More people need mental health treatment today than ever before, but there are not enough therapists to meet the growing demand.
In 2020, it is estimated around 41.4 million adults In the United States receive psychological treatment or counseling. Only an estimated 106,500 psychologists have current licenses in the United States.
A flood of digital health applications has hit the market. However, many of these are designed to be low-density and low-touch; They are mental health apps and tools that guide mindfulness and meditation or don’t require a touch of a doctor. And while telehealth has helped provide universal access to high-touch therapy, virtual care remains limited due to a shortage of therapists.
Virtual reality is the “moron” the mental health sector has been waiting for, says Risa Weisberg, chief clinical officer of mental health technology company BehaVR, a licensed clinical psychologist and expert in cognitive behavioral therapy. She is also Professor of Psychiatry at Boston University School of Medicine and Assistant Professor of Family Medicine at Brown University.
Healthcare IT news I sat down with Weisberg to discuss what telehealth can’t do to address the therapist shortage, how virtual reality works in mental health care, why she thinks virtual reality is an appropriate solution to the employment problem, and how virtual reality can give access to alternatives to drug therapies such as substances opiate;
s. Telehealth has certainly made mental health care possible for many people. Where do you think telehealth comes in short?
a. Telehealth can remove potential patient access barriers such as geographic location or transportation to an appointment. As such, telehealth can often make it easier to find a therapist, because any therapist licensed in the state in which the patient lives may now be a good fit.
Furthermore, it can increase access for patients with busy schedules, who may have 50 minutes of time, but not to travel to and from the therapist’s office, and for patients with mobility difficulties.
These are all really positive contributions. Unfortunately, what we now face in the field of behavioral health is an acute shortage of professionals, something that telehealth cannot solve.
As a psychiatrist, I can personally attest to how difficult it has been for colleagues with job opportunities to find new patients over the past few years. However, the limited number of trained therapists, especially therapists trained to provide empirically supported psychotherapies, was a problem long before COVID-19.
We simply did not have enough providers to meet the demand. Now, due to the pressures of the pandemic, the need is greater and supply may shrink as many therapists leave the field due to fatigue.
There are not enough of us to meet the current demand for high-quality mental healthcare, leaving many patients desperate to find a caregiver or facing long waiting lists of many months to get an appointment.
Telehealth may ease the burden of traveling to your therapist’s office, but it doesn’t create new capacity within the industry. What we need are new and 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 such care.
Q: What is virtual reality technology and how does it work in mental health care?
a. Most digital health experiences are now two-dimensional. When we interact with our smartphone or laptop, our brains process these experiences the same way, that is, they don’t happen to me – it’s something I read or watch.
Virtual reality replaces your sensory input, creating an immersive experience that your brain processes as if it were an entirely new reality. It’s as if everything you see and hear is actually happening to you. This level of engagement means that experiences in virtual reality are processed by your brain in 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 health and behavioral problems. Virtual reality gives us the ability to transport someone to a calm, quiet place for a meditation session, removing distractions from the outside world and promoting intentional focus.
Importantly, we can also create environments that are intentionally designed to excite and challenge individuals as part of exposure therapy. In fact, exposure to fearful situations, including flying, heights, and even fighting, is one of the most consistently studied and applied uses of virtual reality for mental health.
Q: You have said that virtual reality is a “moderate” mental health care need. Please explain.
a. We have seen an exponential increase in digital health solutions aimed at bridging the gap in mental health care over the past few years. Many companies have created platforms to find and deliver telehealth psychotherapy sessions.
These solutions are a touch high in that although personal care is not needed, there is still a need for a licensed physician to be concurrently present for all patient care and, therefore, does not extend our limited reach. The 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 a great job and, like telehealth, have played an important role in the space.
The majority of these mobile application solutions are designed to be used independently, often without any supervision by a physician. Thus, these low-touch solutions do an excellent job of addressing the shortage of mental health practitioners by offering individuals seeking mental and behavioral health assistance options that do not require upfront.
However, because most of us can be easily distracted when using our phones, and because the apps we use on our phones aren’t completely immersive, the impact of these interventions may be limited to individuals who need more than a low intensity of care.
Virtual reality experiences based on empirically supported psychotherapies may provide an ideal solution. Because these trials are completely immersive and treated as if they were actually happening to you, they promise to demonstrate potential clinical efficacy that may be more comparable to some in-person treatments, but with the flexibility to use them without a current clinician.
Whether it is wellness products that individuals use entirely on their own or prescription virtual reality programs in which a physician is involved in care but does not need to be present concurrently during all sessions, VR can be the moderate or hybrid solution the industry needs to scale health services psychological service without adding a new burden on existing service providers.
Q: You are also suggesting that virtual reality could provide access to alternatives to drug treatments such as opioids. How?
a. First, it is important to note that virtual reality will not completely replace medication or in-person therapy. There are use cases that may require pharmacological interventions and/or conventional psychotherapy in the clinic. However, for some individuals and for some indicators of behavioral health, VR interventions may prove to be equally powerful treatment options.
One such area is pain care. Virtual reality interventions can be effective in treating and reducing pain, both as a stand-alone solution and as a complement to physical therapy and other methods of treating pain.
A significant amount of research has explored the use of virtual reality to provide distraction and/or relaxation during acute pain episodes, making it a promising alternative to opioid use in acute and postoperative care.
In a 2021 review of virtual reality applications in military and advanced healthcare, researchers reported, among other findings, a 39% reduction in the total dose of opioid medications used for patients who received VR intervention during burn wound care. The authors suggest that virtual reality could provide a scalable non-opioid pain relief solution for soldiers recovering from combat injuries in the future.
Moreover, solutions have recently been developed to treat chronic pain through virtual reality interventions. These programs often include mindfulness strategies, calming environments, and/or breathing techniques to activate the patient’s parasympathetic nervous system and relieve pain over time.
Virtual reality interventions have also been developed to help individuals better understand their chronic pain, reduce their tendency to destroy their pain and/or encourage exercise in patients who have developed a fear of pain and movement.
Amid the opioid epidemic, virtual reality interventions for acute and chronic pain could reduce the amount of opioid medications prescribed — and potentially lead to fewer problems with drug use problems in the future.
In addition, virtual reality interventions are being developed to directly address opioid use disorder, using evidence-based treatment methods.
Overall, I think we’re in the midst of a major shift in how most people view their mental health and access care. The pandemic has taught many of us how important our mental health is and has shown us how difficult it is to access high-quality, evidence-based care.
Likewise, virtual reality (VR) technology has seen rapid growth in the past several years with a greater ability to create fully immersive experiences at an affordable price. I believe that the synergy between these two changing areas will provide more robust solutions and a greater number of behavioral healthcare scenarios to which VR solutions can be applied.
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