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Real Problems, Virtual Solutions

By Jason Patterson

Virtual Reality: Making the Real World a Better Place

Virtual reality (VR) is often thought of as a means of escape or at least avoidance of the real world, especially by those with antipathy towards the concept. But the truth is that one of the primary uses of VR today and one of its primary uses for years to come will be in helping people better handle the real world, both in terms of pathological conditions that afflict individuals and their loved ones, and sociological conditions that afflict us all. Albert “Skip” Rizzo and Dave Sackman are driving the respective conversations in the academic and private sector, with both recently sparing some time for WinWin to discuss how VR is bettering our world.

Better access to care

One of the biggest differences between the haves and have-nots is access to quality medical care, with the gulf perhaps even wider in terms of psychological care (psychology as a profession is largely non-existent in wide swaths of the world). Virtual reality has the potential to help on two fronts. First, through greater access, as anyone with a broadband connection and an inexpensive headset (perhaps a few hundred dollars today, no doubt less in the future) could have access to therapeutic options for a variety of conditions – post-traumatic stress disorder (PTSD), autism, phobias, dementia, brain injury, etc.

According to Albert “Skip” Rizzo, Director of Medical VR at the University of Southern California Institute for Creative Technologies, “VR fits within a collection of technologies that are going to improve the whole care delivery system in mental health. Teletherapy, phone apps, websites with interactive virtual agents; all are a new sphere of networked, mobile, in-home access that I think is going to make a big difference. When you get a well-informed application developed, whether it’s a mobile or VR app, you do see improvements and you are pushing more care out into the world where there was none before. We can use these technologies as tools to extend our skills, and that can’t be anything but positive for healthcare.”

Poor man’s therapy?

Rizzo would admit that quality varies with these things, especially with mobile apps, which he calls, “a Wild West show” in terms of the variety of what’s out there. But Rizzo would also say that we need not necessarily consider such technological methods as inferior to being in the same room. “With teletherapy, we’re finding, even with difficult types of therapy like exposure therapy for PTSD, equivalent outcomes when a person is in a remote location and you’re interacting over the Internet compared to in-session. That was a big finding because people were saying that you have to be in the same room with the patient. But now, we’re starting to accept that the therapist doesn’t have to.” Yes, you read that right – a low-cost virtual option need not mean an inferior quality of care, as compared to a therapist seated next to you with a beard and a German accent, writing things on a notepad.

Improved quality of care

Technologies like VR can actually improve the quality of care in a variety of scenarios. There are three basic reasons why.

Greater control & replicability

Any good form of therapy is based on experimental results derived from conditions where the experimenter had precise control over what was going on, and repeated a series of precise steps many times. VR offers a similar level of control over what the patient sees, hears, and feels, while making it less important that the clinician supervising the VR protocols have the same level of skills as the experimenter who designed them. According to Rizzo, “Virtual reality is the ultimate Skinner Box (a small apparatus for training lab animals). And now we have that same level of stimulus control, but embedded in a digital representation of an environment.”

Helpful things need not be real

Believe it or not, talking to a virtual avatar can actually be more effective than talking to a live human, especially if it’s about a topic that might be considered embarrassing or shameful. According to Rizzo, “If there’s an actual human controlling what a character says and does on a computer versus it all being software, software wins every time when it comes to discussion of sad events. There’s less feeling like you’re being judged. It unlocks a person because it’s a human form that you can interact with, but there’s no judgment, no risk. You can say whatever the heck you want.”

Creating what was once impossible

And finally, VR makes possible things that were not possible before. This is particularly useful with exposure therapies, where a patient is exposed to something that makes them anxious or fearful in a controlled and stepwise manner that is meant to help them overcome their fears. Rizzo laid out a specific VR scenario where, “For fear of flying, patients can walk through the airport, go to the gate, get on the plane, and you can manipulate whether the plane has turbulence, if there’s a thunderstorm out, and they go though all that in eight or nine sessions. And you see in all these studies dramatic improvements in everyday life.” There are many other treatments suited to virtual environments as well, with one of the most famous examples being pain reduction in an environment called Snow World (See End of Article).

A reverse of the principal in question here, where the patient is virtual and not the environment, is an application that Rizzo has developed called Standard Patient, which has the potential to meet a great need. According to Rizzo, “Novice clinicians have a chance to mess up a bunch of times with virtual characters before they ever get their hands on a live patient. And this is not the same as role-playing with the person sitting next to you in graduate school. A virtual patient can now replicate all the various things that might happen in a therapy session. You can have the patient meltdown. You can have a patient that’s intimidated. You’ve got to use the art of what it is to be a good clinician to help the person feel comfortable. That’s not stuff people are born with. A lot of people think they’re born with it and they turn out to be crappy clinicians. Standard Patient gives people opportunities where there wouldn’t be people to practice with. This is a virtual character that’s always on-call that you can practice with online in your dorm room, and go through a set of steps, and then, based on how you interacted with that patient, have the software give you tips. ‘When you asked this question and got this answer, why didn’t you follow up further? You’re asking the character too many yes/no questions.’ These are all the arts of being a clinician that you’re not going to get out of a book or your supervisor.”

Improving the human condition

Standard Patient is somewhat different than the previous examples in that it is not a treatment element for a medical condition, but rather a tool for improving how clinicians do their jobs. This represents a net benefit to society as a whole, and VR’s potential for positive social change, through the betterment of individual citizens, is easily as great as its aforementioned medical applications, if not greater. For expertise on this topic, WinWin consulted with Dave Sackman, VR evangelist, CEO of LRW (a VR marketing consultancy), and Co-founder of AppliedVR, a firm, in his words, whose “sole purpose is to build VR to be large enough that it can have a real impact on solving some of society’s toughest problems.” According to Sackman, VR has the potential to “change human behavior to make the world a better place.”

If I were you

Some of the most interesting scenarios for VR are those that allow you to be someone else, or that allow someone else to be something else. An example of this is a virtual scenario where users are given a chance to save a baby on rooftop, by either riding up in a helicopter and saving it, or flying up and saving it superhero-style. Users who did the latter prove more willing to help in general for a while longer after the virtual experience ends, and when asked about the lessons to be learned here, Sackman stated, “There are really two lessons. One is the ability to use VR to create greater empathy in people by putting them in situations in which they have opportunities to develop empathy that they otherwise couldn’t. The second is the concept of the Proteus Effect, first identified up at Stanford. This is the idea that people will take on the traits of their avatar. If you give someone a taller avatar, they’ll start behaving more aggressively; they’ll be a more aggressive negotiator, as an example. If you give a male a female avatar, they behave more nurturing. In four minutes in an environment in which a white man sees himself as a black avatar, he changes his racial attitudes.”

Greater empathy

Sackman has spoken frequently about this ability for VR to create empathy by seeing yourself as someone else, even if that other person is still you. One experiment Sackman likes to cite is one where young people are shown older versions of themselves in VR, with this leading to more financial responsibility on their part later on. This could be considered a form of empathy, but with your older self, someone that young people often can’t even imagine will ever exist.

So who’s taking an interest in such VR applications? According to Sackman, “Outside of health and medicine, we’re working with Travelers Insurance to reduce accidents and injuries in the workplace. We’re working with another Fortune 500 company to teach its service representatives to have greater empathy for its customers. We’re exploring ideas on how to teach people to unleash their creativity in support of another Fortune 500 company. We’re talking to senior staffers at the White House and the Police Foundation as well as the top brass at the Los Angeles Police Department (LAPD) to develop applications to reduce racial bias in law enforcement, as well as a number of others.”

When asked to elaborate about his work for Travelers, Sackman responded, “We gave people power to fly around a warehouse to save their co-workers from several common accidents. We also gave people, including senior management, the opportunity to see the consequences of pushing crane operators to perform in unsafe conditions such as high wind. In this environment, people get to experience, first-hand, the quite serious consequences of using bad judgment in an attempt to improve productivity. The crane could collapse and fall on another building. It could crush a car. It could actually kill someone, including the crane operator. And we’re working at the highest level at Travelers – the Vice Chairman and her entire executive team. And we’ve had some good early success.”

A tool for visualizing

Dave Sackman has also spoken about the importance of seeing yourself doing certain behaviors (such as exercising) in VR as a tool to making it easier to do those things later on. Though the opposite effect can happen if it’s something unpleasant (a virtual afternoon spent cutting down virtual trees can actually raise the level of eco-consciousness in a user).

This would seem in line with self-help types who preach the importance of visualizing a goal to it’s later achievement. When asked if it was, Sackman responded, “Yes, except in virtual reality, the impact is so much greater. It’s one thing to ask someone to imagine themselves 60 feet up in the air, but it’s quite another thing to put you in the AppliedVR lab 60 feet above the air in virtual reality, and have you try to walk ten feet across a plank.” In other words, VR may prove a great tool for self-help. And if people are helping themselves stay in better health, do their jobs better, save more for retirement, have more empathy, save lives, and be more willing to help, then VR is indeed making the world, as a whole, a better place.

About Snow World

One of the most famous applications of a therapeutic virtual environment is called Snow World, developed at the University of Washington. Snow World is a calming, wintry environment, and has been shown so far to reduce subjective pain levels in burn victims during the often excruciating tasks of wound dressing and bandage changing. The number of usage cases aren’t huge yet, but some patients have reported pain & anxiety reductions of 50% or more compared with other distraction techniques. And one could easily imagine such a program applying to other anxious, painful scenarios that affect more people, such as physical therapy, dentistry, or childbirth. With over 100 tons of addictive opiate painkillers consumed annually in the U.S., anything that reduces reliance on these meds would be a net social good.

About Skip Rizzo

Albert “Skip” Rizzo is a clinical psychologist and Director of Medical Virtual Reality at the University of Southern California (USC) Institute for Creative Technologies. He is also a research professor with the USC Dept. of Psychiatry and at the USC Davis School of Gerontology. He researches the design, development and evaluation of VR systems, with the common thread of how VR simulations can be usefully applied to healthcare needs. In 2010, Rizzo received the American Psychological Association Award for Outstanding Contributions to the Practice of Trauma Psychology and in 2015 he received the Society for Brain Mapping and Therapeutics “Pioneer in Medicine” award.

About Dave Sackman

Dave Sackman has been President and CEO of Lieberman Research Worldwide Inc., since 1991. He is also the co-founder of the Pragmatic Brain Science Institute and Applied VR. He has a marketing & research background, having held relevant leadership positions at Columbia Pictures, American Medical International, and Winchell’s Donuts. For the Marketing Research Association, he served on the Executive Forum on Research Quality and the Executive Committee of its National Board of Directors. Sackman currently serves as a Director at Data Exchange Corporation and Specialty Merchandise Corporation. He also serves as a Member of the Board of Advisors for RFL Communications and a Board Member of the Council of American Survey Research Organizations.

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