Xavier Palomer, CEO of Psious, details how virtual reality is changing the landscape of patient-centered care
Virtual reality (VR) as a treatment modality has already changed the landscape of mental health care, building on research accomplished over past decades using expensive technology limited to laboratories. Now, while remaining a valued treatment in the traditional therapy setting, complementary technological capabilities allows companies to develop novel and effective techniques that dovetail with the embrace of patient -centered care across the healthcare industry.
To begin, the uses of VR in clinical mental health include overcoming specific phobias and wide-ranging anxiety disorders through the existing exposure therapy protocol in cognitive behavioural therapy. There are also robust treatments for pain management and distraction, stress management and wellness, empathy training, and reduction of self-criticism, among others.
Understanding why these therapies work is fundamental for understanding why their implementation can help achieve patient-centric goals including improved perception of care, providing more service with given resources, providing better information about the patient to the therapist, and reaching otherwise inaccessible patients.
The reasons that VR works are relatively simple, although only fully understood after experienced first -hand. First, it provokes similar physiological and emotional responses as the corresponding lived experience, so therapists can use simulations to recondition the patient’s response to negative stimuli: spiders, claustrophobic tunnels, tense social interactions, and many more. This simulation for outside experiences also functions in pain management by immersion in agreeable environments, lowering perception of pain. To work on empathy, patients inhabit cultural roles dissimilar to their own, experiencing unwelcome social reactions, and facilitating feelings of isolation or victimisation prompted by such experiences.
Established advantages of working with this technology include customisability to each patient by a professional therapist, making anxiety therapy outcomes easier to accomplish than traditional methods using a less wieldy mix of language, images, and lived experience. Studies also show that patients often prefer this form of therapy because it is perceived as more feasible and less arduous. When the corporeal and emotional response align with the lived experience, while the intellect understands the safety of the therapist’s office (or their own home, as explained later) cognitive dissonance creates opportunity for the therapist to actively change their perception of the experience.
These and other established advantages of VR therapy are compelling, but are potentiated by integrating additional patient management tools, as well as cutting-edge techniques in VR.
Patient- centered care focus in virtual reality
To put the patient at the centre of care, virtual reality therapy resources can be potentiated to extend and improve the patient-therapist relationship, allowing patients to make more progress in less time, and allow behavioural health organisations to accomplish more with fixed resources. VR therapies that can be conducted online also allow a number of previously impossible treatment paths: distance therapy for patients with physical disability or severe anxiety that prevents them from leaving their homes. Finally, the implementation of VR group therapy gives greater efficiency in patient management, while potentially improving therapy outcomes through the monitored social reinforcement of group therapy.
A case study possible with available technology will reveal how these layered benefits will give real results for a group of 10 patients suffering from a fear of flying (aviophobia) diagnosis.
The therapist conducts an initial evaluation of each of the 10 participants, and explains the course of exposure they will receive over the coming weeks. She notes the patient’s specific challenges (takeoffs, landings, turbulence), and introduces them to virtual reality through a neutral or positive environment.
Subsequently, the group sessions are managed by the therapist to provide a supportive environment in which she conducts entire flight sequences, while guiding reactions and negative thoughts. After VR exposure, sessions are closed with supportive group discussion that allows patients to empathise and share their progress to each other and the therapist.
In between these 10 weekly sessions, the therapist assigns individualised courses of homework sessions, a combination of customised exposure to the flight simulation and immersive relaxation and Mindfulness exercises that the patient accesses from a low-cost VR system at home. Along with the patient’s own notes, biometric data from technologies such as HRV and EEG can be transmitted securely to the therapist’s reporting and analysis tool, allowing them to remain aware of their progress throughout the week and check in at any time.
While the group therapy sessions are less customisable than one-on-one, they offer social reinforcement that is otherwise difficult to orchestrate. Each patient is individually evaluated and the therapist takes on a broader role in coordinating intensive self-administered sessions in virtual reality.
During the 10 week course, one patient loses mobility with an injury, and the therapist arranges a remote connection to have him participate fully in the group sessions from home until able to return.
The patients take a more active role in their own care, by committing to their homework sessions and collaborating with the therapist. They see their own physical and emotional responses subside in response to events that used to cause uncontrollable panic. They are able to empathise with fellow patients experiencing the same. The therapist, using a collaborative platform, consults other professionals when encountering cases that present unexpected or novel challenges.
In the end, our case study has one therapist conducting a total of 20 sessions (10 individual evaluations, 10 group) and prescribing/monitoring 300 homework sessions (3 per week, per patient) that extend and deepen positive outcomes in shorter time. Progress apparent through biometric measures and subjective perception are individually discussed in the last session, to build confidence and send the patients into real world encounters with lasting confidence.
Doing the same treatment individually not only lacks the group support, but would entail a total of at least 100 sessions to approach the same level of care, at one individual session per week, per patient.
Doing more with less has been called “the principle behind patient-centered care,” but the more important measure, of course, are patient outcomes. Improved outcomes will begin to migrate beyond behavioural health, for example, by helping to prepare patients for stressful medical procedures. One such example is habituating patients to the abrupt noises and confined environment of MRI procedures, where more than 30% of patients experience anxiety, and up to 14% (depending on conditions) fail to complete the costly procedure. The benefits of more widely integrated VR therapy are becoming apparent from both patient and provider perspectives.
Even beyond the benefits apparent in this sophisticated implementation of group therapy, VR-specific technologies will improve the tracking and analysis of patient well-being with increasing sophistication and utility. In particular, eye-tracking and motion analysis can give therapists important information about patients’ avoidance behaviours within VR experiences. Combined with existing biometric data from heart rate, galvanic sensors, EEG, and others, there will be increasing amounts of meaningful information to analyse in the service of improving patient care. As data technologies develop and converge, companies like Psious will continue to build value by helping healthcare companies get the most care to their patients.
Xavier Palomer
CEO and Founder
Psious
