valmaggia vr palermo 27 may 2019 final · 17/06/2019 2 a sense of presence uncanny valley virtual...
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INSTITUTE OF PSYCHIATRY,PSYCHOLOGY & NEUROSCIENCE
USING VIRTUAL REALITY FOR MENTAL HEALTH
Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience
@Lucia_Valmaggia
Dr Lucia ValmaggiaReader in Clinical Psychology and Digital Mental Health
Palermo, 27th May 2019
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Introduction
What virtual reality (VR)
Some examples from our work
Key challenges facing VR.
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Morton Heilig developed the first commercial VR system in 1956.
1994 first used in psychological interventions (North and North, 1994).
Ivan Sutherland and Bob Spoull’screated the head-mounted display in 1967.
2012 Oculus prototype
2014-2015 Cardboard VR; Oculus DK2; Gear VR; Others
2016 Oculus Rift; Sony; HTC Vive and others
2018 Oculus-Go and other wireless devices
1950s 1960s 1970s 1980s 1990s 2000s 2010s
Virtual reality
2019 Oculus-Quest
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Virtual reality is booming
The Goldman Sachs Group, Inc. (2016)
Profiles in Innovation: Virtual & Augmented Reality, Understanding the race for the next computing platform
Key sectors for investment:
Video games ($11.6bn)
Healthcare ($5.1bn)
Education ($0.7bn)
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Safety and ethical concerns
Virtual reality has been shown to be a safe tool, suitable for children, teenagers, adult including when experiencing mental health problems.
Brien et al. (2011); Josmanet al. (2008); Parsons et al. (2007); Valmaggiaet al. 2016)
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A sense of presence
Virtual reality gives a ‘sense of being there’.
The immersive nature of virtual reality environments is unique because it allows for real time experience of emotions.
Body responses: • increased heart rate• Galvanic skin response
Full environment immersion
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A sense of presenceUncanny Valley
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VR has high ecological validity
Loomis et al. (1999)
Virtual reality
Real life setting
Consultation setting / Lab
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How is VR used in psychology?
Experimental psychology
Aims to understand human cognitive processes, such as sense of presence, perception or proprioception
Neuropsychology
Aims to assess cognitive functions, such as memory or planning
Clinical psychology
Aims to assess and treat mental health disorders
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Assessment and Treatment of mental health problems using VR
• enables the assessment of symptoms as they occur
• typically used as an exposure technique
• enables a tailored intervention with virtual reality assisted therapy
• helps the patient to build up sufficient coping strategies in a safe environment
Virtual reality:
• enables the assessment of cognitive functioning in real time
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• Psychological processes and mechanisms associated with the onset and maintenance of paranoid ideation and auditory hallucinations.
• Testing real time response to new medication• Virtual reality assisted therapy for psychosis.• VR for negative symptoms• Body image and eating disorders.• Social anxiety in autism.• VR games to promote physical activity• VR to increase resilience• Unconscious bias training for health professionals.
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Research: underlying mechanisms, testing effect of intervention in real life
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• interpersonal sensitivity• childhood bullying victimisation • physical assault• perceived ethnic discrimination• social defeat• population density and ethnic density • paranoid ideation• anomalous experiences• self-confidence• self-comparison• physiological activation• behavioural response It is SAFE
VR as Assessment and Research method
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Virtual reality assisted assessment and therapy
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Evidence Base: VR Treatment
Limitations:Older studies High drop-out rates (too confronting, or cyber-sickness)Small sample sizes and lacked statistical power
Main findingsVR more effective than treatment as usualVR as effective of more than cognitive behaviour therapy
Valmaggia et al 2016; Freeman et al 2017
• Eating disorders• Agoraphobia with or without panic disorder • Phobias• Anxiety disorders • Social anxiety• PTSD• Psychosis• Autism
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Evidence base for VR in Psychosis
• Immersive VR is safe, no symptom worsening• VR has the potential to be an effective additional tool for neurocognitive
evaluation in psychosis, but it is still in its infancy• Validity and reliability of VR as a neurocognitive assessment tool remains to be
established. • VR enables the introduction of virtual agents and the manipulation of
interpersonal communication cues (sounds, laughs, affect, prosody), enhancing the emotional, social and functional assessment.
• Early days!Rus-Calafell et al 2018 Psychological Medicine
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VR Assisted Assessment and Therapy
Valmaggia, Rus-Calafell, Garety 2015 Software Unity, VR developer: Virtualware
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VR in PICUP Clinic
• Implementation of VR in ‘real clinical setting’• Therapist acceptance• Service users Acceptance
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Negative symptoms
V-NEsT: Virtual Reality Supported Therapy for the Negative Symptoms of Psychosis
The mechanism: Reward learning
The VR Intervention:• To reconstruct everyday situations that are difficult for people with
negative symptoms.• This will enable therapists to provide real-time feedback on everyday
tasks and focus on improving cognitive regulation processing.
Dr Matteo Cella
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Prevention and New Interventions
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• to examine the developmental origins of mental health problems in diverse ethnic groups in an accelerated cohort study ...
• ... and, from this, identify modifiable risk and protective factors and mechanisms
Dr Charlotte Gayer-Anderson Prof Craig Morgan
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age 11, 12 age 12, 13 age 13, 14 age 14, 15 age 15, 16
Time 1
(2,760)
Cohort 1 Cohort 2 Cohort 3 - -
Time 2 - Cohort 1 Cohort 2 Cohort 3 -
Time 3 - - Cohort 1 Cohort 2 Cohort 3
Design
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(1) ~ 4,500
mental healthfamily structure, ses
life eventsbullying
discriminationsubstance use
exposure to gangsnetworks and support
integration
coping
(physical, sleep, internet)
(2) ~ 800
mental healthvictimisation
coping, support (resilience)
social cognitionneurocognition
----------------------------(3) ~ 400
virtual reality
hair cortisol
Measures
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Basic data: part 1 N>4000
n % Lambeth % Southwark %
boys 2,026 49.4 50.0 51.7
girls 2,077 50.6 50.0 48.3
free school meals 1,022 26.2 24.2 28.8
black Caribbean 708 18.7 23.2 10.4
black African 1,042 27.6 25.6 28.5
(mixed) 569 15.1 11.8 9.8
white British 470 12.4 10.4 20.2
white non-British 326 8.6 13.0 7.7
other 665 17.6 16.0 24.4
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initial findings (n 200)
• Higher suspicious thoughts in VR environment: β (95% CI) p
Boys (vs girls) 0.10 (-1.07 1.28) 0.863
Ethnicity (vs white British)
Black African -1.61 (-3.05 -0.18) 0.028
Black Caribbean -2.54 (-4.40 -0.68) 0.007
Mixed -0.57 (-2.13 0.99) 0.477
Other -1.59 (-3.06 -0.11) 0.035
Other White 0.67 (-1.44 2.79) 0.532
Age 0.11 (-0.38 0.60) 0.665
Born abroad* 0.89 (-1.02 1.29) 0.221
Free school meal* -0.26 (-1.45 0.94) 0.676
Mixed level models used to account for clustering by schools; *adjusted for sex, ethnicity, age;
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initial findings (n 200)
• Higher suspicious thoughts in VR environment:
β (95% CI) p
Bullied at least monthly 1.12 (-0.11 2.35) 0.074
Number of adverse life events 0.32 (0.11 0.52) 0.003
Experiencing discrimination 1.24 (0.18 2.30) 0.022
Having few friends 1.72 (0.59 2.85) 0.003
Having no friend to confide in 1.27 (-0.42 2.97) 0.141
Having no friend who confides in them 1.97 (0.13 3.82) 0.035
Having no adult to confide in 1.12 (-0.62 2.85) 0.207
Feeling lonely for 6months + 1.63 (0.40 2.87) 0.010
Mixed level models used to account for clustering by schools; adjusted for sex, ethnicity, age;
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New Interventions
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Eating disorders
Body Image: Mountford, Tchanturia & Valmaggia (2016)
Current studies in collaboration with Riva et al STUDY 1A) Filming different foods in different environments (public, private) using a 3-D camera.B) Piloting of VR scenarios with community samples. Assessment of cognitions, emotions, behaviors associated with exposure to the scenarios.
STUDY 2Piloting the use of a software to create 2-D personalized avatars for patients to interact with (software previously used for AVATAR therapy in psychosis, Craig et al., 2018).
Dr Valentina Cardi
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Autism
Virtual Reality Supported Therapy for Adolescents with Autism Spectrum Disorders and Social Anxiety
Project starts June 2019
Prof Emily Simonoff
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Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study funded by a Wellcome Trust Investigator’s Award.• virtual reality to examine how biases and
discrimination impact clinical interactions and treatment recommendations.
Dr Stephani Hatch
VR to tackle Unconscious Bias in health professionals
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Virtual reality applied to healthcare
Pros and cons of virtual reality
Key challenges
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Other important considerations
Immersion level
VR vs augmented reality
Madary & Metzinger (2016) ; Mohr et al. (2013); Valmaggia(2017)
Evidence
Small amount of studies available
Costs and implementation
Cost too high for some medical institutions
Ethical concerns
Data privacy
Isolation
Physiological and experience sampling
method (ESM) measures
Recording people’s wellbeing
EvaluationRCT
VR RCT
Industry, academia and clinical implementation
Bridging the gap between different entities
Training of staff
Training healthcare staff in using digital health assessment and interventions
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The four ‘P's of VR
All these aspects should lead to new interventions.
Hood et al. (2011)
Personalise
Predictive
Preventative
Participatory
Right assessment and treatment, for the right person at the right time
Help to establish which individual factors play a role in the onset of mental health problems
Improve functioning and wellness
Interactive and responsive environments
Vejo vocês no Brasil! Te veo en Brasil! See you in Brazil!
20 -23 September 2020
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• Colleagues in the VR Research Lab• BRC, NIHR• CRF, NIHR• NARSAD• Psychiatry Research Trust• MRC• NIHR
Acknowledgments
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Thank you for your attention