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  • Virtual reality therapy could soon be mainstream.
  • Research shows that virtual reality exposure therapy may be effective for treating mental health conditions like PTSD and anxiety disorders.
  • Early evidence suggests that computer-generated avatars, driven by motion capture technology, could even enhance the client-therapist relationship.

Video game and film companies widely use motion capture technology to create lifelike digital characters and avatars.

Now, a January 2022 study from researchers at Edith Cowan University in Western Australia suggests that virtual reality (VR) therapy using realistic motion capture avatars is not only possible, but it may be more effective than traditional therapy for some.

As VR technology develops, your therapist may soon join you in the metaverse in the form of an avatar. What may seem like a graphic video game or dystopian future has been demonstrated by new research.

The study suggests that realistic motion avatars could be “the future of social interactions in virtual reality,” which could have clinical implications for therapeutic relationships.

Shane L. Rogers, PhD, researcher and lecturer in the Edith Cowan University psychology department in Australia, and the lead author of the study, said that due to the increasing affordability of motion capture technology, it could start to become widely adopted for a greater variety of purposes — such as psychotherapy.

“The therapist can drive the movement of a digital avatar in real-time so that the avatar mimics their face and body movements in a smooth and lifelike manner,” Rogers told Psych Central.

Details of the new study

The study focused on the interactions between two avatars in a three-dimensional virtual setting.

Fifty-two undergraduate psychology students from 18 to 53 years old rated their experiences communicating with an avatar driven by another person wearing motion capture technology.

They engaged in casual getting-to-know-you conversations and were interviewed about positive and negative experiences.

The researchers compared the avatar conversations to face-to-face conversations and found that about 30% of participants felt more comfortable disclosing negative experiences in virtual reality compared to face-to-face.

“This indicates that for a substantial proportion of people, this mode of communication might be quite useful for psychological therapy,” Rogers said. “We are currently doing more research to further investigate that.”

Virtual reality is not a new concept, even in therapeutic settings.

Virtual reality exposure therapy (VRET) that places people in simulated environments related to combat — developed by technology companies like Bravemind — is being used at over 100 sites across the United States to treat combat-related post-traumatic stress disorder (PTSD).

Though the process of reliving trauma may sound intense, 2021 research suggests that VRET can have benefits.

Research on the benefits of VR therapy for mental health conditions dates to at least 1995, when a small-scale study showed that virtual reality exposure could help people who have a fear of heights.

But the idea that a therapist-client relationship could occur in a virtual world is relatively new.

“Communicating in VR transports you into another world,” Rogers said. “When you step outside the real world for a moment into the virtual one, for some people, this might feel like a safer space to process the negative feelings around negative experiences.”

Rogers added that disclosing negative experiences to another person face-to-face may lead to feelings of shame or embarrassment. Interacting in VR provides an added layer of interpersonal distance, making disclosing feelings easier for some.

He was also surprised by how much participants seemed to enjoy their social interactions in the virtual setting, suggesting increasing acceptance of the technology.

“Human beings are social beings,” Rogers said. “Now that we can really put the social into VR experiences, this opens up a massive amount of possibilities.”

A growing body of evidence, according to a 2021 review, suggests that VR therapy may benefit people with specific mental health conditions.

David A. Merrill, MD, PhD, an adult and geriatric psychiatrist, and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in Santa Monica, California, uses VR therapy at his outpatient Memory Clinic to provide “brain training” for individuals with Alzheimer’s disease.

He said that many people could benefit from VR therapy, particularly children and adolescents who might feel shy or wary about disclosing their feelings face-to-face with a therapist (even online or over Zoom).

“With VR technology, you could engage in clinically meaningful therapy that’s actually preferred without ever leaving the house,” Merrill told Psych Central. “I think it’s meant to be a proxy for togetherness when you can’t actually be together.”

PTSD

Research from 2020 suggests that prolonged exposure therapy and virtual reality exposure could help people experiencing post-traumatic stress manage their symptoms by re-creating the narrative of their trauma.

“The core of post-traumatic stress is avoidance and anxiety that becomes so severe that you’ve stopped doing things because you’re avoiding triggers and reminders,” Merrill said.

“You can create a narrative where you realize that you were there, that you lived through such an awful thing, and that you survived.”

Anxiety and phobias

Research from 2019 shows that VRET may also be beneficial for anxiety disorders, particularly phobias.

Virtual spaces can be created to expose individuals to specific anxieties or phobias in a virtual setting, such as a fear of heights or spiders.

In addition, another recent study suggests that virtual companions in the form of avatars may help reduce anxiety by providing support, particularly among women.

Depression

VR therapy may also hold promise for treating individuals with depression and mood disorders, according to a 2021 study.

Merrill said VR could help those who’ve lost their sense of motivation, pleasure, and joy.

“Bringing joy or enjoyment into therapy would be an important element that could be an advantage,” Merrill said. “You can meet [your therapist] on the phone or Zoom — but I think there are some people who’d be kind of jazzed to meet in the metaverse.”

VR may seem like all fun and games, but it’s not for everyone. Side effects of VR may include:

In addition, psychotherapy can still come with risks — even in the virtual world.

Those trying VR therapy can work through feelings of overwhelm and anxiety about the therapeutic process with a professional.

“You need to have confidence that the therapeutic framework is going to be maintained and that it’s professional therapy,” Merrill said, “That kind of safeguards against the vulnerability of altered states or altered realities.”

In a tech-driven world already grappling with Zoom fatigue, is metaverse burnout on the horizon?

Meta, formerly known as Facebook, will soon release its VR communication platform, “Horizon Worlds,” which means it won’t be long before cutting-edge VR technology and headsets become widely available.

“I predict we’re going to witness VR social interaction becoming a lot more commonplace in the not too distant future,” Rogers said.

“Harnessing motion capture to make the avatars more faithfully mimic the body language of the person behind the avatar is the key ingredient to enhance the experience enough to bring VR communication into the mainstream.”

Although the Edith Cowan study is preliminary and the technology still needs development, meeting your therapist in the metaverse, as proposed by the new research, could present a new pathway for those who might not feel comfortable in traditional therapy, be it in real life or online.

Research supports VRET therapy for certain mental health conditions, but avatar-based VR therapy is still in its early infancy.

Emerging research suggests that VR technologies could supplement — not replace — the in-person therapeutic process. For some people, a combination of traditional and VR therapy may work well.

“I think one of the fears of the metaverse is that you just stopped living in reality, whereas VR is intended to help you get back to living more healthfully in the world,” Merrill said.

“It’s hard to imagine the technology evolving to the point where you would replace the therapist because this is really more about connecting with another person in a virtual space rather than connecting to a virtual entity.”