The latest use of Virtual Reality? Diagnosis of mental illness

Diagnosis of psychiatry and neurological conditions are difficult. Doctors have long reported that diagnoses are fraught with complications and subtleties. According to the World Health Organization (WHO), 35 to 85 percent of mental illness remains undetected and undiagnosed, depending on where you live in the world. To treat depression, Alzheimer's or autism, it must first be discovered.

Clinicians and researchers are now trying a new tool: virtual reality. VR has been touted as a promising remedy for some illnesses, but can also be helpful in diagnosis. As a diagnostic tool, VR may have some great advantages: It can produce convincingly realistic simulations of experiences that can cause symptoms. This can be done consistently, making diagnoses possibly more objective or at least more subjective.

A scene from the virtual environment developed by Dennis Chan and his colleagues as part of their study of VR and Alzheimer's.

Dennis Chan

In September, the UK-based Alzheimer's Society announced it was funding a three-year research project with VR to identify early signs of Alzheimer's disease. In a first study, researchers under the direction of Dr. med. Dennis Chan of Cambridge University manages the spatial navigation and memory of participants by placing an HTC Vive headset, following an L-shaped path in a virtual environment (initially represented by Kegel), and then following their steps without the help of markers up back to the starting point.

In an article describing the preliminary results, Chan's team reported that the VR-based navigation test was more accurate in diagnosing mild Alzheimer's impairment than conventional gold standard cognitive testing, such as the following: Eg fetch and symbol tests. In an email, Chan says VR could play a bigger role in diagnosing mental disorders as VR equipment is cheaper and easier to use.

Treatment of PTSD

Researchers at Emory University in Atlanta have used VR to diagnose and treat veterans with post-traumatic stress disorder associated with sexual trauma in the military. Participants were shown two-minute clips of a simulated foreign military base and a typical American city, while researchers observed their heart rate and "frightening" responses. In an article published last year, researchers reported significant reductions "in physician-assessed and self-reported PTSD symptoms".

VR is a promising diagnostic tool, researchers say, because it generates scenarios and experiences that are not readily available in a traditional clinical setting. "VR provides a unique opportunity to bring" real experiences to the clinic, "explains Dr. Martine van Bennekom, a researcher at the Department of Psychiatry, University of Amsterdam." Some psychiatric disorders, such as OCD or panic disorder, are occurring Patients usually have symptoms in their personal environment or in crowded places on and not in the clinic room, and with VR it is possible to immerse patients in an external environment while the clinician can observe symptoms and ask patients about these symptoms and underlying thoughts. "

In addition, VR can generate a very regular, controlled experience that provides the scientific consistency that is often lacking in the doctor's office. "Content can be created exactly to specifications and experienced in the same way," says Eric Abbruzzese, VR analyst at ABI Research, via email. "Everything is digital, so the parameters can be controlled almost infinitely."

In addition to Alzheimer's and PTSD VR is now being tested for the diagnosis of a variety of other diseases, such. Social anxiety disorder, dizziness, ADHD and concussion. For example, a team from Exeter University reported in 2017 that a VR-based mirror game in which participants had to duplicate the movements, gestures and facial expressions of a virtual avatar supported the early detection of schizophrenia.

Dr. Piotr Slowinski, head of the Exeter team, says by email that mental health practitioners have turned to the group with the application of the mirror game and that the group is testing a prototype to further evaluate the idea. He says the practitioners are excited about the prospect of diagnosing schizophrenia earlier in young adults, as earlier discovery and treatment tends to produce better results.

The "Mirror Test" game used in the Exeter University Schizophrenia study where a participant is asked to reproduce the movements of an avatar on screen.

Another advantage of VR, according to Slowinski, is that it is cheaper than techniques like neuroimaging, and it is getting cheaper as headsets become cheaper and more user-friendly, making them suitable for small spaces in many clinical settings.

Problems and promises

To be sure, VR is far from being widely used to diagnose mental disorders. "VR has tremendous potential for improving mental health assessment, but it is not currently used in clinics," says Daniel Freeman, a professor of clinical psychology at Oxford University, and co-founder of Oxford VR, which develops VR. Treatments for a variety of psychiatric disorders. The proposed uses of VR to diagnose mental health conditions require further investigation. Until then, clinics would not use VR for diagnosis.

Dr. Brian Chau, a doctor writing about new medical technology, agrees. "The key is data - we need validated measurements" to show that VR is comparable or better than traditional methods, he says. He says ongoing partnerships between clinicians and VR developers are needed to bring the technology "from the bench to the clinical bed." , "

Abruzzese, the ABI analyst, also notes that "not everyone can use VR" because it can cause nausea or motion sickness. In addition, developers must create content for each type of test.

"VR provides a unique opportunity to bring hands-on experience to the clinician's office."

Dr. Martine van Bennekom, University of Amsterdam

However, Freeman points out that VR is increasingly used in laboratories and research facilities, especially to understand the causes better than to diagnose. Freeman's team hopes to develop a VR-based test that better diagnoses paranoia by showing people "neutral" social situations. "If they see hostility from the VR characters, we know it's really unfounded, and therefore examples of paranoid thinking." His team is also looking for other factors that could affect paranoia, such as marijuana use.

Researchers are seduced by the prospect of VR because psychological issues are known to be difficult to diagnose. A highly cited review paper from 2006 psychiatry misdiagnoses and discrepancies were most commonly the result of a lack of consistency among clinicians and patients and the "inadequacy" of terminology. VR keeps the promise because "it depends less on the memory of the patient (recollection bias) and the interpretation of the clinician (interviewer bias)," says the Dutch researcher van Bennekom.

Other researchers agree. In 2017, van Bennekom and his colleagues reviewed 14 studies testing VR as a diagnostic tool. They found that the diagnoses tended to be consistent with the traditional diagnoses. In addition, the researchers involved "usually favor VR" because it offered the opportunity to assess behavior in real time in "realistic environments that are similar to daily activities".

So there is every reason to believe that VR goes beyond an experimental diagnostic tool for mental illness to a practical everyday life. It provides the opportunity for realistic experiences that can be consistently repeated from test to test, further standardizing tests and making them more reliable. And because it can detect symptoms early and often without expensive equipment, it promises to open the detection of psychiatric and neurological conditions to a greater number of people, at a time when such conditions are becoming more common.

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