Dr Lucia Valmaggia, the immersive power of virtual reality

Lucia Valmaggia, “Virtual reality for the treatment of child and adolescent at risk or affected with mental disorders” – Vienna 2019 Keynote Speaker

Embracing virtual reality as a future technology for mental health

When looking at the ESCAP Vienna congress program, you may see Dr Lucia Valmaggia’s name pop up in several places. An indication of her expertise in an area that is quickly becoming a technique to know in medicinal research, Virtual Reality. Virtual reality isn’t all about Gaming; it is increasingly used to understand neuro-cognitive behaviour. Lucia and her group have developed several paradigms for virtual reality-assisted therapy for mental health.

Lucia is a reader in clinical psychology and digital mental health at King's College London, UK and leads the virtual reality lab at the NIHR/Wellcome Trust King’s Clinical Research facility. Their work aims to improve the understanding of the mechanisms that play a role in the onset and maintenance of mental health problems. They use virtual reality environments to assess and develop treatments to improve the well-being of people with mental health problems. As well as being a keynote speaker in Vienna, she will also be an expert speaker for the ESCAP Research Academy and a panel expert in a discussion group.
How do you use virtual reality in the lab?
"From the moment you put the device on, activate the program and start being immersed in a virtual environment, only then can you truly understand its immersive powers. It’s quite a different medium, despite the fact you know it’s not real, you feel like it is. The body responds as if it is a real environment, you engage in conversation, you move away if something is approaching you” explains Lucia. The devices over recent years have advanced hugely in their resolution, affordability and are more portable, with no need to calibrate it each time; it’s a plug and play approach. In Lucia’s lab, they use the Oculus Rift system, which can be seen in her YouTube videos explaining the system.
Depending on what purpose you are using the virtual reality system for, as an experimenter, it is important to let the participant be absorbed and immersed in the environment. Lucia explains “it’s important not to break the ‘sense of presence’ as the experimenter, to talk as little as possible”. “However, in a therapy setting with a patient, you may want to interact with them, we can stop the program and modify aspects if necessary, we can discuss a different way of coping with a situation, then reactivate the program and allow them to try a different way of dealing with it”. Sometimes during therapy, it is hard for a patient to recount their thoughts, feelings and emotions to a previous event. “The advantage of the virtual reality environment is the patient is exposed to an environment that they know will be difficult for them. The therapist alongside them will assist in developing coping strategies and mechanisms to deal with the situation, i.e. as in the YouTube video above, the laughing aspects was an issue for the patient, parameters can be adapted for the patient to start using techniques to cope with such a situation”.
Lucia’s group have recently collaborated with Dr Charlotte Gayer-Anderson who works in REACH, a pioneering project led by Professor Craig Morgan, exploring mental health and resilience in young people aged 11-14 years. The experimental task is set in a school canteen environment. “The environment is the same for all of the young participants, and we want to see whether different children respond differently to the same settings, in this respect, we talk as little as possible as not to interfere with their experience”.
Designing a virtual reality situation
Intricate detailing and planning go into designing a virtual reality environmental situation. The virtual reality lab at King’s College London has an in-house programmer (Mr Jerome Di Pietro) to assist in the making. “We develop them [the programs] really alongside people that have the real-life experience, specifically psychosis. We go about it by writing a film-script. Just like a film script, we think of a situation, we create a person(s), an environment, the social interactions. At each stage, we discuss it with patients who have lived experiences to shape the environment to make it as real as possible. They may tell us they had difficulties in a specific situation, we develop some common themes associated with anxiety or psychosis, i.e. laughing, murmuring in the background, neutral comments that are a bit ambiguous. All these parameters are adaptable, again allowing the patient to develop coping strategies”.
Interestingly, Lucia is also collaborating with Dr Stephani Hatch, to build a virtual reality healthcare setting with various different avatars involved to test how unconscious bias can influence a healthcare professional when diagnosing, or prescribing treatment to a patient. Virtual reality has a diverse capacity to be used not only in a clinical setting but for training and educational purposes too.
Development of psychosis: the use of virtual reality
Daniel Freemen, professor of clinical psychology in Oxford and a pioneer in developing automated immersive technologies to increase access to evidence-based psychological therapies, was the instigator for Lucia’s passion in virtual reality. In the late 1990s, she first heard him give a lecture on the subject and later she went on to work with him. “In our earlier studies done in the early 2000s, we aimed to check the safety aspect and the use of virtual reality with these types of symptoms. If you are dealing with people with hallucinations or delusions you want to make sure your technologies are safe. In those early studies, we found that people are very able to distinguish between reality and virtual reality and that it does not make the symptoms worse”. Attention needs to be drawn to the phase of psychosis the patient is in, “patients in an acute phase of psychosis may not want to put the headsets on because it may be too threatening to them. They worry they will lose sight of what is going on around them”.
Lucia has also collaborated with research projects using virtual reality in different settings that explore eating disorders and body image and is advancing with a project to develop a virtual reality social system for young people with autism. These aspects will be discussed during her keynote presentation.
“I’m convinced that virtual reality is one of the technologies that can improve psychological treatments in the future, but with every type of new technology or intervention, we need evidence-based research to back up their use in the clinical setting”. The Topol review raised several issues about the future of digital technologies in the healthcare system. Lucia describes the situation in the UK but it can be translated to other countries “if we want to have a health service that is able to use different technologies, we need to start now to incorporate training to the new generation of doctors, nurses, psychologist etc. We recognise that we are quite far from that. Unfortunately, despite the fact that virtual reality is booming there are not many people that can teach it, and it is not part of a curriculum, I think it’ll take some years to get this incorporated and be part of the training”.
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