Are VR gamers stumbling onto a mental health power-up?

A virtual reality game became a lifeline for a player dealing with depression and anxiety. Experts say he stumbled onto a tool that may one day be a normal part of therapy.

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Kier Simmons wearing a VR headset. (Image courtesy of Kier Simmons)

Kier Simmons wearing a VR headset. (Image courtesy of Kier Simmons)

Kier Simmons is a new dad living near Houston. For most of his life, he’s come off as a bit of a jerk.

“Did you ever watch the show `Big Bang Theory?’ ” he asked. (It’s a network TV sitcom.)

“So when that show first came out, I had friends calling me up, saying, ‘Dude, you should watch this show, that Sheldon guy is you,’ ” he said.

Sheldon Cooper is the main character, a super-smart nerd who can be awkward and abrasive.

Simmons works in tech, and, like the Sheldon character, he’s from Texas.

“A lot of it does unfortunately line up,” he said. “And so I was like, all right, that’s fair.”

Simmons doesn’t mean to come off the way he does, he has Asperger’s syndrome — a disorder on the autism spectrum that makes social interaction really tricky.

“I mean, the closest description I’ve heard from anybody is when I hear a comedian talk about going into a group and they kill or going into a group and they completely bomb, it’s just brutal,” he said. “And I was like, wow, that actually most of my life I’m bombing, but then occasionally I have moments where I kill.”

But when Simmons would play video games with other people online, things were different. Especially in PlanetSide 2, this massive first person shooter. You can yell out to players near you in the game with a voice chat feature.

“I would just kind of throw out my best monster-truck-rally impression, and maybe throw in some, like you know, a little bit music here, background music here and there,” he said.

He does a demonstration:

“It’s your man, PooNanners! Your Texas caster and hype master rocketing to ya live from the indoor excavation side,” he said, practically shouting. “This rockin’ bunch of freedom fighters are ready to shove 10 gigatons of high explosives to the enemy!”

Simmons is, of course, PooNanners. To his surprise, though, people didn’t just laugh, they listened.

“People would just flock, and we would just — like locusts — just wash over the land and just destroy,” he said. “I’d get people to do all kinds of hilarious stuff.”

Screenshot from Planet Side 2 trailer

He could be PooNanners, this monster-truck commander online, at ease with people he’d never met. But offline, he was still basically Sheldon Cooper.

Then a new type of gaming platform came out: Oculus Rift. It’s a virtual-reality headset that has a futuristic sports game called Echo Arena. It’s like ultimate Frisbee in space, all very “Tron”-looking. Players rocket around trying to get this disk to a goal and bash each other.

“It looked absolutely wild, and it looked beautiful,” said Simmons.

Simmons had barely started flying around in the virtual world, when he took a bad fall in the real world. He was fixing something on the roof, when he took a few steps backward.

“I wake up on the ground, and an EMT is putting a neck brace on me and I have a broken leg,” he said. “I fell 25 feet.”

He had surgery and got an opioid prescription during recovery. When that ran out, he went into withdrawal. He had his first panic attack, and developed an intense depression, anxiety.

“So with depression, right, they told me that I needed to be around people,” said Simmons.

They being, his therapists. But when dealing with depression, Simmons said, it can be hard to even go outside. And remember, he was never exactly good with people to begin with.

But he had his VR kit, all set up, with this space ultimate Frisbee game. So he decided to go online and join a match.

“I’m just sweating to death playing. I’m having a good time, camaraderie of people, like what I see people do when they play basketball together,” he said.

It felt like real social interaction, he said, more real than any other traditional online game.

“I’m having that experience playing sports with other people and making friends, and it’s doing a lot for my mental health and a lot for my well-being,” he said.

Screenshot from Echo Arena trailer

Virtual reality just made everything more convenient —  simpler.

“In VR, you just put it on, and you’re there. You definitely also don’t have to do any of the other things that you get anxiety about and freak out about. I have to go take a shower. I have to do my hair, I have to put on some clothes and are my clothes even clean,” he said “You know? You don’t have to worry about any of that. You just put the headset on and play.”

Simmons talks about VR like it’s some lifeline he stumbled onto in the depths of his depression and anxiety. He’s big in the VR gaming scene, he runs a commentary site. And he says, he’s not alone, lots of VR gamers are finding a kind of unexpected relief.

You move, and your brain reacts

So, what does VR actually do to users? Jeremy Bailenson, director of the Virtual Human Interaction Lab at Stanford University in California, explains by way of a demo his team did for a bunch of legal types in 2001.

“We had a federal judge who was probably in his 60s and a big guy,” he said.

They fit the judge with a VR headset and booted up a simulation that put a deep chasm in the middle of the room. The judge had to walk to the other side, but started slipping off the plank.

“And so his reaction was to dive off at a 45-degree angle in the middle of the floor in front of all of these judges and lawyers,” Bailenson said.  

Bailenson actually caught the guy.

“Luckily, he didn’t get hurt, nobody got sent to jail, he didn’t sue us,” he said. “But this illustrates this concept of presence.”

Presence is when players are no longer aware of the medium they’re using — in this case, a VR rig. All they’re left with is the experience. 

When you’re using VR, Bailenson said, you’re not guiding an avatar across a plank like in a video game. Instead, as far as your brain is concerned, you are walking the plank. 

“What are the five most important features that make VR experience?” Bailenson asked. 

Ethan Miller leads a VR demonstration at the Free Library of Philadelphia. (Jad Sleiman WHYY)

“Tracking, tracking, tracking, tracking and tracking.”

Tracking — you move your body, and the image you see changes. Turn your head, lean this way, lift your arm, the image the headset shows you reflects that in real time.

“The brain has got dedicated real estate that is about moving your body: the sensory motor cortex, there’s the word ‘motor’ in it and the word `sensory’ in it,”  Bailenson said. “And this is a part of your brain that has — for as long as people have been people — we’ve used it to engage with scenes, physical scenes by moving our bodies and by getting feedback from that movement.”

He said VR, as opposed to traditional media, taps right into this basic part of our wiring to make things feel real.

“It’s a simple medium in the sense that you’re just doing the same things that you’ve always done out in nature,”  Bailenson said. “You’re just getting separate perceptual feedback that you wouldn’t have gotten otherwise. VR uses the natural evolutionary mechanisms that have always been used when we look [at] explored scenes.”

Bailenson sees VR revolutionizing all these different corners of daily life — from how we think about business meetings, to how we take vacations. He even had a hand in a program that trains rookie retail workers for the horrors of Black Friday.

‘You don’t have to imagine’

Skip Rizzo, a neuropsychologist at the Medical Virtual Reality Lab at the University of Southern California, is more interested in the therapeutic value of the tech. For years, he’s used VR to help treat veterans with post-traumatic stress disorder.

“When we study people with PTSD and we put them in an fMRI system, for example, and study their brain activation when they’re presented with cues that are reminiscent to the trauma, we see hyper-activation of the amygdala, the fight-or-flight area in the brain,” Rizzo said. “They react as if it’s a real thing.”

One classic example: A vet with PTSD may see some trash on the side of a California highway, and feel a fear that’s as real as the fear felt on an Iraqi highway as an improvised explosive device disguised as garbage exploded. For people with chronic PTSD, these triggers come often and linger for years.

A common treatment for this type of issue is exposure therapy.  A patient describes a troubling event or source of anxiety to a therapist, over and over again, imagining it, confronting it in a safe setting until it starts to lose its bite.

With VR, you don’t have to imagine.

“We have 14 different worlds that represent different contexts in Iraq and Afghanistan, the marketplace, an outpost,” Rizzo said.

Vets carry a prop gun, there are rigs for vehicles, and even a smell device that produces scents of gunpowder and burning trash.

A soldier uses the Bravemind VR program at the University of Southern California. (Image courtesy Skip Rizzo)

“A clinician can ignite explosions around them, IEDs at different distances and intensities, they can have jets fly over or helicopters,” he said.  

Using VR has accelerated treatment for his vets when compared to traditional talk and imagine methods, Rizzo said. That’s critical, he said, because many patients will drop out of treatment too early when it doesn’t seem to help right away. 

So what about VR gamers, these players finding relief, could this be possible? Short answer, he said: Yes. 

“I like to say that, you know, we can get people to confront things in VR that they wouldn’t do in the real world,” he said. “To go into a social situation with a lot of people, to get a person with social phobia to do that, or somebody with autism to do that, they’re so anxious, they may avoid it. They may use coping strategies that are less effective, and it’s not a therapeutic exposure.”

But he emphasized that guys like Simmons who feel like they’re finding therapeutic value in the VR, they’ve only discovered a tool — not a cure. And VR is a tool most useful when handled by a clinician. Still, Rizzo said, if VR can help people recognize the potential of getting actual clinical help, it’s a good thing. 

“A large majority of people with mental health problems never see the inside of a therapy office. You know, they go through life …  managing and getting by and so forth,” he said. “Never, never seek help — and that’s mind-numbing.”

VR therapy app

So the need is there, the tech has potential. Is it at all surprising that for VR-based therapy, it turns out there’s an app for that? Or, at least, that there’s one on the way?

“Our application, it’s a social platform where users can immerse themselves in and interact with each other, everything in real time,” said Sever Sfrengeu, CEO of UniVersusVR, a digital health startup with a focus on social anxiety.

The program makes an avatar of you based on a photo, then puts you in a virtual group-therapy session with other patients and a clinician.

You do weekly sessions, all based around cognitive behavior therapy. Sfrengeu sees it as a way to democratize therapy, putting it in a smartphone or headset.

Eventually, the therapy extends into the real world.

“For example, if you would be a person that suffers from social anxiety, one of your homework [assignments] would be, on Friday night go out to a pub for example, and have a drink with two people that you know,” he said. “And let’s say you guys have to join a group of two or three more people you don’t know now in the real world.”

You take a geolocated selfie that your therapist receives, with fun filters of course.

Sfrengeu, and the rest of the experts interviewed, see VR becoming a regular, everyday component of therapies.

As for Kier Simmons, aka PooNanners, he has a real-life therapist he sees in person. VR hasn’t made it into his regular treatment, which it’s important to note, he still relies on. He still struggles and works hard to stay well.

But he said leaning on VR helped him stay well enough to do the hard work of therapy, of taking care of himself. And the people around him, they’ve noticed a change in him.

“So … while I was playing those VR esports games and making friends and getting that extra social interaction that I needed on a constant basis, it was that Christmas when my sisters came to visit.”

They visit every year at the holidays. Simmons comes from a big family.

“That was the time that they had noticed that I had changed,” he said.

Kier Simmons competes in a VR tournament. (Image courtesy Kier Simmons)

Pre-VR Simmons and post, he said, his family wasn’t too specific, he just seemed nicer, easier to talk to. But there was one instance he shared.

“One of my sisters was having a panic attack, and I had noticed that she had disappeared. So I went to go find her, and it was something we had said that sort of set her off,” he said.

Another one of his sisters was talking to her trying to help, but not getting far.

“She’s talking the way that I’ve talked too most of my life, which is very fast, not a lot of emotion, usually telling you why you’re wrong,” Simmons said. Not what someone coming out of a panic attack wants to hear. He stepped in.

“I said, ‘You can’t hear it, but in your tone of voice and your word choice, it sounds like you’re attacking her. I know you’re not, but that’s how it’s being received,’ ” he said.

He asked her to leave the room, just for a second, to calm things down. And it worked.

“My three other sisters all just looked at me dumbfounded,” he said. 

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