More people are in need of mental health treatment today than ever before, but there just aren’t enough therapists to meet the growing demand.
In 2020, it was estimated that around 41.4 million adults in the US received mental health treatment or counselling. Only an estimated 106,500 psychologists possess current licenses in the United States.
A deluge of digital health apps has hit the market. Many of these, however, are designed to be low-intensity, low-touch; they’re mental health apps and tools that guide mindfulness and meditation or don’t require the touch of a clinician. And while telehealth has helped provide sweeping access to high-touch treatment, virtual care is still limited by the shortage of therapists.
Virtual reality is the “goldilocks” the mental health sector has been waiting for, says Risa Weisberg, chief clinical officer at mental health technology vendor BehaVR, a licensed clinical psychologist and an expert in cognitive behavioral therapy. She also is a professor of psychiatry at Boston University School of Medicine and an adjunct professor of family medicine at Brown University.
Healthcare IT News sat down with Weisberg to discuss what telehealth cannot do to cure the therapist shortage, how virtual reality works in mental healthcare, why she believes VR is the goldilocks answer to the staffing problem, and how virtual reality can give access to alternatives to pharmacological treatments like opioids.
Q. Telehealth certainly has made mental healthcare available to many more people. Where in your view does telehealth come up short?
A. Telehealth can remove potential access barriers for patients such as geographic location or transportation to an appointment. As such, telehealth can often make it easier to find a therapist, as any therapist licensed in the state in which the patient lives may now be a potential fit.
Furthermore, it can increase access for patients with busy schedules, who may have time for a 50-minute appointment, but not for travel to and from a therapist’s office, and for patients with mobility difficulties.
These are all really positive contributions. Unfortunately, what we’re facing in the behavioral health space right now is a severe shortage of professionals, something that telehealth doesn’t solve for.
As a psychologist, I can personally attest to how difficult it has been to find colleagues with openings for new patients over the last few years. However, the limited number of trained therapists, particularly therapists trained to deliver empirically supported psychotherapies, was an issue long before COVID-19.
We simply never had sufficient numbers of providers to meet the demand. Now, due to the pressures of the pandemic, the need is greater and the supply may be shrinking as many therapists are leaving the field due to burnout.
There just aren’t enough of us to meet the current demand for quality mental healthcare, which leaves many patients desperate to find a provider or facing many months-long waiting lists for an appointment.
Telehealth may alleviate the burden of traveling to your therapist’s office, but it does not create new capacity within the industry. What we need are new, sustainable solutions that will bridge the gap between the growing number of patients seeking mental and behavioral health treatment, and the number of qualified professionals trained to provide that care.
Q. What is virtual reality technology, and how does it work in mental healthcare?
A. Most digital health experiences right now are two-dimensional. When we’re interacting with our smartphone or laptop, our brains process those experiences in the same way, which is to say, it’s not happening to me – it’s something I am reading or watching.
Virtual reality replaces your sensory input, creating an immersive experience that the brain processes more like a completely new reality. It’s as if whatever you’re seeing and hearing is actually happening to you. This level of engagement means that the experiences in VR are processed by your brain in much the same way that actual experiences are.
The ability to activate neural processes in this way is incredibly useful for implementing well-understood therapeutic techniques to address mental and behavioral health concerns. VR gives us the ability to transport someone to a calm, peaceful place for a meditation session, removing distractions from the outside world and enhancing attentional focus.
Importantly, we can also create environments that are deliberately designed to arouse and challenge individuals as part of exposure therapy. In fact, exposure to feared situations, including flying, heights and even combat, is one of the most consistently studied and applied uses of VR for mental health.
Q. You have said that virtual reality is “the goldilocks” mental healthcare needs. Please elaborate.
A. We’ve seen an incredible increase in digital health solutions aimed at closing the gap in mental healthcare over the last few years. Many companies have created platforms for finding and delivering telehealth psychotherapy sessions.
These solutions are high-touch in that although in-person care isn’t needed, there remains a need for a licensed clinician to be synchronously present for all of the patients’ care and thus, they don’t expand the reach of our limited mental health workforce.
Solutions at the other end of the spectrum, such as smartphone apps, have also proliferated in recent years. Many of these companies are doing fantastic work and, like telehealth, have played an important role in the space.
The majority of these phone app solutions are designed to be used independently, often without any oversight by a clinician. These low-touch solutions thus do an excellent job of addressing the shortage of mental health practitioners by offering individuals looking for mental and behavioral health assistance options that don’t require a provider.
However, because most of us can be easily distracted when using our phones, and because the apps with which we engage in on our phones aren’t fully immersive, the impact of these interventions may be limited for individuals who need more than low-intensity care.
VR experiences built on the foundations of empirically supported psychotherapies may provide an ideal solution. These experiences, because they are fully immersive and processed as though they are actually happening to you, have promise to potentially show clinical effectiveness that may be more comparable to that of some in-person therapy, but with the flexibility of being utilized without a clinician present.
Whether wellness products that individuals utilize entirely on their own or prescribed VR programs in which a clinician is involved in care but does not need to be present synchronously during all of the sessions, VR could be the goldilocks, or hybrid, solution that the industry needs to scale mental health services without adding new burden to current providers.
Q. You also suggest that virtual reality can give access to alternatives to pharmacological treatments like opioids. How?
A. First, it’s important to note that virtual reality will never completely replace drugs or in-person therapy. There are use cases that may require pharmacological interventions and/or traditional in-office psychotherapy. However, for some individuals and some behavioral health indications, VR interventions may prove to be equally robust treatment options.
One such area is that of pain care. VR interventions can be effective in addressing and reducing pain, both as a stand-alone solution and as a supplement to physical therapy and other methods for treating pain.
A good amount of research has explored the use of VR to provide distraction and/or relaxation during episodes of acute pain, making it a promising alternative to the use of opioids in acute and post-surgical care.
In a 2021 review of VR applications in military and veteran healthcare, researchers reported, among other findings, a 39% reduction in the total dose of opioid medication used for patients who received a VR intervention during burn wound care. The authors suggest that VR could provide a scalable, non-opioid pain relief solution for soldiers recovering from combat injuries in the future.
Furthermore, solutions have more recently been developed to address chronic pain via VR interventions. These programs often incorporate mindfulness strategies, calming environments and/or breathing techniques to activate a patient’s parasympathetic nervous system and bring pain relief over time.
VR interventions have also been developed to help individuals better understand their chronic pain and reduce their tendency to catastrophize their pain and/or to encourage exercise in patients who have developed a fear of pain and movement.
Amid the opioid epidemic, VR interventions for acute and chronic pain could lessen the amount of opioid medication prescribed – and potentially lead to fewer issues with medication use problems in the future.
Additionally, VR interventions are being developed to directly address opioid use disorder, using evidence-based treatment methods.
Overall, I think we are in the midst of a major transformation in how most people view their mental health and access care. The pandemic has taught many of us how crucially important our mental health is and shown us how difficult it is to access high-quality, evidence-based care.
Similarly, VR as a technology has been growing quickly in the last several years with greater capacity to create fully immersive experiences and at a more affordable price point. I believe that the synergy of these two changing fields is going to bring about more powerful solutions and a plethora of behavioral healthcare scenarios to which VR solutions can be applied.
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