Roos Pot-Kolder is a psychologist and cognitive behavioral therapist based in the Netherlands, who in 2014 along with her colleagues began the “CBTvr” treatment – using virtual reality to treat patients with psychosis, paranoia, and crippling anxieties. Roos had a free moment in her busy schedule to chat with us about how she uses virtual reality in her treatments and studies, as well as where she thinks VR will be heading in the future.
Can you briefly explain what you do and why you got into your field?
I’m a psychologist specializing in cognitive behavioral therapy. I love helping people regain their own strength and recover from psychological problems. However, psychology is a very young science and also a complex one – biological, psychological, and social factors all have an impact on our mental health while at the same time being subject to change. While there has been some amazing work on developing effective psychological treatment, we need to do better as we are not yet able to help everyone. This is why four and a half years ago I started my Ph.D. – I wanted to be able to do scientific research as well as continue my work as a clinician.
What got you interested in VR?
I started working as a VR therapist about six years ago for a scientific study on the effect of VR exposure therapy on social phobia by Isabel Kampmann at the University of Amsterdam. I was positively surprised by all the additional options this technology offered me and my clients in my psychological therapy sessions!
Can you explain a little more about how you’re using VR to treat psychosis patients?
Together with Mark van der Gaag & Wim Veling, my PhD-supervisors, we saw the advantage VR could offer these clients. We see many of them becoming socially isolated and lonely, and this avoidance behavior makes sense if you are having paranoid thoughts and if you expect other people are going to hurt you. In cognitive behavioral therapy, you can explore and test these expectations both in the therapy room and in real life. But try to imagine how hard it must be to go outside if you expect to be killed! Would you take the risk? Many of our clients feel the risk is too great for them. Virtual reality brings social environments such as a supermarket or public transportation into the session, so clients can take part in psychological exercises in the privacy and safety of the therapy room. In addition, the virtual environments can be tailored to the therapeutic needs of the individual client. The therapist can manipulate stimuli in each virtual environment, like how many people are in the scene, whether they are male of female, are nice or hostile, and more.
What kind of results have you received from your treatments?
We found that the effect of the virtual reality therapy is gradually integrated into the daily life of the client. They became much less paranoid and anxious during social situations, which we measure with ‘PsyMate’, an app that allows for multiple real-life measurements. Recently we completed a large randomized controlled trial with seven mental health care centers, and expect the scientific results to be published soon!
Has there ever been a moment where you’ve seen a drastic change in a patient thanks to VR treatments?
Quite a few actually. For example, there was a client who, after the treatment, went on a big theater stage to perform! Even if you have never suffered from paranoid thoughts, that would be quite scary for many people. Another example is from a client who had stopped using public transportation for many years. At the beginning of each session, we ask if anything special happened since we last met, and the client said “no.” Halfway through the session, he casually mentions a bus trip he made! He had semi-forgotten he was afraid of this: after 20 trips on the virtual bus, this was just not such a big deal for him anymore.
How are you expanding or planning to further enhance your VR treatments in the future?
We are now able to bring real life situations into the therapy room with interactive virtual environments. A very interesting development is 360 cameras becoming more affordable. While a 360-degree film doesn’t give us the many tailored options the virtual environments have, they might complement each other. If clients are able to do psychological exercises in their own home with 360 videos on their smartphone, this is likely to boost the treatment effect. We know in general the higher the frequency with which people are able to practice psychological exercises, the better the treatment effect will be.
Where do you think the future of virtual reality in health care is heading?
I think virtual reality will close the gap between the therapy room and the real life day-to-day situations a client encounters. It will also lower the therapy threshold to start therapy, which many people find scary as they know they are expected to do anxiety provoking exercises. There’s already twenty years of scientific research on virtual reality therapy available, and now VR technology has finally become cheap enough to be able to use it in a clinical practice.
Are you a fan of VR in your personal life? If so, what VR platforms do you use? (Oculus, Vive, Gear VR etc.)
I want a VR platform at home! Lucky for me I am married to a computer programmer and gamer, so he agrees that we totally need one. After the summer holidays, he will build a computer specifically to be strong enough for VR. We are getting either the Oculus or the Vive, but we are not quite sure which one yet.
What mobile VR apps can you recommend?
The YouTube app has many VR channels and videos I often use. ‘Dreams of Dalí’ is one of my favorites there. If I give presentations, I often put people in one of the VR roller coaster apps right at the start! They feel their own body react to the virtual experience. That saves me a lot of time having to convince people that, even though it is ‘not real’, it still works.