Luke Robert Mason: The future is always virtual. And many things that may seem imminent or inevitable never actually happen. Fortunately, our ability to survive the future is not contingent on our capacity for prediction. Though sometimes on those much more rare occasions, something remarkable comes of staring the future deep in the eyes and challenging everything that it seems to promise. My name is Luke Robert Mason and you're listening to the Virtual Futures Podcast.
On this episode, I speak with virtual reality therapist Michael Carthy.
The whole point of the therapy is to build them up in to a moment where they have this sense of belief and you're hoping that they will then leave the therapy room and find a sense of efficacy that I can do this now.
Michael Carthy, excerpt from interview
Michael shared his insight into how he uses virtual reality to help individuals overcome anxiety, conquer their phobias, and tackle their fears. This episode was recorded on location in England, at London's first virtual reality exposure therapy clinic. It's time to bury the 20th century and begin work on the 21st. So, let's begin.
Luke Robert Mason: Michael, could you explain what VR therapy is?
Michael Carthy: The reason why I’ve set this kind of clinic up is really because I’m fascinated by the application of psychology. You know, not necessarily figuring out why are people experiencing what they’re experiencing… You know, why am I experiencing fears or phobias or anxiety in my day? But I’m really interested in the how of change.
Traditional psychology and counseling will help people understand in a very linear way why they are the way they are. Whereas what I’m really focused on and what I’ve been specializing in for the last number of years is the how. And for me, virtual reality therapy is the how of change.
Mason: Now, you’ve gone through a number of different types of therapy before you got to virtual reality therapy. I know you were working with hypnosis at one point? I just wonder what is the story behind your work?
Carthy: My story starts like everyone else’s, I suppose. At the aged of twenty‐five experiencing… You know, you wouldn’t say depression but maybe just a moment where I was… I’d classify it as probably a quarter‐life crisis. Working in a professional wasn’t fully fulfilling me. I wasn’t probably getting what I needed in my relationships, whether that was at home or with my friends or with partners, etc. And I spent about six to nine months just reassessing, trying to figure out how can I make myself better, how can I get more of what I want?
And when I turned to—and this is in Ireland at the time—when I turned to the traditional services available, whether it was my GP—going to the doctor who tried to prescribe medications that were supposed to make me feel better, or whether it was going to the local church and getting some counseling, and that was just me sitting there for an hour just kind of feeling worse as I walked out than feeling what I expected to feel, which was better.
Or else going to psychiatrists, who again just looked at me in terms of my symptoms and what I was presenting with and wanted to prescribe me more medication, you know. In that moment, I started to look elsewhere into the world of psychology and really into the application of psychology. And that’s where I started to find things like cognitive behavioral therapy. The fact that I can change my thinking. And if I change my thinking that will change how I feel. And that will change ultimately how I act and behave.
I started to get interested in hypnosis as a really kind of rapid way to work with some of the emotional barriers and emotional blocks that were there within myself first, again to be able to change how I feel about myself and ultimately to translate that into my real world.
So that’s when I start to get interested in I suppose rapid change and also in the application of psychology. So that’s where the hypnosis and cognitive psychology comes in. And then later on I started to get interested in human givens, which Joe Griffin and Ivan Tyrrell, the founders of this process of change which really did create a methodology or an approach that is very quick compared to what you get in the NHS here with twelve sessions of CBT if you present with some debilitating disorder. They found that in three or four sessions, using the human givens approach, they can get people into a similar situation where they’re completely free of what they were experiencing.
So these approaches for me, what excites me is that they’re counter to this idea or this view that change is hard. That we have to struggle through two years of psychoanalytical work in order to kind of have some epiphany that’s going to make me feel better. And they’re counter to the idea that I need some medication, I need something that’s been created by the pharmaceutical industry in order to make me feel happy about myself.
So we have the cognitive psychology (CBT). We have hypnotherapy, which is extremely effective in my experience and with my clients. We have human givens approach, which I really really enjoy reading about and learning more about. And the final one is the positive psychology, which has become of interest for me in the last five or six years. I’m recently doing a masters in positive psychology, and again it’s in the application of the principles and the tools that have come out of the positive psychology space that I’m really interested in.
Mason: So are you finding crossover between some of the work that you were doing previously to VR therapy? Is VR a form of enhancement of pre‐existing therapies, or is it an entirely new form of therapy?
Carthy: You could compare it to things like systematic desensitization of fear. You could compare to flooding exposure, which was developed in the kind of 60s and 70s. But really for me I think it’s a new, completely new form of of treatment, which has been extremely lacking in the therapy room. Something where I can sit with my client in the comfort of my office here in London, or if I’m in Dublin, and I can gradually and slowly, using my experience and all the session time that I’ve had to kind of judge how quickly and how fast to take these people into the situation that they’ve been trying to avoid for such a long time.
And for me it’s really been a missing piece in terms of the arsenal or the set of tools that I can turn to when I’m sitting in a client session. You know, before, over the last kinda ten years without the VRT, helping people to overcome their fears and their phobias, there would be this moment after session two or three or four where I would be taking them, physically, into the Tube for the first time or maybe taking them to the top of a tall building here in London—the Heron Tower’s around the corner with the nano elevator that goes from 0 to 40 floors in sixty seconds or whatever. And really I was hand‐holding through that process. You know, the whole point of the therapy is to build them up into a moment where they have this sense of belief and you’re hoping that they will then leave the therapy room and find a sense of efficacy that I can do this now.
And sometimes it’s that one moment where they’re standing at the top of the Heron Tower looking out over London, something they haven’t done in ten years. Or they’re in that tube and they’re there sitting there feeling comfortable as the train moves away from the platform. Sometimes it’s that one moment that allows them to find that sense of, “Well, I can maybe do this now. Maybe this idea is in my past.”
Mason: So could you take us through what an average VR therapy session looks and feels like? So what is the process behind a VR therapy session?
Carthy: Yeah, there’s much more to it than just the VR system, just the technology, just the headset, and just the immersion. Beforehand I’m very very careful to meet the person, get to know them, to understand their experience of fear or this phobic reaction, or what we would call the fight‐or‐flight response. Even though there are huge commonalities across everybody who experiences fear and it’s one of those universal emotions that we all experience probably almost every day—fear, worry, concern—there is individual kind of triggers or individual traumas or individual experiences that that person has had.
So it’s really about gathering the information initially, getting to understand it from their perspective, building a sense of trust and rapport with the client, going to some scales and really kind of analyzing exactly where they’re at in their experience. And then it’s about deciding what form of treatment they need. Whether it is some cognitive therapy. Whether it’s a bit of positive psychology, maybe the interventions from that space. Whether we use some guided visualization techniques to even first of all, just in their imagination, imagine overcoming the fear.
And then eventually the VRT comes in. It’s a stepping stone between the therapy room and the real world. You’re hoping that in the immersion of this virtual experience which feels extremely real, that they start to get this idea that maybe this can work for me. Maybe I can now leave the office and walk out and face my fear.
Mason: I think there is a degree of miscommunication when it comes to virtual reality therapy. People just assume that you come into your office, Michael. You sit down, you put the VR headset on, and suddenly you’re cured. But it feels like the key aspect to make the technology work is this kind of feedback process where it’s not just the technology itself but it’s the fact that the technology is assisted by someone like yourself with cognitive psychology training. Could you talk to the importance of this thing around being assisted? The fact you need someone to guide you through it.
Carthy: Yeah, you’re completely right. I mean, I would completely agree with you in saying that. The VR therapy, the technology—and it is at a position where it’s extremely useful as a tool—is actually—I would consider to be dangerous on its own, ie. if someone was just to come in and start playing around the software without having that trusted and experienced therapist or practitioner with them, they could probably do more damage than good.
The reason is that it’s about being able to judge the situation, to recognize how far to take the person into the exposure. There’s the rare occasion where you flood someone with with an exposure, ie. they have a fear of spiders and you have four tarantulas walking around their virtual arm and that’s a flooding experience. Maybe sometimes that can help the person get over, but it wouldn’t be an enjoyable experience.
So the core of this is actually the self‐determination theory, and that’s what a good practitioner will do, will be to give the person a sense of autonomy over the process. Which means that they’re in control of it. As I’m explaining it to people I’m explaining to them that you’re in control of everything. I’m going to be communicating with you throughout the whole process, and through the repeated exposures. And at any moment you can take the headset off. At any moment you can just decide not to walk into the Tube. You can decide to close your eyes, even, in the virtual world as well. So really they’re in control of that process, which gives them a sense of autonomy over the situation.
The second part of the self‐determination theory is a sense of competence or mastery. So it’s a gradual mastery over their fear, the thing they’ve been avoiding. Because sometimes it’s maybe for twenty years, twenty‐five years of their life they’ve been avoiding it. So it’s a gradual sense of mastery. It’s not this quick win, this quick moment, even though I would say the whole process is quite rapid comparatively to other treatments that are out there. But it’s about a gradual sense of mastery over the situation.
And then the last component of the self‐determination theory is a sense of belonging. And I think that comes from a sense of feeling proud. What would their parents say? What would their family say when they see them kind of finally getting in that car and hitting the motorway, or you know standing up and doing a public speaking event which would have been debilitating for them a couple of weeks before? So the sense of belonging comes from how will people see them, how will they see themselves.
So I think a good practitioner is thinking about all of these ideas, thinking about these well‐established theories, and is taking people at a pace that’s not dangerous, that’s not going to cause damage. And it’s done in a really safe and controlled way. And I think that’s the skill in working with someone as a VRT therapist or whatever you want to call it.
Mason: So one of the things about therapy is it needs to be hyper‐customized to the individual or the patient you’re dealing with. And one of the things around VR is that you can hyper‐customize these environments, at least as far as I understand it. Could you talk a little bit about the software you’re using to generate the experiences for the individual you’re working with?
Carthy: Yeah, I think that is actually the beauty of the application, the backend, the software. Psious is actually the name of the company who develop these environments. There are thirty‐plus environments that you can use for a spectrum of different fears and phobias that people might face. The most common ones being fear of heights, fear of driving, fear of the Tube for transport, fear of public speaking, these kind of ones are the most common. Fear of flying would be another one that’s really common.
Mason: And what do some of those look like? What’s the experience of being in one of those examples?
Carthy: Well the best way to describe it would be to say it’s like being in a cinema. Imagine if we were sitting in West London right now, maybe sitting in Leicester Square in one of those big cinemas. It’s an immersive experience, you know. You’re sitting there watching a hero movie. Or you’re sitting there watching a sad movie, maybe you cry. You’re splitting a horror movie, you feel afraid. You know just by sitting in a cinema screen and by observing what’s happening on the screen and the kind of sensory experience of the sound and the whole situation, it can trigger a very real response inside the body and inside the mind.
For example if I’m watching a horror movie, there’s a part of me that cognitively, intellectually, knows that I’m sitting in a cinema screen. I’ve been here one hundred times, it’s the middle of the day. But there’s another part of me, the emotional part (you can use any metaphor you want to describe it, whether it’s the unconscious mind or just the emotional part who we are) that will trigger very real feelings. Because that part of me cannot really tell the difference between what’s real and what’s fake, what’s fantasy or what’s reality. As it watches the cinema screen it just can’t tell the difference. So what does it do if there’s someone being killed or it’s a scary moment? There’s a part of me that’s kind of pushing the fight‐or‐flight response. The survival instinct kicks in. Adrenaline, heart rate, increases. Body temperature increases. And it feels so real even though cognitively, intellectually, I know I’m completely safe.
This is the exact same when it comes to a phobic reaction. A lot of people feel silly, or they feel ashamed, or they feel like, “Why do I have this thing? I know I’m completely safe.” But there’s a part of me that’s generating this survival instinct, this fight‐or‐flight response.
So recognizing that that’s what it’s like in a cinema screen, VR is probably one step further. It’s a fully immersive experience, where now you’re kind of the star in the show. You’re not sitting there watching a screen, you’re in the screen. So now you’re in the horror movie. Now you’re standing there, and if it’s something you’ve been running away from for a long time…well, you feel like you’re the star of the show.
So it’s this fully immersive experience where you’re in control, and I would say that it works with that part of the mind where there’s no logic. The part of the mind that controls the fight‐or‐flight response in the exact same way. So when people are sitting here in my office here in London or in Dublin, I sit them down and they’re having very real‐world responses as they’re immersed inside the virtual reality environment. And that’s amazing, because what it allows me to do is in real time, work with that person through the emotion. And the ultimate goal is to allow people to recognize the impermanent nature of emotion. That even something like fear or the fight‐or‐flight response will of course come, but if we start working with it instead of running away from it, it goes quite quickly. Very impermanent; they can come and go quite fast.
What most people are doing when they are experiencing high emotional arousal like fear is they’re trying to control everything, almost. If they’re on an airplane, they’re thinking you know…they’re trying to listen for noises in the engine. They’re trying to see if the stewardess knows what she’s doing. They’re listening and hoping that there won’t be bombs or turbulence because they think if they’re guard, if they’re protected, if they take care of themselves, they can do something about it. Which of course is not true. So their locus of control is really external—it’s really outside.
So in the therapy room here, what we do is we immerse them into those experiences like being on an airplane where there’s turbulence. But what I’m doing with the client is I’m getting them to focus on what they actually can control. And there’s only a few very finite things that we can control in this world, you know. I can control my breathing. I can always control my breathing. I can control things like my body posture. If I’m speaking I can control the pace at which I speak, which is very relevant for something like public speaking, for example. I can control whether I’m smiling or not, or what I’m doing with my face.
The reason why these things are really powerful is actually because it creates a feedback loop. What I do physically with my body in terms of my body language, my smile, my breath, will actually calm the body and calm the central nervous system, the parasympathetic and the sympathetic nervous system that goes completely out of whack. By focusing on what I can actually be in control of, it can bring people through that emotion quite quickly. And they experience high emotional arousal, it comes, it goes, and as the wave washes over them they’re still standing there and they’re still in the experience recognizing that, “I survived it. I coped through it this time.” Instead of having that really debilitating moment of, “I can’t do it. I’m not going to board the plane. It’s time for me to go home.” Or else they create a plethora of coping strategies or drinking alcohol or maybe taking some Valium or whatever it might be. All of these things are just kind of helping get through the moment, but in a way where they believe they still can’t do it.
So people are leaving this experience focusing on what they can control, finding evidence to support the fact that they can do it, which builds a sense of self‐belief and self‐efficacy. And it translates into the real world. I sometimes describe virtual reality as a stepping stone between the therapy room and the real world. And for me that’s exactly what I’ve seen, using it now for about a year with hundreds of clients, hundreds of sessions with people. And I wouldn’t say it’s a stand‐alone treatment, it’s a catch‐all and it’s a silver bullet or anything like that. But I would say in conjunction with everything else that I’ve been specializing in for the last ten years, it’s become extremely effective and something I’m using every day.
Mason: So let’s talk about some of that control. So are you able to control the environments through the software? Are you able to make them more intense or less intense, depending on the individual you’re working with?
Carthy: Yeah, exactly. To answer your original question, I would say yeah, of course. That’s why it’s so good. Because being able to tailor‐make an approach for the client is really important. Everyone comes with their own kinda specific situations that we have to change. So the backend, the Psious software, provides a backend that is completely customizable.
Let me give you an example. So we’ve been talking about fear of flying. Someone could have a trigger that says they have a fear the night before the flight, for example. Or it’s the anticipation at the boarding gate. Or else it’s none of that, it’s actually when they sit down on the plane and the doors close. Or it could be it’s only when I’m at the window. Or it could be it’s when I’m on the aisle. Or it could be when I’m at the front of the plane of the back of the plane. It could be it’s only when it’s raining, or it’s only at nighttime. Sometimes the trigger that creates the phobic reaction is so specific. Because really it ties all the way back into a moment that they’ve had in the past, what we call the initial sensitizing event, some traumatic situation.
So what it allows me to do is to capture information from the person, get to know them and their experience, and then I can really custom‐make the experience for them. What I mean by that is if it was at nighttime in the rain and they were sitting at the window at the front of the plane, I mightn’t give them the experience straight away. I might build up to the one moment. But I could take them on the plane, maybe sit them on the aisle, it’s the middle of the day, there’s no turbulence. And that could be their first experience of getting on a plane. And then eventually we’d build up to this triggering moment which they’ve been afraid of or running away from for a long time. So that customization of the software and the technology is really really important.
Mason: Does the VR experience lose efficacy over time? Are you finding that initially it’s a very visceral experience because it’s so new, and then eventually the effect kind of wears off because they’re beginning to realize it’s a virtual environment? Or does it continue to have the same efficacy throughout the period of time that you work with the individual?
Carthy: That’s a really good question. I actually believe that there has to be some more research into that exact idea. What I can tell you from my experience using it, and what I can tell you from seeing it with clients, is that definitely there’s a change in the client’s anxiety level over repeat exposures. And I can see that when they’re leaving after session three or session four that if I compare (and we get a report and I can show the client this as well, which becomes a massive convincer for that person), they can say, “When I walked oh wow, look at my anxiety level was doing this. Just before I boarded the plane I could see how it increased. But now actually when I go through the experience, it’s normal.” And that becomes a strong convincer for the client to go out into the real world and prove that that’s true in the real world, too.
So I can tell you that there is a shift across the reporting and over the repeat exposures. Whether that’s down to the fact that it’s losing efficacy as a technology and maybe they’re just getting used to the environment I don’t know. Or is it due to the fact that maybe they’re gaining a sense of self‐belief and they’re boosting that idea of efficacy that maybe I can do this now.
I want to believe that it’s the latter. I want to believe that it’s not that they’re just getting used to the environment and it’s becoming easier. And my instinct, and obviously more research could be done around this, but my instinct and my gut feeling is telling me, because people do report back to me after they eventually get on that plane to Berlin or they get on that plane to Dubai or whatever it is that it is, that it is translating into their real experience, too.
So whatever’s happening in the therapy room over a number of sessions seems to be translating into their real world. Which might be evidence to support the fact that it is just due to the fact that they’re changing and the technology is staying static in terms of how effective it is.
Mason: Let’s talk about the fact that some of this technology is to a degree static. I mean is there things as a therapist you’d love to be able to work with or add on to the VR technology? For example smells or other senses. You know, the smell of the fuel going into an airplane, things like that. Is that something that you want to see progress into VR therapy eventually?
Carthy: Well we know that movement and the olfactory senses are sometimes some of his strongest triggers for people in terms of bringing them back to emotional memories. And that’s what this is. It’s about allowing someone to be immersed into experience; maybe they see it, maybe they hear it, maybe they feel it in some way. And if you can add more sensory inputs into that, it’s going to I suppose be a fully more immersive experience for that person. I can’t really imagine how that would happen apart from putting someone inside like, a pod‐like device where the smell’s being pumped in and there’s movement, I suppose. Because one of the limitations I have noticed is when someone is getting onto Tube or maybe they’re about to board a plane, they’re standing here in my office and they’re walking around you know, a four‐foot by four‐foot room. And so how they’re moving or how they’re physically moving doesn’t really translate into the world in the same sense.
So I do see that adding some joysticks or adding some way for them to move a situation would make it feel more real for the person, and maybe even boost that sense of autonomy over how in control they are of the environment. Maybe that would make a big difference.
Mason: We’ve realized that to a degree there’s massive efficacy with VR therapy. But does that mean there’s certain exclusionary criteria that you have to look at when putting someone into it? If you know it’s going to have this massive effect, could it also do the reverse?
Carthy: It’s something that I have thought about a lot and have put a lot of safeguards in place. So there are certain criteria or certain individuals that… Say for example people are taking medication, someone’s taking a beta blocker or taking Valium or they’re on an antidepressant or an antipsychotic. I mean, you could put them into the virtual experience after they’ve taken their daily medication and they won’t have a response, ie. the biomedical system has been hijacked to a certain degree and it would be you know, apart from them just enjoying the experience, you’re not going to be able to get them to actually face their fear in any real sense.
So that’s one limitation, people who are on daily medication. They might not be able to use the technology. And there might just be a process of helping them maybe get into a situation where they don’t feel like they need the medication and then eventually they can come and face their fear or their phobia or anxiety.
And the other large consideration is to make sure people don’t leave with a negative experience. It’s true to say, as I’ve already mentioned, without a trusted practitioner and without someone who kind of has all the experience that maybe I do or my business partner has, it could be very easy to give someone more evidence to support the fact that they can’t do it.
And we’re always very careful to take people as far as we can, even if it’s an inch, a step, sometimes a mile because they’re able to do that. To a point where they can leave with a big smile on their face, they have a breakthrough moment, and that’s the whole…I suppose that’s the art to this, being able to watch someone and just subjectively judge… You know, when I see people I can see what’s happening even in their pulse in their neck, in their breathing, in their body posture. You can kind of just gauge over a long period of time where someone is. And obviously you do have the biometric sensors that are capturing the anxiety level in real time as well. So there is that kind of a delicate balance between taking them just as much as they need to go but not too much so they have a negative experience.
Mason: Could you run a therapy session over the Web with someone with a device at home, or do you still need to be in the same environment as that person to recognize those very subtle cues you were just talking about?
Carthy: That’s a really really good question. So, I am fascinated by technology probably as much as I am by psychology. And this VRT is kind of where psychology and technology meet for me. You see the mobile phone apps. You can see wearables these days. And you can see that what were kind of separate domains are starting to kind of cross and we’re getting these wonderful applications. And a big step forward could be—and I know this is something that companies like Skype and there’s other companies out there who are trying to create this—is having virtual meetings with people where you’re sitting at home in your kitchen but everyone puts on their virtual headset and now you’re sitting in a virtual boardroom and someone’s able to draw out what they’re going to do for today or come with a strategy for the day or whatever it might be. And you can have these wonderful conversations quite remotely but it feels like you’re there, and it feels like it’s real. And I can see a future where that’s possible in this capacity where it’s a therapist and a client, someone in need.
And it would be particularly useful for places like you know, I can think of the West of Ireland, for example. Or places like New Zealand or some very remote places where maybe access to high‐quality experience therapy is not available. Or else maybe it’s too expensive. And if we could create these platforms where we could have these virtual settings where maybe I could judge someone’s body language through the virtual experience. Maybe I could have an accurate reading like the biometrics of anxiety and maybe body posture, maybe get a representation of what the face looks like. And you would be able to safely take people through the situations but from two remote locations. And I think that’s a very exciting idea, and I don’t know how far we are away from the execution of those ideas, but—
Mason: I mean, let’s take it one step further. We talk a lot about the obsolescence of certain jobs through technology. Do you think your own job as a therapist is at risk from some AI that will be able to understand these sort of biometric trigger and then be able to deliver to the human automatically at home with their own device the exact sort of therapy they need? Or do you think that’s a very dangerous possibility, in actual fact, there’d still need to be a human‐to‐human element to make this stuff work?
Carthy: You know, because I’m so interested in the technology sector, I think it would be wonderful if there was an advanced enough AI to be able to provide people with relevant and effective and rapid applications of psychology. I think that would be absolutely amazing.
Would that mean that I would be out of a job? Probably not. I probably would find a way to still be a part of that in some capacity. But really you see this as kind of the democratization of psychology through the method of technology. And I would welcome it massively, and I think it would be—I think it’s really required, in fact.
You know, we only have to look at the statistics coming from the World Health Organization about depression in 2020, and we only have to look across the world at suicide rates, etc. to recognize that we are an ever‐increasing disenfranchised population, our species. And anywhere where technology can be applied to provide people with an increased sense of identity, an increased sense of well‐being, high emotional positive emotions each day, make us healthier. I really would welcome that idea. Now, would it mean that I’d be out of a job? Not to sure. I’d probably just go sit on a beach somewhere.
Mason: Or you could clone multiple Michaels and have versions of you in everybody’s headset. The other question that I have with regards to the work that you’re doing, what makes you specifically interesting, and the work that you’re doing here in London interesting is the fact the you’re working with these tools in the wild with individuals who need this sort of work and this sort of therapy. And I wonder what sort of feedback are you giving to the people who make these platforms and make this software? Are you actively involved in that research process, and what are some of the things you’re asking for and some of things that you’d like to see?
Carthy: Yeah. You know, the size of the company that I’ve been working, they’ve been very very good in terms of providing information for me to build a business around virtual reality. And we have been in contact quite frequently and quite often in terms of giving feedback, and they have webinars and they have training sessions all the time, etc. And I feel like they’re a little bit ahead of the curve in terms of, every time I kind of log in— I might go away for a week or work for week and can come back into the system, and there’ll be a new application, there’ll be a new environment that they’ve created.
One of the latest ones is the EDMR or rapid eye movement technique, which now you can do in the virtual world. It’s been used quite effectively in France, for example, after the terrorist attacks, and it’s become this treatment or technique that isn’t exactly about facing fears and phobias but it’s about curing anxiety or trauma, post‐traumatic stress—
Mason: Could you explain that a little bit more? So, how was it used after Paris? I’m not aware of this—
Carthy: Even outside of the virtual world how it’s used is it’s about moving the eyes back and forth while allowing your mind to wander back to a traumatic event. And what they find is—there’s still a lot of research to be done; it’s something to do with short‐term memory and long‐term memory. But what they find is once you follow this exercise and you practice it, kind of like you would practice meditation, is that the emotional currency of the traumatic event starts to disappear. And that’s how post‐traumatic stress, or that’s how traumatic events can affect our experience. What happens is we keep getting brought back to this emotional memory and it kind of replays into our experience and we feel high emotional arousal in situations where we’re actually quite safe.
So what this technique does is allows us to engage with the memory, which holds a lot of emotion, but it allows us to desensitize the emotion. So if I was to say to you, Luke, “What did you have for dinner three Wednesdays ago?” what would you say?
Mason: I have no idea.
Carthy: Great. Because there’s no emotional currency associated with that memory. But if I said to you you know, “Tell me about the best holiday you’ve had this summer,” or if I said, “Tell me about the best job promotion you ever got,” or I asked you about a very specific situation where there’s a lot of emotional connection, it would come back to you in full Technicolor. And that’s kind of how negative experiences work as well. There’s so much emotion associated in that moment of shock or trauma that it keeps replaying on our experience. So what we do is we kind of avoid it, we run away from it. And EDMR is a way for us to really stop running away from it, running metaphorically back towards the emotion, but just desensitizing in a way so it becomes like that memory of what did I have for dinner three Wednesdays ago? Well, I can’t even remember? It doesn’t come back up into my experience.
What Psious have done very effectively is they’ve provided an application now where you can put the headset on, and what it does is it takes you into a calming experience, you go through the process of moving your eyes back and forth. It just leads you through this kind of like a meditation, I suppose. But it’s a way of desensitizing the fear associated with previous trauma and previous shock.
Mason: Now, do you think that these tools could be ever used for preventative medicine? You’re talking about some of these statistics around mental health. I mean, how do you kind of get in there before any of the bad stuff starts happening? Could VR be a potential solution to that?
Carthy: Absolutely. Absolutely. I mean, the curing fears and phobias is not preventative. It’s working with people who have already experienced a traumatic events or some situation or a conditioned response that they’ve learned from their environment or from the people around them. You know, depression, psychosis, most of the mental health disorders that we have are very much set up in a medical model, the curative model.
But these technologies and where kind of this virtual reality is feels real. I think we could get into a situation where people are using it from a preventative perspective. And whether that means creating some new environments that will allow people to develop emotional intelligence, for example, games that are associated round increasing emotional intelligence… Like, focusing on I don’t know, building the compassionate self. Or working on what your values are, what your strengths are. You know, there’s so many actual positive psychology interventions that could be so easily translated into the virtual environment.
Mason: But I wonder if there’s one step further. If it could be almost building a immune system toward something like depression.
Mason: So an early warning—
Mason: —system, essentially, so you’re able to recognize the triggers before you get to the point where you’re sitting in your office saying, “Look I have this thing now.”
Carthy: Yeah, absolutely. I mean, that would just…it’s an exciting and a big piece of work for some. It’s the gamification of trying to get people into a situation where they’re focusing on building that emotional immune system as much as they’re focusing on building a physical immune system. That they really are hyperaware of what it means to be emotionally healthy.
And I think this is about young kids, maybe, or the generations that are coming now. And maybe this is something that when we’re in our fifties and sixties we’ll look back and say, “There it is, it’s happening!” Maybe there’s a younger generation that will be put into a virtual world quite early on and it will just automatically be able to kind of give them this sense of what it means to be physically and mentally healthy. And there’s a range of games, there’s a range of practices, there’s a range of applications that they can turn to that are preventative at stopping people from having these moments where their quarter‐life crisis, half‐life crisis, where they’re turning to medication in a moment where they can’t deal with stuff.
And that I think is so exciting, and I think there should be, and maybe there is, people working on it. And that’s kind of the principles of the positive psychology movement, which is a move back towards a more preventative set of tools and strategies available to people. Which I actually feel with the right development company could easily be translated into that type of game that kids maybe or teenagers could use.
Mason: On the flipside, do you think some of these technologies, whether it’s VR or the mobile phone, are causing some of the mental health issues that you’re talking about? Do you think there’s this weird feedback loop between the VR’s causing it, then you have to go into VR to solve it, and then back again, and it’s a continuous, inescapable loop?
Carthy: I’m probably not qualified enough to answer that question. But what I would say is, just to my own life and to your observation, it is clear that this has become a pervasive idea, where in particular kids these days to be stuck on their iPhones, stuck on the iPad, it seems like we have just accepted that that’s the way things will be in the future. And it doesn’t seem like it’s something that’s going to change.
I do have reservations about wearables and tools, like technological tools that are suppose to tell us how we feel. What that stops us from doing is to be mindful enough or to be connected to ourselves enough to actually be able to judge how we feel in the moment without some little alarm that’s going to go off on my arm every five minutes. Or without some device that’s been designed to help me cope through my life. That just becomes another exterior crutch that I believe that I need.
And I do see technology, unless we’re very very careful about how we set it up, I do see some technologies going down that road. I mean, I don’t know. I’m an 80s child, so even playing with technology when it came out, you know super Nintendo and Sega Mega Drive—I used to play them for days and hours and stay up all night. And you know, it feels like we will always get these excitements. We will always have this drive and this want for these types of technologies. It then comes down to the developers, maybe to the government policymakers or whoever those people might be, to maybe create a very responsible way for us to engage with these types of technologies.
Mason: It’s interesting what you’re saying about quantifying some of this information. I mean, earlier you said that the ability for someone to actually see there has been a change in the software, and the way in which they’re reacting to something is massively transformative because “there it is, there’s proof, the computer says I’m getting better.” It’s massively psychologically important for them as part of their recovery.
But then also you’re saying that the ability to have all this information is actually making us less aware of ourselves. I wonder where do you think is the right balance between capturing as much data as possible versus allowing some people to build some form of intuitive awareness. So I wonder if your experimenting yet with EEG headsets on folks as you’re doing these sorts of therapy sessions. The question is, that amount of data, is it actually showing us…anything, or is it just noisy at this stage in time?
Carthy: I think it depends on the context and the situation you’re using it. I use VRT the way that a surgeon would use a scalpel. Only very specifically, and only when I know it’s going to have a big impact on the person. I don’t just wheel it around and use it session one just so they can get an experience.
So I think if technology is used in that way, very specifically when it’s going to have an impact on people’s lives, well I think that’s probably a nice way to look at it. You know, just capturing information for the sake of capturing information, using technology because it’s a kind of fad or because it’s going to create some sort of magic wand sense of like, “this technology is going to fix you,” I don’t like that idea because actually that takes away a sense of autonomy—what we talked about the self‐determination theory. I want people to recognize that they’re doing it. That’s not the VRT that’s helping them overcome their fear. The VRT is creating the situation, the context where they are overcoming their fear. But that they’re doing it themselves. That you did it. It wasn’t that some technology or some hypnotherapy or some cognitive wizardry made you feel better. It was that we created a context where you came in and you did it yourself. It’s a way of using technology very specifically to achieve a very specific goal.
Mason: Thank you to Michael for showing us behind the scenes of how he uses virtual reality as part of his therapy practice.
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