Virtual Reality for Depression: Interview, Bibliography, Clinical Trials

An Interview with Christopher Tacca and Dr Barbara Kerr at the University of Kansas

What is the status of the treatment of depression with Virtual Reality? Our invited experts present their perspective and we add additional bibliographic and clinical trial references from Denise Silber

At the 6th Annual IVRHA conference in Nashville, Tennessee, VRForHealth co-founder Denise Silber met up with Christopher Tacca, PhD candidate at the University of Kansas. Learning that Chris’s PhD research focuses on the use of Virtual Reality for depression, and having herself observed the relative lack of data on depression and virtual reality, Denise invited Chris to do an interview on his work. His supervisor Dr Barbara Kerr kindly agreed to participate in the conversation.

Denise Silber adds at the end of this article:

–two recent Pubmed bibliographic references on the topic of the use of virtual reality for depression, and which confirm the need for further research on VR and depression

–and a chart of the 17 completed clinical trials concerning virtual reality and depression, as listed on ClinicalTrials.gov


Can you introduce us to the Department at the University of Kansas in which you Christopher Tacca are doing your PhD?

Chris: I’m a fourth year PhD candidate in bioengineering at the University of Kansas. One of the focuses of bioengineering at KU is a focus on research that is translational outside of academia, particularly in the track I’m in, the Biomedical Product Design and Development track. The program covers a broad number of topics including applications in molecular biology, biomaterials, orthopedics, biomechanics, and computational bioengineering. However, across these wide variety of topics, the objective of the research is the same, research that focuses on improving the health of people. Previously, KU bioengineering did not have an emphasis on mental health research, however, I was fortunate to be introduced by my bioengineering research advisor Dr. Lisa Friis to Dr. Barbara Kerr, who will also be answering these questions, in educational psychology. Together, we devised a way to meld the principles of bioengineering that I was trained in and Dr. Kerr’s background in counseling and educational psychology to address an area of need that we are both personally passionate about, the treatment of depression for those that feel they don’t have any options.

Barb: This is the first time I’ve been a co-advisor for an engineering student! I am the Williamson Family Distinguished Professor of Counseling Psychology, in the Department of Educational Psychology. I’ve worked with Dr. Lisa Friis on a number of STEM projects, and it was natural to collaborate with her as well. Chris took part not only in my counseling training courses but also a Study Abroad course in which we visited psychotherapy founders’ therapeutic environments, such as Freud, Jung, and Victor Frankl.

How/why did you pick the topic of VR and depression for your PhD work?

Chris: The story of how I picked this topic comes from a very personal space for me. Like I said earlier, my background is in bioengineering, and I had always had a passion for building, creating new things, and finding new ways to help people. In the spring of 2018, I had just graduated from college, I was looking forward to a fun summer, and I was getting ready for my new life in Kansas for graduate school in the fall. It was only about a week after I graduated, when I found out that one of my friends, fellow graduates with me, and someone who I had just celebrated our time in college together, took his own life. It was confusing, shocking, and heartbreaking for me, but more importantly for his family and closest friends and for him. I saw firsthand the pain that a condition like depression can cause. When I started graduate school that fall and had the opportunity the first semester to pick a lab and research topic, I decided that all I wanted to do was create something that could help at least one person like him. I went searching for professors who could help me with this, and I found two wonderful, wonderful people in Dr. Friis and Dr. Kerr. Together we were able to bring this idea to life.

Barb: One of the most difficult disorders to diagnose and treat properly is depression, and it is the major presenting problem, along with anxiety. A big problem is that the people who need therapy the most are those who are least likely to be able to get out of their bed, leave their house, and transport themselves to a therapist’s office. Depressed people are isolated people, and our system really addresses that issue.

What are the key findings and bibliographic references about the value of virtual reality for persons with depression?

Chris: Virtual reality has long been an intriguing technology for mental health treatment, because of its properties for inducing immersion. VR, in comparison to other forms of media, can truly bring people into a virtual environment, where they physically feel like they are in that space. Thus, in the mental health field, VR has been successfully used to treat various phobias and anxieties through immersive exposure therapy, promote mental wellness through meditation training, and other innovative treatments. For depression, we believe VR can provide immense value for that same reason. Fundamentally, our research focuses on common factors theory, which identifies the key factors that influence therapeutic healing. Thus, they identify what’s important to developing an effective therapy system for the treatment of depression. One of the common factors, the therapeutic environment, states that for healing to occur, the person must be in a space where they feel comfortable, safe, and open to being vulnerable. For someone who feels stuck in a place that doesn’t meet those requirements, VR can meet them where they are and take them there.

Barb: As Chris said, VR therapy has mainly been in the therapist’s office rather than a remote treatment. It’s increasingly popular with a generation that is comfortable with virtual environments; but the big problem there is that the therapist cannot see the client’s emotions in a remote setting. Our system, which is EEG enabled, makes emotions visible to the therapist. That is, the therapist has a real-time monitor on the client’s arousal, while the client gives the narrative context of the arousal. The therapist can infer from the combination of the narrative and arousal the emotion that is being communicated.

Fewer companies are working on VR solutions for depression than for anxiety, for example. What are your thoughts on this? Which solutions have you identified?

Chris: There are many wonderful companies tackling mental health challenges using VR. Many of the treatments using VR focus on PTSD, phobias, or anxieties, however few specifically tackle depression in a clinical way. I think one of the reasons for this discrepancy is that for something like the treatment of a certain phobia there is a very linear relationship between what is needed for the treatment and the value that VR provides. For example, for the fear of flying it might not be feasible to ask someone to get on a plane and face their fears. Instead, VR provides a very controlled and emotionally stimulating alternative. For depression, the benefits might not be as obvious. Hopefully, with more research and work being done on VR for depression, its value will become more evident for more psychologists, counselors, companies, and people.

Barb: Yes, we know of very few people working in the area of VR for depression. A small number of people opened therapy offices in Second Life when it began, but these never seem to have become popular.

What about in academia? Are you aware of the research going on in the use of VR for depression?

Chris: In academia, I think it’s a very similar story, especially in origin. However, more and more people are tackling mental health challenges using VR across the world. I think it’s becoming more accepted and prominent in research, and I’m excited for what new ideas come out of universities.

Barb: No, most academic applications seem to be using VR for social skills training or other basic skills training for developmentally disabled or neurodiverse people.

How do you see this area (VR for depression) developing in the next few years?

Chris: I’m excited for what the next few years of VR for depression hold. Over the past couple years, during the global pandemic, therapists were forced to accept the use of technology in their practice and many found out that it could be very beneficial. We are at a very interesting crossroads of huge advancements in VR technology, more acceptance of technology by practitioners, and an emphasis on mental healthcare. I think in a few years VR for depression research and practical use will have grown substantially.

Barb: Given the increase in professional development workshops at the American Psychological Association and the steady increase on articles published, I think a wave is beginning. I’m glad we caught the wave.

***

Denise Silber:

Please find below two bibliographic references and comments derived from my Pubmed search under these criteria: open access articles, Virtual reality and depression appear in the title, published since 2020. In contrast to anxiety and pain, and as our guests Chris and Barb noted, there is much less specific, published research on depression and VR.

Virtual Reality Therapy for Depression and Mood Disorders in Long-Term Care Facilities Geriatrics (Basel)2021 Jun 4;6(2):58. doi: 10.3390/geriatrics6020058.

The following image appearing in this article demonstrates that there is evidence of the improvement of mood and related symptoms, but there are various limits to the demonstration: minimum treatment period, depression criteria not fully evaluated…

Virtual Reality for Depression and Anxiety: Scoping Review September 2021 (JMIR)

https://mental.jmir.org/2021/9/e29681/

Denise : The conclusion of this article also underlines the need for further research on the use of Virtual Reality in Depression!

« Specifically, we found a lot of studies dedicated to one or the other form of anxiety, whereas a limited number of studies were found to concentrate on depression (4/34, 12%). Supporting people with depression in VR settings could be an interesting area to explore for health and technology researchers in the future. »

We are excited to note that ClinicalTrials.gov reports 17 completed trials on VR and depression. The search is hyper-linked in our introduction to this article.