Virtual Reality: The Future of Telehealth?

The COVID-19 pandemic has necessitated a change in patient care, from simple check-ups to psychiatric help. As a result, patients, practitioners, and providers have had to quickly pivot and adapt to the changing times. And although most medical needs were met adequately with the technology we have already, some parts of medical care have not remained accessible and helpful for patients as in-office care.

These areas of concern include mental health care and support, like the delivery of group-based therapies, education, and psychotherapy. Because they are reliant on the patient and provider sitting down together, communicating via body language and other non-verbal cues, and interacting without any outside distraction, mental health aspects of healthcare are more difficult to outfit with the right technology.

In short, our current technologies (like telehealth video conferencing and telephone) don’t work as well as they should for patients requiring mental health and support. But new strides in virtual reality (VR) could change the landscape of medical applications and healthcare delivery for the foreseeable future.

Extending Virtual Reality

VR has been most recently associated with gaming, seeing real estate without stepping foot inside a new building, and even medical training. But in order to extend the closeness of real-life human interaction into VR, we need to extend the reality. We need to enhance our virtual interactions with new tools and close the gap in virtual therapy so that it remains effective and high-quality even as a remote service.

Extended reality is a real technology term that encompasses VR, mixed reality, and augmented reality in a spectrum of various levels of immersion. These three technologies themselves offer various levels of immersion, from mixed and augmented reality allowing the user to see their real-world surroundings with an overlay on a screen to VR which creates a new reality using headphones and body-tracking sensors. VR is the most advanced, mature, studied, and available technology of the three.

VR’s early days included use in applications for medical care and education in the 1990s, which brings us back full circle to today. Since the 90s, VR has been used in healthcare settings for pain control, education, anxiety, exposure therapy, and even to manage the fear of death. Studies show that VR creates a literal change in perspective, creates neural correlates to manage and numb pain, and reduces pain-related brain activity in several parts of the brain.

Additionally, research shows that exposure therapy using VR has had direct, measurable effects on the prefrontal cortex, which plays a major role in cognitive and behavioral activities. These changes are similar to the effect of in-person exposure therapy on the patient.

A Perfect Companion for Telehealth?

When VR was still a young technology, it required expensive, immobile setups using computers, headphones, cameras, and sensors. But these days, consumer-ready headsets are widely available, and they remove the need for cameras and computers. The current state of VR is perfect for studying VR’s potential in telehealth and telepsychiatry.

The Adolescent and Young Adult (AYA) Oncology department at the Yale-New Haven Hospital has begun researching how VR engages AYA patients in support groups. New York City-based VR firm Foretell Reality designed and developed software for the AYA project, and it runs on readily-available $400 Oculus Quest headsets. Four patients attend each support group session using their Oculus headsets.

The patients can attend from anywhere that has Wi-Fi or a cellular data connection. They virtually enter a therapeutically-curated space and sit in a circle with a moderator and the other participants. Each session lasts for 45 to 60 minutes, and each patient must attend six total sessions. The study consisted of five support groups, making it a total of 20 patients. The research team says that the initial results are very promising.

Overcoming Longstanding Obstacles

But there are some challenges to overcome. For example, the team had to ensure physical and emotional safety for all of the patients. Things like motion sickness or triggers could lead to further care or even suicidal thoughts. Headsets had to be sterilized between uses. And the tech industry part of the team clashed with the academic part of the team on timelines and urgency.

Metrics were designed before the study took place to measure depression, resilience, and anxiety before and after the VR experience. Early results show that patients performed well with lower anxiety levels and higher resilience. Attendance to the virtual group support meetings has been steady.

Patients have been encouraged to share their thoughts and ideas with the team, and the team has been grateful for the user feedback. Many patients have stated that they feel more comfortable meeting with the rest of the group when they’re feeling ill. Some patients have noted the need to take a break when their headset starts to feel heavy. Others have asked for more robust and dynamic avatars to represent themselves. And quite a few patients have expressed interest in meeting their support group in-person after their six sessions are completed.

Finding Patients

When the team is done analyzing the AYA group’s findings, they plan to expand their research with a larger, multi-institutional Phase 2 trial. In the second trial, the team hopes to assess risk, dig into the benefits of VR-based mental health support groups, and work with a larger and more diverse patient population. The AYA group was a great starting point because the patients were young, technologically-savvy, and willing to learn a new technology.

But research from other studies shows that elderly patients have performed well in virtual grief counseling, even with their propensity to not pick up new technology as fast or as enthusiastically. VR has the potential to change the lives of patients who live with rare diseases and away from adequate medical care. But the research team at Yale-New Haven worries about rural and lower socioeconomic populations that lack access to a stable, high-speed internet connection.

Coming Soon to VR Goggles Near You

The team hopes that emerging technologies like 5G and Space X’s Starlink system will provide better internet access to underserved populations, allowing VR to be a realistic therapeutic option for anyone who is interested in trying it out.

Would you attend a support group meeting with a VR headset? Why or why not? Let us know in the comments below!