How virtual reality therapy can cure PTSD, obesity and even the pain of childbirth

Erin Martucci declined an epidural when contractions started during the birth of her second child at Orange Regional Medical Center in Middletown, NY, in 2016. When the pain became too intense, her gynecologist handed her a headset.

Minutes later, she was enraptured by a beach scene. The sun set as a flock of birds flew overhead. A fire burned. And a soothing British woman’s voice instructed her to breathe.

“We’re ready to push,” her doctor said. “She’s crowning! She’s ready!”

Martucci had been so overtaken by the beauty of her virtual world that she lost track of the two hours of labor and didn’t even realize that the baby was coming. She delivered her child — the first baby born in history with the help of VR — in less than two minutes. Just over a year later, she did it all again, drug-free, giving birth to her third child with the help of VR technology.

This unusual treatment for pain management is just the beginning of a revolutionary new approach to medicine.

VR can “lower blood pressure, treat eating disorders, and combat anxiety. VR helps deliver babies and enables soldiers to cope with the mental scars of war,” writes gastroenterologist Brennan Spiegel, director of one of the largest therapeutic virtual-reality programs in the world at LA’s Cedars-Sinai Medical Center, in his new book “VRx: How Virtual Therapeutics Will Revolutionize Medicine” (Basic Books), out now.

From brain injuries to schizophrenia to dental procedures to end-of-life care, VR has “an uncanny ability to diminish pain, steady nerves, and boost mental health — all without drugs and their unwanted side effects,” he writes.

It may sound far-fetched, but Spiegel has successfully used VR on 3,000 patients. He believes that it should be in the arsenal of treatment alongside opioids, sleeping pills and anti-anxiety meds. Big Tech seems to agree: Facebook, Google, HP and Sony have all invested billions into developing VR, while Goldman Sachs projects that VR will generate $80 billion in revenue by 2025.

VR’s ability to manage pain — even pain as intense as childbirth — has been widely researched. Studies suggest that even during episiotomies, when a woman is cut to make room for the baby’s head, virtual reality not only reduces the visceral pain but also seems to fast-track time, reducing the perceived length of the procedure by up to 46 percent.

On average the treatment works in over two-thirds of patients and the benefits are durable.

VR can even help manage the extreme pain burn victims experience during recovery when bandages are replaced, an excruciating process that involves reopening wounds. In one study, when people watched a VR program called “Snow World,” where the participants throw virtual snowballs at penguins in a winter scene, cognitive pain was lessened by 44 percent and sensory pain by 22 percent.

Chronic pain, too, can be helped with virtual therapy. In a 2016 study of people with fibromyalgia, a disorder that causes diffuse musculoskeletal pain, those who entered the virtual world of “Cryoslide,” where you attack the limbs of a “neuron tree” (meant to represent the way pain snakes through the human body), experienced a 37 percent reduction in pain versus those who did not receive VR therapy.

Spiegel has personally seen people weaned off opioids with the help of VR. And unlike drugs, the benefits of the therapy seem not to diminish over time. Clinical psychologist and pain consultant Ted Jones says in the book that virtual reality “cuts chronic pain twice as much as morphine, does it with far fewer side effects, and doesn’t exhibit the same habituation and tolerance that we see from drugs.”

VR is especially successful at treating pain because it can modify our negative perceptions, Spiegel writes. We can lower our pain awareness by using a sleight of hand called inattentional blindness. Essentially, when our mind is preoccupied (with, say, throwing snowballs at penguins), we are less consciously aware of the “oh, my God, this hurts” signals from the body. When our awareness has shifted, the pain from the body doesn’t reach the brain to the same degree.

Entering a virtual-reality world also helps us enter a flow state, which can happen during meditation or when running. During a flow state, the prefrontal cortex is partially suppressed, quieting the monkey mind — the yammering inner critic. As we pay attention to this amazing virtual world, we focus less on the bad stuff.

One VR program called “Bravemind” treats soldiers with symptoms of PTSD. The goal is to deploy exposure therapy, which “gradually inoculates the brain against the triggers of PTSD,” writes Spiegel, by placing veterans back in the middle of battle. They are surrounded by Humvees, the sound of bombs blasting, the heat of the sun, a virtual space where they can work on the scars that have endured in real-time. “Bravemind” pipes in a wide array of scents including sweat, cordite, burning rubber and those from a Middle Eastern market. The outcomes, researchers claim, have been remarkable. “On average the treatment works in over two-thirds of patients and the benefits are durable,” Spiegel writes.

A similar mechanism is used to treat phobias, including fear of flying, fear of heights and fear of spiders. By “inhabiting” the body of a healthy person through VR, patients with anorexia nervosa and morbid obesity have been shown to adopt better nutritional habits.

VR is also used to address and ease dementia by bringing people back in time, thus making the present less frustrating and confusing. In the UK, some homes are using “immersive reminiscent experiences,” by transporting seniors back to key moments in history, like the 1960s version of UK’s Brighton Beach, where sunbathers lounge in vintage suits and caps.

Some paralyzed patients have even recovered partial muscle control in their legs, bladder and bowel with the help of VR technology.

VR treatment has even enabled patients to have breakthroughs about their own health.

Spiegel treated one man who believed that a piece of chicken was stuck in his throat. His face was red, he beat his chest, sweated profusely and paced. But imaging showed that nothing was actually there.

Spiegel suggested that the man try VR. As a tranquil beach scene played around him, the man started to open up.

“My life is spinning out of control. My relationships are falling apart. I can’t go on like this. I need my life back,” he said.

The man was in the midst of a panic attack, an existential crisis prompted by the circumstances in his life. He may not have had the chance to come to that conclusion without the aid of the virtual world, which gave him a moment to relax, disconnect and achieve insight.

Spiegel also treated a woman who complained of severe stomach pains. When she put on a headset that allowed her to swim with dolphins, the realization hit her. “I figured out why I have this stomach pain,” she said, according to Spiegel. “My older brother died of stomach cancer. I think I’m carrying this pain with me.”

Psychologist Mel Slater at the University of Barcelona had the ingenious idea to place volunteers on a couch with none other than Sigmund Freud. The study participants were asked to share their personal problems with a Freud avatar, but then returned to the scene as Freud, offering counseling back to themselves. One person described how he missed a girl who left his school. When he embodied Freud, he gave himself the sage advice: “I recommend you move on . . . It doesn’t help to live in the past.”

Slater found “significant” improvements in the participants who embodied Freud, but not in those who had just talked to avatars of themselves. The process of taking on another persona allowed for a new perspective on their suffering.

With the rise of telehealth and the need to social distance, there is now a rise in self-administered, home-based VR treatment. Instead of applying VR headsets in hospitals, Spiegel says a Cedars-Sinai program is shipping the headsets directly to people’s homes.

This is especially relevant for senior citizens in nursing homes and senior living facilities. One company, Rendever, which sells VR to senior living facilities, has added two-way voice communication and live sessions to their VR options to facilitate greater connection during the pandemic.

Studies of nursing-home residents showed that those who engaged with VR had lower anxiety and depression scores, increased physical ability and higher perception of their overall health than those who did not. What’s more, virtual screen time also increased their “trust” in staff and other residents, compared to those who just watched TV.

And yet, despite all these benefits, “chances are high that your doctor has never offered a VR treatment to you or anyone else you know,” Spiegel writes. “There’s a good chance that your doctor has not even heard of immersive therapeutics.”

The pandemic might just tip the scales and help VR go mainstream. Spiegel wants to see “VR pharmacies” at every hospital staffed with “virtualists” who can administer specific virtual-reality programs to meet patients’ individual needs.

“When used in the right way, in the right person, and at the right time, VR brings wonder and beauty to mankind,” Spiegel writes in the ending statement of the book. “And joy is good. We should leverage that like crazy.”

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