then hearing their own words back, patients are indirectly giving themselves compassion. The aim was to teach patients to be more compassionate towards themselves and less self-critical, and we saw promising results.”

Co-author, Prof. Mel Slater added, “We now hope to develop the technique further to conduct a larger controlled trial, so that we can confidently determine any clinical benefit.”

Low budget virtual reality systems for domestic purposes have become more prevalent in the past few years. Slater is optimistic that virtual therapy may be a viable treatment option that can be done at home.

The results of the study are promising, but the researchers note that the population was too small to deduce anything conclusive at a general level. The researchers encourage future studies with larger patient populations to verify the benefits of virtual therapy.

 

Image credit: glitch.news

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In the coming adventure video game Sea of Solitude, the main character — a young woman named Kay — navigates a partly submerged city as she faces a multitude of red-eyed scaly creatures.

None are as terrifying as her own personal demons. As the game progresses, Kay realizes the creatures she is encountering are humans who turned into monsters when they became too lonely. To save herself, she fights to overcome her own loneliness.

Kay was modeled after the game’s creative director, Cornelia Geppert of Jo-Mei Games, an independent game studio, who struggled after a 2013 breakup. “I felt like I was trapped in a cage,” Ms. Geppert, 37, said of her experience.

Sea of Solitude, which Electronic Arts will publish this year, is among a growing number of video games that are tackling mental health issues.

Last year, a game called Celeste explored depression and anxiety through a protagonist who had to avoid physical and emotional obstacles. In 2017’s fantasy action-adventure video game Hellblade: Senua’s Sacrifice, a young Celtic warrior deals with psychosis.

Other games in recent years, including Night in the Woods and Pry, have delved into self-identity, anger issues and post-traumatic stress disorder. All followed the 2013 interactive fiction game Depression Quest, which asked players to step into the shoes of a character living with depression.

These games are a far cry from the industry’s better-known story lines of battlefield heroics or the zombie apocalypse. But as a cultural conversation around mental health grows louder, makers of content are responding. According to the National Institute of Mental Health, one in five American adults lives with a mental illness.

“Mental health is becoming a more central narrative in our culture, with greater efforts to normalize mental health challenges,” said Eve Crevoshay, executive director of Take This, a nonprofit that educates video game developers on best practices around portraying mental health. “With that trend comes response from creative industries, including games.” (Take This was founded in 2013 after the suicide of a video game journalist prompted a debate about the issue.)

To date, most of the games tackling mental health have come from independent makers, which are typically more willing and able to take risks by exploring unusual subject matter. Sea of Solitude points to a shift: a gamble by Electronic Arts, one of the industry’s largest publishers and better known for its Madden football and Battlefield war games, to invest in the topic.

“We were immediately captivated by Connie’s passion and artistic vision for Sea of Solitude, which is unique, beautifully realized and made more powerful by being an important one,” said Rob Letts, general manager of EA Originals, the label focused on publishing independent games.

Some in the industry said the interactive nature of games made them more effective than film or television at dealing with mental health. Embodying a video game character who suffers from depression might leave a deeper impression of the challenges of the illness than simply watching a film about the same character, for example.

Video games can be “a more effective way of bouncing back from negative moods than passive forms of media like TV or movies,” said Raffael Boccamazzo, a mental health practitioner in Seattle who works with Take This.

That was what Sam Rodriguez, 26, experienced after playing one of these video games, Night in the Woods. Ms. Rodriguez, a freelance writer in Atlanta, said a diagnosis of bipolar disorder last year had left her feeling isolated and lost.

But she said she felt a connection to the protagonist of Night in the Woods, Mae, a college dropout who returns to her hometown but struggles to reconnect with family and friends. Ms. Rodriguez’s first play-through of the game was extremely emotional, she said, because “I was able to experience the world through the eyes of someone like me, who felt helpless and aimless in life.” She added that she felt especially drawn to Mae’s use of sarcasm to deflect and bury her own problems.

While Ms. Rodriguez was already in treatment, she said, the game motivates her to be more honest and receptive with her therapist. She has since become an ambassador in a Take This program, in which she regularly discusses mental health on her social media channels and on the live-streaming platform Twitch.

Makers of mental health games said they had seen a similar reaction from other players. After the 2016 simulation role-playing game Stardew Valley — which does not punish players for not completing tasks and creates a slow-paced atmosphere where the objective is to take care of a run-down farm — was released, Eric Barone, the game’s creator, received hundreds of messages, he said. Players wrote to share their stories of how the game helped them cope with difficult periods in their lives.

“One story that comes to mind is a person whose little brother had autism, and as a result had great difficulty in relating with him,” said Mr. Barone, 31. “But playing Stardew Valley caused him to open up and allowed the two brothers to bond in a way that was never possible before.”

Some makers are now developing games to explicitly promote better mental health. Orpheus Self Care Entertainment, a start-up that was founded last year, is publishing virtual reality games in which players practice mindfulness and meditation through activities like dancing. In one game, players move their bodies in virtual reality to create patterns and shapes that move and change color.

IThrive Games Foundation, a nonprofit that aims to improve mental health in teenagers through games and education, is also working on a new mobile game for teenagers who suffer from anxiety. The nonprofit is experimenting with a few different game styles — from role-playing to choose-your-own-adventure — for it. IThrive hopes to test the game by next year.

“Asking someone to play with you sets a very different vibe than asking someone to talk about their problems,” said Kelli Dunlap, iThrive’s director of mental health research.

Ms. Crevoshay of Take This said the games industry was at a tipping point in how it accepted and embraced mental health challenges. She said she wanted to see more mainstream developers tackle the topic and more support for gamers who spoke out about these challenges.

“We know these are not easy changes to make,” she said. “But we want to try.”

 

Image credit: nytimes.com

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