Gaming the system Battling opioid addiction with virtual reality

[Music]

[Applause]

so

[Applause]

[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

[Applause]

[Music]

you