Diagnosing psychiatric and neurological conditions is tricky. Physicians have long reported that diagnoses are fraught with complications and subtleties. Anywhere from 35 percent to 85 percent of mental health conditions go undetected and undiagnosed, according to the World Health Organization, depending on where you live on the planet. Needless to say, to treat depression, Alzheimer’s, or autism, it must first be detected.
Now clinicians and researchers are trying a new tool: virtual reality. VR has been touted as a promising means of treating some conditions, but it also may help diagnose them. As a diagnostic tool, VR potentially offers some big advantages: It can create convincingly realistic simulations of experiences that may provoke symptoms, and it can do so consistently, potentially making diagnoses more objective—or at least less subjective.
In September, the UK-based Alzheimer’s Society said it would fund a three-year research project using VR to try to detect early signs of Alzheimer’s disease. In an initial study, researchers led by Cambridge University’s Dr. Dennis Chan tested participants’ spatial navigation and memory by having them don a HTC Vive headset, follow an L-shaped path in a virtual environment (initially mapped out by cones), and then trace their footsteps back to their starting point without the help of any markers.
In a paper describing preliminary results, Chan’s team reported that the VR-based navigation test was more accurate in diagnosing mild Alzheimer’s-related impairment than traditional “gold-standard” cognitive tests, such as figure recall and symbol tests. In an email, Chan says VR could take on a bigger role in diagnosing mental disorders as VR gear becomes cheaper and easier to use.
Researchers at Emory University in Atlanta have used VR to diagnose and treat veterans suffering from post-traumatic stress disorder related to sexual trauma while in the military. Participants were shown two-minute clips of a simulated foreign military base and a typical American city, while researchers monitored their heart rate and “startle” responses. In a paper published last year, the researchers reported significant reductions “in clinician-assessed and self-reported PTSD symptoms.”
VR is a promising diagnostic tool, researchers say, because it generates scenarios and experiences that can’t easily be produced in a traditional clinical setting. “VR provides a unique opportunity to bring real-life experiences into the clinician’s office,” explains Dr. Martine van Bennekom, a researcher at the University of Amsterdam’s Department of Psychiatry. “With some psychiatric disorders, for example OCD or panic disorder, patients usually experience their symptoms in their personal environment or in crowded places, and not in the clinician’s room. With VR it is possible to immerse patients in an exterior environment while the clinician can observe symptoms and interview the patients about these symptoms and underlying thoughts.”
Moreover, VR can generate a highly regular, controlled experience, providing the scientific consistency that’s often lacking in the doctor’s office. “Content can be created to exact specifications and experienced in the exact same way every time,” says Eric Abbruzzese, a VR analyst at ABI Research, via email. “Everything is digital so parameters can be controlled to a near infinite level.”
Beyond Alzheimer’s and PTSD, VR is now also being tested for diagnosing a variety of other conditions, such as social anxiety disorder, vertigo, ADHD, and concussions. For example, a team from Exeter University reported in 2017 that a VR-based “mirror game,” which required participants to duplicate the movements, gestures, and facial expressions of a virtual avatar, helped early diagnosis of schizophrenia.
Dr. Piotr Slowinski, the leader of the Exeter team, says via email that mental health practitioners have approached the group about employing the mirror game, and that the group is testing a prototype to further assess the idea. He says the practitioners are excited about the prospect of diagnosing schizophrenia earlier in young adults, because earlier detection and treatment tend to lead to better outcomes.
Another benefit of VR, Slowinski notes, is that it’s cheaper than techniques such as neuroimaging, and is becoming more affordable as headsets get cheaper and more user-friendly, making them more suitable for the small spaces of many clinical settings.
Problems and Promises
To be sure, VR is a long way from being used widely to diagnose mental disorders. “VR has immense potential to improve the assessment of mental health conditions but it is not currently used in clinics,” says Daniel Freeman, a professor of clinical psychology at the University of Oxford, and the cofounder of Oxford VR, which is developing VR-based treatments for a variety of psychiatric conditions. More research is needed on proposed uses of VR to diagnose mental conditions, he adds. Until then, “clinics would not use VR for diagnosis.”
Dr. Brian Chau, a physician who writes about new medical technology, agrees. “The key here is data—we need validated measurements” to show VR is comparable to or better than traditional methods, he says. Continued partnerships between clinicians and VR developers are needed to move the technology “from the lab bench to the clinical bedside.”
Abbruzzese, the ABI analyst, also notes that “not everyone can use VR,” because it can bring on nausea or motion sickness. And he says developers will have to create content for each type of test.
“VR provides a unique opportunity to bring real-life experiences into the clinician’s office.”
Dr. Martine van Bennekom, University of Amsterdam
Even so, Freeman notes that VR is being used increasingly in labs and research institutions, primarily “to inform understanding of causes rather than diagnose [conditions].” Freeman’s team is hoping to develop a VR-based test that will better diagnose paranoia, by showing people “neutral” social situations. “If they see hostility from the VR characters, then we know that it is genuinely unfounded and therefore instances of paranoid thinking.”
Researchers are enticed by the prospect of VR because psychological problems are notoriously hard to diagnose. A highly cited 2006 review paper published in the journal Psychiatry said misdiagnoses and disagreements most commonly stemmed from a lack of consistency by clinicians and patients and the “inadequacy” of terminology. VR holds promise because “it depends less on the patient’s memory (recollection bias) and the interpretation of the clinician (interviewer bias),” according to van Bennekom, the Dutch researcher.
Other researchers agree. In 2017, van Bennekom and colleagues reviewed 14 studies where VR had been tested as a diagnostic tool. They found that the diagnoses tended to agree with diagnoses made by more traditional means. Moreover, the researchers involved “usually expressed a preference for VR” because it offered a chance to assess behavior in real time in “realistic environments resembling daily activities.”
There is, then, every reason to suspect that VR will move beyond being an experimental diagnostic tool for mental health conditions, to a practical, everyday one. It offers the possibility of realistic experiences that can be repeated consistently from test to test, thereby standardizing tests further and making them more reliable. And because it can detect symptoms early and often without the need for expensive equipment, it promises to open up the detection of psychiatric and neurological conditions to a greater number of people, at a time when such conditions are becoming more commonplace.