Gaming the system Battling opioid addiction with virtual reality
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so
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[Music]
i want you to visualize how someone
looks
who’s addicted to heroin
now look at me you might think that
there are differences
but we’re actually very similar the only
main difference is our drug of choice
when i was 13 i began to play a game
called runescape
this is a game where you can escape into
a virtual world
level up go on quests with friends
i was obsessed with this game
how obsessed well throughout my teenage
years i spent
eight thousand hours logged into
runescape
that’s the same as if i had a full-time
job 40 hours a week for
five years
i would do quite literally anything to
play more runescape
i lied to my parents i faked being sick
to miss school
when they removed the ethernet cable
from my computer i routed one through
the entire house in secret
when they took the door off my room i
woke up at 3am every morning to play
before school
but why was i addicted to runescape
what could lead me to quite literally
run and escape
for 8 000 hours
well when i was 13 i also realized that
i was gay
i started to have feelings of shame
anxiety and guilt
thoughts were racing through my head
would my parents still love me
would i ever be accepted could i ever be
happy
but in runescape things were different
as i leveled my strength in my room
crafting
in the virtual world hits of dopamine
kept me going in the real one
i even made friends in runescape and i
led a clan of 400 people
i was kind of a big deal but
when my parents would walk into the room
and i’d close the game
all of those thoughts and emotions would
come flooding back to me
and it quickly became apparent runescape
wasn’t the problem
it was a coping strategy for my problem
it was my heroine
the opioid crisis is a huge issue in the
united states
this is a heat map of drug-related
overdose deaths most of which were due
to heroin
last year 72 000 people died from
drug-related overdose deaths
that’s more than gun violence or suicide
or fatal car crashes it’s a huge problem
in the united states and around the
world and i believe
that virtual reality has the potential
to stem the tide and turn us to the
other direction on the opioid crisis in
this country
it can provide an escape thing that’s
being sought through things like
runescape or heroin but it can provide
an escape into an intervention
over the next 10 minutes i intend to
show you how the process that led me to
play runescape
is similar to that of a heroin user
and i’m going to show you how virtual
reality intervention is superior in many
ways to traditional psychological
treatment
it can provide access to an intervention
that’s portable
so people can bring it with them
wherever they are it’s accessible so
that people can go in at the moment that
they need it
it’s anonymous so when you’re in there
you feel like you’re with other people
immersed but they all have avatars and
usernames
and it’s affordable at the cost of just
a few therapy sessions
i’m going to show you how what i’ve said
is played out through the lives of the
patients that i’ve had over the past
three years
but first in order to show you how the
process that led me to play runescape is
similar to that of a heroin user
i need to tell you a little bit about my
type of therapy
now i know what you might be thinking
when i say therapy
that it involves laying on a couch three
times a week exploring unconscious
drives
and discovering a freudian impulse
through mother
well that’s not quite how we do it in my
lab this is a picture of me with my
mentor steve holland
and his mentor aaron tim beck
the creator of cognitive behavioral
therapy
one of the most well recognized
interventions around the world
tim is 98 years old and he’s still
writing papers on how to help others
he’s basically a badass he developed a
model that we try to teach our patients
the basic idea is that we have our
environment wherever we are
and within our environment we have
thoughts feelings
behaviors and physiology that are all
connected to one
another so for example right now
i’m standing on this ted stage i’m
feeling anxious
and excited my physiology involves my
heart racing
lots of thoughts are going through my
head including i hope i don’t forget my
talk and
i haven’t stood in front of real people
in months because of the quarantine
but my behavior is to continue as if
everything is normal
what we teach in therapy is that you
can’t just decide not to feel anxious or
depressed or guilty or ashamed
we don’t have control over our emotions
but because our emotions are related
to our thoughts behaviors and physiology
we can change
those things to change our feelings we
can examine our thoughts
to see if our perception is accurate we
can change our behaviors to try
something new
or we can adjust physiology through
things like medication and exercise
runescape for me was a behavior playing
the game
that allowed me to escape into a virtual
world and
avoid feelings and thoughts
heroin is similar although it is
different in a few ways so heroin is a
behavior using heroin
but it’s adjusting physiology which
numbs feelings
and suppresses automatic negative
thoughts but
as the cycle continues eventually the
person’s using just to avoid withdrawal
symptoms
and it continues to numb
but i wanted to see as part of my
research at vanderbilt university
whether we could take the properties of
runescape which is designed
to get people to play more and more
and use some of them to build a virtual
environment
that could help people with their
problems
so i started working at an inpatient
treatment facility called journey pure
this is the place where people go when
they go to rehab which by the way is a
method of changing
someone’s environment to help them learn
coping strategies for their issues
i wanted to bring virtual reality with
me after i first discovered it at the
nih about seven years ago before i
started my phd
i remember being in the lab and putting
on the headset for the first time
i experienced the suspension of
disbelief as i was transported to an
outer space station it was incredible
and i knew at that moment that it could
be powerful for psychology
but i wasn’t quite yet sure how
so i brought the headset with me to
journeypure and i started doing intake
interviews with patients in the detox
unit
my first patient was brittany
she was 25 years old and she started to
tell her story while my supervisor was
sitting next to me
for our first intake interview she was
using heroin
with her family of six and her parents
were also using heroin
they were forcing her to do prostitution
to get money for drugs
eventually the heroin was not enough of
an escape and she attempted suicide
by jumping out of a car moving 65 miles
an hour
luckily she survived and she was
transferred to our facility
at the end of the interview i empowered
her for being in rehab
and instead of going back to lay down
the detox unit i asked her if she wanted
to try some virtual reality
although she was still visibly upset she
hesitantly said
okay sure i’ll give it a try my plan was
to put her in some apps and games so she
could just kind of play and see how she
felt
but before i could launch any
application she was in the home default
loading environment
a cabin in the woods and she put on the
headset and instantly started to smile
she looked around she said oh my god
this is so beautiful
she walked out under the deck and said
look at the mountains i’d never been
hiking before
we put her in apps and games for about
30 minutes afterwards she took off the
headset
she looked at us with a bewildered look
on her face she said all of my anxiety
is gone
we were really surprised because you
don’t typically see these types of mood
changes in a patient
who’s just been describing such extreme
trauma
something about the virtual reality was
different and this started happening
with patient after patient
after patient and the nurses in the
detox unit eventually asked me what i
was doing to the patients because they
were coming back
completely different so this led me on a
process to conduct a single arm trial
with 241 patients
we measured their mood before and after
their first virtual reality session
we asked them to report on 20 different
emotions 10 positive
and 10 negative emotions and we compiled
them into positive mood and negative
mood
what we found is that positive mood
increased significantly before the
session in dark blue to after the
session in light blue and negative mood
decreased significantly
with the largest effect being in the
increase in positive mood
and when you break out each emotion
individually every single positive
emotion
increases significantly and almost every
single negative emotion
decrease significantly this is really
powerful because medications are
generally able to suppress negative mood
but it’s very hard to induce a positive
mood which is
often the thing being sought through
drug use
so we saw that virtual reality was able
to help people with their mood
but i wanted to try one more thing
because so far
the patients were putting on the headset
and i was standing in reality
but i was there to learn how to do
therapy so i wanted to go in with the
patients
and i brought a second headset down to
journeypure so that we could be
in therapy together one of my first
patients
was janet she was 23 years old
and using heroin as well we met in
person and then she went into a separate
room
and i was in a different room we both
put on our headsets and we went into a
virtual environment
represented as avatars and we started
our therapy session
she told me how she got to rehab she was
sexually abused by her father when she
was young
later as she was older she got in a
motorcycle accident and was prescribed
opioids
but they didn’t just take away her
physical pain they also took away her
psychological pain
she became addicted and eventually
switched to heroin because it was
cheaper
for the rest of the session we went
through an example to
help her learn how to apply the model in
the virtual reality i was able to write
in the air
in 3d and we did a whole session and we
used an example when she wasn’t able to
fall asleep
everything was floating in front of her
and she was able to visualize the
different elements of the model
a few days later something happened in
rehab
her mother didn’t show up to family
weekend she told me that she was
devastated about this she was really
really upset
but something interesting happened she
was able to think about the model
and visualize that virtual environment
and apply it in her own situation
and so she was able to realize she was
having a thought that her mother didn’t
love her and that’s why she didn’t
show up to family weekend and she
reframed it and realized it was more
likely her mother simply forgot
and she later told me that the whole
session was very powerful it felt like a
mental vacation
for her that she never would have told
me about her trauma if we had been in
person
she felt safer in the virtual reality
this is powerful
because it’s showing that virtual
reality not only
can help people feel better but it can
potentially deliver a more effective
intervention
and normally it takes seven to eight
in-person therapy sessions to get to
this point and we’re seeing that people
can get there after just one or two
virtual reality sessions so what’s
happening
here so according to the model we have
these three ways
to get at changing feelings examine
thoughts
change behaviors or just physiology
but what we’re seeing with the virtual
reality is that there might be a fourth
way
by immersing someone in a virtual
environment
to change the context of the thoughts
feelings behaviors and physiology
we’re calling this cognitive behavioral
immersion
and we’re adding one more thing because
these environments are so powerful
we’re using them to teach peers on how
to help each other
a completely peer-based version of
therapy
so we’re building an experimental app
called help club
and we’re seeing whether or not this can
be
as effective as therapy people can go
into
lots of different virtual environments
they can escape the real world
but they’re escaping into an
intervention with other real people
represented as avatars
they’re anonymous but they can talk
about real problems
they can learn coping skills for the
real world
we can use the virtual environment to
present models and go through complex
issues
and we can help them cope with the
issues that they’re facing
using 50 years of evidence-based
research
this is powerful because right now we
ask patients
to avoid using drugs and relapsing by
thinking about not using if they’re
having a craving
they can’t go to their therapist in the
moment or go to a peer group
virtual reality can change that we can
provide an intervention that people can
go to
when they need it an intervention that’s
portable
accessible anonymous and affordable
affordable the head the cost of headsets
has come down dramatically to about
three hundred dollars
and because it’s peer-based people can
have 24 7 access for a fraction of the
cost of therapy
people can escape the thing that’s being
sought through runescape
or heroin but they can escape into an
intervention that’s helping them cope
with the reasons why they want to escape
in the first place and the goal is that
they won’t even need the virtual reality
eventually
and it can be completely peer-based but
just as effective as therapy
and isn’t that the goal i haven’t had a
single patient who started using drugs
for fun
every patient is coping with something
depression or anxiety or trauma
heroin her runescape is not the problem
the real problem
and the real crisis in the country is
psychological pain
and that’s the underlying factor in all
mental health issues
think about your friends
your family your children
or the children you plan to have in the
future
a lot of them are dealing with
psychological issues and
some of them may turn to substances to
cope with those issues
but what if they were more likely to
escape into an intervention
what if this headset could be used for
more
than just gaming people could escape
into an intervention one that’s
accessible to them
portable anonymous affordable
they can get it whenever they need it
and it’s appealing to a younger
generation
i believe if we can make the
intervention more accessible
than drugs we can not only put a dent in
the opioid crisis
but we can virtually change the standard
of psychological care
thank you
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you