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How VR is changing the mental health landscape

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As the gap in support for mental health widens, new methods of treatment using technology are coming to the foreground.

According to Mind, one in five people in England report experiencing a common mental health issue, such as anxiety and depression, in any given week. However, only one in eight people with a mental health problem are currently receiving treatment.

Virtual reality is being touted as a transformative force in psychological therapy, giving people a way of facing their fears and anxieties within the safety of a clinical environment.

VR treatments are based on the concept of exposure therapy, a technique used in behaviour therapy to treat anxiety disorders by exposing patients to the source of their anxiety.

One of the key companies driving the treatment forward is Oxford VR.

Founded as a spin off from Oxford University in 2017, the company is developing a VR-based treatment for people suffering with psychosis; a symptom found in a number of serious mental health illnesses, including schizophrenia, bipolar and clinical depression.

A loss of contact with reality associated with psychosis makes it difficult for people to put themselves in social situations. This is what Oxford VR are aiming to tackle with its latest treatment.

Face-to-face care involves a clinician taking the patient into a social environment and delivering cognitive behavioural therapy by exposing them to situations which trigger anxiety.

Oxford VR’s COO, Arvind Tewari, points out that this form of treatment is difficult both to scale and to deliver, especially for patients with severe mental health issues.

The treatment, known as the Social Engagement Programme, is running through the largest virtual reality trial of its kind, with 458 participants and a budget of £4 million.

Oxford VR’s first product was a VR and behavioural health treatment to help people overcome their phobia of heights.

In a randomised control trial with a base of 100 patients, the average improvement was between 66% and 75%, which the Oxford VR says is “slightly better” than face-to-face therapy.

Tewari says: “The results from the RCT was an incredible proof of principle for us. It showed that there is an automated way of delivering behavioural health that’s better than the current standard of care.”

Oxford VR sees itself as a medicated treatment, as opposed to a digital wellness product which Tewari says, “help people live with their conditions rather than treat them.”

Sessions with the Oxford VR are referred to as doses. One dosage amounts to six 30-minute sessions over the course of six weeks. Outcomes are measured before the first session, during the programme, at the end of the six weeks and a follow up 24 weeks later.

Tewari says: “Behavioural health is still quite a qualitative area. Right now, the way you measure outcomes and growth is through self-reported questionnaires.

“I think what’s next is to start moving the industry from being qualitative to quantitative. Using the technology to pick up biomarkers, such as heart rate, heart rate variability, eye tracking and skin temperature to help quantify outcomes.”

One company that is working to make VR treatments for mental health more quantitative is Emteq Labs.

Although the Brighton-based company is at an earlier stage than Oxford VR with its first clinical trials planned for 2021, it has developed a VR headset which is able to measure facial expression and biomarkers during the VR experience in real-time.

As users progress through the VR experience, data is recorded and streamed to an “interpretation engine” which uses a machine learning model to generate insights into the emotional state of the user. These insights are then fed back into the system and alter the experience based on how the individual is feeling.

This is what CEO Graeme Cox believes separates Emteq Labs from other companies developing VR therapies.

Cox says: “What we’re building here is a machine learning tool that accurately translates biometric data into emotional response.

“We’re combining exposure therapy with virtual reality, exposing the individual to the thing that triggers them and then objectively measuring their response, allowing the VR experience to automatically adapt to the level of anxiety or stress that the individual is displaying in that moment.

“Currently there are no other companies that have the ability to provide the biosensing dosage control, measurement of emotional stress and management of the experience that we do.”

The headset uses a variety of sensing modalities. One of the primary methods is called electromyography, which reads electrical muscle activity through contact electrodes in the headset itself.

It measures the zygomaticus muscles, which are responsible for pulling the corners of the mouth, along with the corrugator; the vertical frown line in the middle of the forehead, which are associated with confusion and concentration. Other muscles that the headset can measure include the nose, eyebrows and corners of the eyes. The latter is where Cox says the “real” emotional expression is seen.

Together with heart rate sensing from the forehead, inertial measurement units (IMUs) are also used to gauge head movements such as approach, withdrawal and general nervous energy.

Cox uses public speaking as an example to explain how the technology works.

“Part of the skill of public speaking is learning how to deal with the stress of standing up in front of an audience,” Cox says. “For one of the experimental models we use, we created an experience in which the individual has to walk into an auditorium with 300 people in front of them and deliver a speech.

“We can vary the response of that audience. So, if the speaker is feeling relatively confident, the audience could start making lots of noise or play with their phones, or we can go the other way, and have them really attentive, quiet and engaged. All of this is done automatically depending on how much stress they are feeling.”

Cox says this can then be transferred to a clinical environment for treating conditions such as phobias and social anxiety.

With the need for mental health treatment rising and public services unable to cope with this demand, virtual reality could be the solution. However, it will still be some time before we see VR headsets in mental health clinics nationwide.

Emteq Labs is still in its early stages with a few 10s of headsets currently in use with clinical psychologists and researchers. The headset is CE certified and the company has recently started the NICE approval process for Emteq Labs’ entire platform, which includes the real-time dosage control function. The process is expected to last until the end of 2021.

Oxford VR’s Arvind Tewari says: “We are in the process of not only defining the clinical efficacy, but also making sure we develop a product that fits with the clinical pathway.

“We’re not far off and I believe we are ready to commercialise; we have a commercial product ready and we’ve had commercial discussions with partners. However, for us as a business, product with a capital P is so important. It’s not just about the VR, it’s also about the broader ecosystem and how we fit into that.”

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  1. Pingback: Interview: Transforming mental health with VR therapy

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