Reducing depressive feelings with Virtual Reality

Can virtual reality help someone with a depression? Arq Psychotrauma Expert Group, VU University Amsterdam and an SME called IJsfontein believe so. In co-creation they have developed a virtual reality application called 'Lunchroom Sunday'. The application is developed within the e-Mental Health Center (eGGZ Centrum), a European Regional Development funded project which is also sponsored by the province of Noord-Holland. The project focuses on setting up an e-mental health center in the Netherlands.  

Virtual Reality application Lunchroom Sunday is developed primarily for people with depressive feelings. The VR game is currently being tested and expectations of the developers and care institutes are high. Users are asked to put on a VR headset, after which they become a waiter in a virtual lunchroom. In the lunchroom they have to deal with different social situations. This is a very recognizable situation for most clients. The role of waiter makes it easier to approach different situations and to interact with other people, as this is what waiters do.  

One of the scenarios of Lunchroom Sunday is a student who sits behind his laptop, with a cup of coffee. He thinks out loud: "I've been staring to this laptop for two hours without making any progress with my thesis. This is really hopeless!" He sighs deeply. "If I do not get anything on paper today, I will never achieve a decent career!” After this scene the computer responds: "What do you think, if you hear this? Do you agree with the student or can you maybe help him with an alternative thought?” After this question is answered by the patient, the treatment professional asks for more helping, alternative thoughts. If both parties are happy about what’s been said, another scene can be played.  

Cognitive behavioral therapy 
“Virtual Reality has already been used and proven effective for treating anxiety disorders”, says Annet Kleiboer, Associate Professor of Clinical Psychology. She is working at VU University Amsterdam and is involved in the development of Lunchroom Sunday. “The effectiveness of a virtual world for treating depression needs to be researched and proven”. 

"Because the use of virtual reality in treating depression is new, we try to stay as close as possible to the existing treatment protocol for cognitive behavioral therapy", Kleiboer continues. "Lunchroom Sunday focuses especially on cognitive restructuring. This means that people in therapy should think of a moment they feel negative about and subsequently examine if an alternative thought is possible. This is done because people with a depression tend to have automatic negative thoughts.  

This current approach still has some shortcomings. "If you have to tell an experience from the past, you often do not know exactly what you thought or felt”, Kleiboer explains. "For homework assignments you must actively contact other people in real life, and for some people this is too demanding". That is where Lunchroom Sunday comes in: it is a game which let clients practice actively in a safe environment. On the flip side, the treatment professional is given a more direct look in what a client finds most difficult to do or change. That is also why in-game scenarios are ambiguous: moments that can provoke both negative and positive reactions.  

Effective development process 
The Amsterdam based gaming company IJsfontein introduced a new agile development process which combines development steps with small studies to prevent early design flaws. Before building the game, the team undertook a literature research and organised brainstorm sessions with researchers, therapists and experiential experts. The team analysed which components of the current treatment have an effect and can be supported with VR. 

Before IJsfontein started with the actual development of the application, the company first started with a paper prototype in cooperation with therapists and people who had faced a depression. This learned the team for example that’s it is better to work with abstract faces to reduce distraction and to give the client the opportunity to project their own ideas about the emotions of the characters. Early detecting this saved a lot of time and effort.  

Kleiboer emphasizes that careful research is being done but because of this ‘agile’ approach, it takes less time than normal. "Because things already have been tested during development, we already have an idea about what works and what does not. This allows us to concentrate more quickly on the core of this research: can people learn faster and easier when using VR?” 

Next steps
Currently Lunchroom Sunday is being tested and presented to mental healthcare institutes. The intention is to start using the VR application within a pilot in May 2019.

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