Depression: virtual reality can help improve mental health

A new study is exploring the use of augmented reality headsets to treat major depressive disorder.

The authors of a study published in the journal JMIR Mental Health found that virtual reality treatment showed encouraging results comparable to current telemedicine therapy for depression.

Augmented reality (XR) places the headset user in a synthesized virtual reality (VR) consisting of visual and auditory images.

The current study compared the effectiveness of one of the current mainstay interventions for major depressive disorder (MDD), behavioral activation therapy, with a version enhanced with augmented reality, which the study referred to as "XR-BA."

The researchers suggest that XR-BA therapy may offer a more enjoyable treatment, thereby encouraging patients to continue it.

How do we know if augmented reality helps treat depression?

The primary outcome measure in the study was participants' ratings of the Patient Health Questionnaire (PHQ-9) administered by telephone. Higher PHQ-9 scores indicated more severe MDD.

The study included 26 participants who were randomly assigned to receive either a 3-week course of 4 sessions of behavioral activation therapy or a course of XR-BA therapy sessions in a similar configuration. Participants in the XR-BA group were equipped with Meta Quest 2 virtual reality headsets.

The average age of participants was 50.3 years, with a range of 17 years. Of these, 73% were women, 23% were men, and 4% were non-binary or third-gender.

Both groups showed similar and statistically significant reductions in their PHQ-9 scores as well as symptom severity between the start and end of the trial.

Among the XR-BA group, PHQ-9 scores decreased even before the first session, suggesting positive expectations for the upcoming trial and a placebo effect.

Virtual reality could help 'lower barriers' to depression care

For people with MDD interested in new technologies, XR-BA therapy can present therapeutic content in an engaging environment.

First author Dr. Margot Paul, a clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, explained in a press release:

“Clinicians can use XR as a treatment tool to motivate clients to actively engage in their psychotherapeutic treatment by completing ‘homework’ tasks that are innovative, interesting and accessible. These findings suggest that XR may help destigmatise mental health and reduce barriers for people seeking help.”

Is there a placebo effect?

Sherife Tekin, PhD, an assistant professor in the Center for Bioethics and Humanities at SUNY Upstate Medical University who was not involved in the study, said that while the placebo effect may play some role in the positive mental health effects of XR-BA, it is worth further study.

"We know," Tekin said, "from both research and patient reports that being actively involved in their recovery process strengthens patients' sense of control and power over their environment and lives."

After sometimes challenging training in navigating the virtual world, participants receiving XR-BA treatment were able to engage in a variety of engaging activities.

These activities included playing a magical board game, practicing workshop games, solving puzzles based on clues, dancing to music, and the opportunity to "play" miniature golf on their own or with others.

Tekin suggested that XR-BA could be "an antidote to how someone feels when they're depressed."

"Usually the person withdraws from previously enjoyed activities, becomes more isolated from their community, and a state of almost complete inactivity sets in," she said.

However, in this study, participants "may have felt energized, entertained, and most importantly, they felt like they were in control by physically pressing buttons to play the game," Tekin suggested. "This may have contributed to the effectiveness of VR."

Important to 'Proceed with Caution' When Recommending VR for Treating Depression

"Psychiatry has a history of being overly excited about new interventions, placing great hopes on them," Tekin said, "investing all the research resources and effort into that intervention, only to be disappointed later."

"We have research and a lot of evidence," Tekin said, "showing that in mental health disorders, a combination of different interventions gives a patient a better chance of dealing with their problems than just one."

"This is primarily because human nature is complex and it is difficult to find one intervention that will suit everyone," she added.

While adding XR-BA to the list of therapies above may seem plausible, it is important, as the expert noted, to "proceed with caution and ensure that the patient is given the opportunity to try different treatments to find what works best for them."

Virtual reality may help treat other mental illnesses

It is noted that studies have already been conducted on the use of virtual reality for people suffering from post-traumatic stress disorder (PTSD).

"In these studies, scenes and episodes that had a traumatic impact on veterans were simulated in virtual reality in a more controlled setting," Tekin said. "This gives veterans the opportunity to experience the traumatic event, but also feel more confident because they can stop the virtual reality at any time."

Tekin added that she has faith in the new study's prospects "provided we make sure that patients receive these new types of interventions in addition to their usual treatments."