Using Virtual Reality (VR) to Improve ADL/IADL Performance in Adults with Mental Health Conditions
Lets go over some basics of VR terminology:
-Virtual reality (VR) has been defined in many ways and in many contexts. The dictionary defines virtual reality as “an artificial environment which is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one’s actions partially determine what happens in the environment” (Merriam-Webster, n.d.).
-VR’s “artificial environment” or virtual environment can be presented as non-immersive on a screen (mobile or larger), semi-immersive through extended visual displays such as CAREN, or fully immersive through a head-mounted display (HMDe.g., OculusRift)or a CAVE system (Motek,n.d.) (Proffitt & Anderson, 2020).
-In VR, the participant is active which means they need to push a button, perform a movement, or say a command/word/phrase in order for the system to get the needed input to perform an action.
Th use of VR in Occupational Therapy was an article posted in OT practice magazine in August,2020. So far this article pointed out the research on using VR in rehabilitation settings. The research shows that VR can improve UE motor function, gait, balance, and ADL performance (Proffitt & Anderson, 2020). Plus there is a significant amount of research done on using VR with adults post-stroke. The main thing the OT Practice article did not mention is the large amount of research that has been done on using VR in Mental Health settings.
Before I go further, let me explain my current role as an OT in a little more detail. I am currently the Program Director and Fieldwork Supervisor at a Outpatient Rehabilitation clinic that specializes in Mental Health. Sounds confusing right? Rehabilitation and Mental Health? Well, as OTs we know that individuals that have Mental Health conditions also have multiple other comorbidities or complex medical/physical conditions. Our clinic focuses on the whole person which means we pride ourselves in being client-centered with the ability to both address physical and psychosocial needs. Therefore, I could be doing upper body strengthening, endurance, balance, or cognitive skills training, meal preparation, job skills training etc.
A big part of my job is developing specialized programs within our company. For example, we have a program working with Karen refugees, and another program focused on Hoarding/Excessive Acquiring or Saving. Lastly, we have been working on developing a specialized program using VR head-mounted displays. We have been using VR as a tool to provide specific OT intervention for approximately 6 months now. We have purchased specialized headsets and programming from limbix VR (https://vr.limbix.com/). This system allows us to simulate a job interview or other social anxiety situations. For example, there is a scenario/simulation of having to socialize at a party in which the clients have to actually respond in phrases/words out- loud to questions they are asked. This system also has relaxation tools including deep breathing, mindfulness, guided imagery, meditation all within different virtual environments including a beach, forest, river, or lake. We can also do cognitive skills training by doing trivia or doing a game that involves visual scanning. There are modules for education on different diagnoses including anxiety, addiction, depression, and trauma. One of my favorites, is a simulation involving having to turn down an alcoholic beverage at a bar which is very useful for our clients that have recently completed inpatient chemical dependency treatment. Other simulations involve practicing driving a car with added distractions and a public speaking scenario.
As you see VR has a lot of potential to expand the way we provide OT interventions in a what feels like a very realistic environment. I have also used VR as a behavioral/motivational strategy especially with younger adults. I use VR as a reward for example, if an individual can shower 3 times in a week then you will earn a reward of using VR for 10 minutes. This may not be the main reason of why we have the VR in the clinic but it has been effective as some of these individuals previously were not showering for weeks at a time. Once they get in the habit/routine of showering then it becomes easier and they start to notice the benefits on there mood and health. This way, the reward can be tapered down to eventually not needing a reward. Another observation of using VR in light of the COVID pandemic is that it has been extremely beneficial for those clients who are continuously isolated in fear or because they are considered to be “high risk”. A unique tool using VR is that you can do “time travel" using google maps in which you can transport yourself anywhere in the world. This is also helpful for many Psychologists for doing exposure therapy or working on managing agoraphobia.
As a company, our goal with developing specialized VR programming is to partner with a local University to conduct a study on the benefits of using VR in an adult Mental Health setting. The research will hopefully be ADL/IADL performance improvements. However, if you are interested... there is a good amount of research that has been conducted already (although it might not be OT specific). For example, a small study done on using VR for social skills training on adults with Schizophrenia showed the following (Ku J et al., 2007):
Improved generalization of new skills to the patients' daily lives.
Patients showed an improvement of social cognition and performance after treatment.
Patients reported high treatment satisfaction and acceptance of the VR system.
Affect-computing devices facilitate real-world testing and help treating psychosis.
Srivastava, K., Das, R. C., & Chaudhury, S (2014) have found that VR has been effective in the treatment of acrophobia, spider phobia, panic disorder, and agoraphobia, body image disturbances, binge eating disorders, and fear of flying. It has also been useful in the treatment of agoraphobia, social phobia, claustrophobia, and fear of driving. VR has also been used in cognitive rehabilitation. VR has helped individuals on the spectrum develop the skills necessary for independence including how to cross a road, how to identify different facial expressions or how to pick up visual cues when they need to pay attention to another person whilst they speak.
Personally, I am excited to see the use of VR grow as I believe it can help individuals practice and develop skills needed for daily occupations. I hope that sometime in the near future I can write an updated blog post about the research or study our company conducted on using VR with adults in a mental health setting. This is just the beginning!
References
American Occupational Therapy Association. August 2020. Rachel Proffitt and Sarah Anderson, "Virtual Reality for Occupational Therapy". https://www.aota.org/Publications-News/otp/Archive/2020/virtual-reality
Merriam-Webster. (n.d.). Virtual reality. Merriam-Webster.com dictionary. https://www.merriam-webster.com/dictionary/virtualreality
Lee JH, Ku J, Cho W, Hahn WY, Kim IY, Lee SM, et al. A virtual reality system for the assessment and rehabilitation of the activities of daily living. Cyberpsychol Behav. 2003;6:383–8
Ku J, Han K, Lee HR, Jang HJ, Kim KU, Park SH, et al. VR-based conversation training program for patients with schizophrenia: A preliminary clinical trial. Cyberpsychol Behav. 2007;10:567–74
Srivastava, K., Das, R. C., & Chaudhury, S. (2014). Virtual reality applications in mental health: Challenges and perspectives. Industrial psychiatry journal, 23(2), 83–85. https://doi.org/10.4103/0972-6748.151666
