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Episode 2: Using Virtual Reality for Therapy
23 Plays5 years ago
Today on the show Rolf and Joe discuss the use of virtual reality for the treatment of mental health disorders like phobias and PTSD. They explore research from Dr. Skip Rizzo on the state of the art, discuss limitations of VR, and then engage in some wild and possibly irresponsible speculation.
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Transcript
Introduction to Cognation Podcast
00:00:06
Speaker
This is Cognation, the podcast about cognitive psychology, neuroscience, philosophy, technology, the future of the human experience, and other stuff we like. It's hosted by me, Joe Hardy. And by me, Rolf Nelson. Welcome to the show.
Focus on VR in Clinical Psychology
00:00:24
Speaker
On today's episode, we're going to be talking about a paper called, Is Clinical Virtual Reality Ready for Primetime? by Albert Skip Rizzo.
00:00:34
Speaker
and Sebastian Koenig. This is a paper that talks about the use of virtual reality technologies for clinical psychology applications and something that I think hits on a number of pretty interesting points related to what is VR, how does it work, what's working well, not working well with it, and how might it be useful in the world. Skip Rizzo is someone who has been working on this topic for a long time and has a lot of experience
00:01:04
Speaker
developing practical applications of virtual reality and is one of the leaders in the field. And I think it brings up a number of interesting points related to how virtual reality might be helpful and some of the potential downfalls as well. Yeah, I thought this was a really nice paper. I enjoyed some of the depth that this brings to the idea.
00:01:29
Speaker
To what extent can we use virtual reality as a tool that's really gonna augment the life of a clinical psychologist? And the first thing that I thought before considering a whole lot about the use of virtual reality in clinical practice is one of the obvious applications for this is in treating fears or phobias.
Ethical Concerns and Therapist Role
00:01:55
Speaker
It makes a lot of sense because the two main methods for treating phobias are gradually exposing someone to a more and more realistic version of that thing. So systematic desensitization or the other maybe a little harsher version flooding where you get an immediate complete exposure to something that you have a fear of. So the systematic desensitization, it's safe, you're scared of snakes.
00:02:25
Speaker
you start out with the word snake, then you move on to a drawing of a snake, then a picture of a snake, and eventually as you get comfortable with that, you are able to encounter a snake, maybe even touch a snake. So that's systematic desensitization. And then flooding is the immersion into it. So if you're scared of snakes and you're claustrophobic, the first thing you do is get locked into a trunk with a whole nest of snakes.
00:02:55
Speaker
Right. Which scares the crap out of you, but then you find out you're not actually harmed and the idea is that it's a fast way of doing it. Anyway, virtual reality seems like the perfect tool for these kinds of things because it represents something that you can safely explore and get exposed to, whether it's a slow, progressively more realistic version of what you're scared of.
00:03:20
Speaker
or it's in immediate flooding, you can get this more realistically and more safely, and you can do this in a regimented sort of way. So that makes
VR in Simulations vs. Video Games
00:03:29
Speaker
perfect sense. And that's, I guess, what I would have thought that virtual reality would be good for. But I think he gives a lot of other things that it can be effective in and really makes a good case that virtual reality therapy is qualitatively different than
00:03:46
Speaker
other say just watching something on a video or interacting with a computer program. So that's where I came into it. And I enjoyed it from that perspective. Yeah, I think it sort of speaks to this topic of what is virtual reality good for. And I think one of the things that we think about systematic desensitization or flooding for treating, for example, post-traumatic stress disorder or any kind of phobia
00:04:17
Speaker
is that you can safely explore environments that you would not otherwise be able to safely explore.
Challenges: Realism & Sensory Feedback
00:04:24
Speaker
So it works in that world. And I think it also, for exactly the same reason, another important use of the technology is in flight simulators, which they bring up quite a bit in the article. Flight simulators is a situation where if you're flying a plane and you get it wrong, that's a high risk
00:04:47
Speaker
situation and it's difficult to fly a plane for the first time. The first time you fly a plane can be a very risky situation, so the advent of flight simulators that are highly realistic helps you kind of get into the interaction in a safe way. Yeah, actually, so I know that you've done some flying before
00:05:14
Speaker
Did you use flight simulators to start on that? No, I didn't. I did use flight simulator on the Atari when I was a kid. Those are amazing games. It kind of gets to this idea that basically VR is just like a really good video game, right? Or it affords the opportunity to just create really good video games. And so the question becomes,
00:05:44
Speaker
How important is the VR aspect of it versus just a regular video game? And then why is it that you want to be using a video simulation or a simulation, digital simulation, rather than doing the real thing? What are the reasons why it would be advantageous to have a simulation versus doing the real thing? Yeah, and certainly one of these is sort of as you described,
00:06:12
Speaker
This is a, it's an analog of something that you could do in the real world, but it's just
Effectiveness of VR in Clinical Treatment
00:06:17
Speaker
a dangerous thing to do in the real world. So flying an airplane, but you can also in a video game, since you're not limited by the physics of the real world, you can fly like Superman or you can, you know, you can shoot lightning out of your hands. There's no essential limitation to what it is that you can do. If you want to get out your anger, you can stomp around on a city like Godzilla. It doesn't have to be,
00:06:42
Speaker
tied to reality, I suppose. No, it doesn't. And I think that's where they kind of get into some interesting topics with regards to the idea of there's some ethical issues that you run into in the clinical application of virtual reality. Yeah, go into that. Where it speaks to the issues around systematic desensitization and flooding
00:07:11
Speaker
more broadly, which is that sometimes you can actually trigger some pretty negative reactions in people if you expose them to these situations that are fear inducing. And it can cause some pretty bad reactions in certain situations. And the thought is that if it's in a properly controlled clinical setting, that can be controlled for. But I think that's a little bit controversial in general. The risk then is that if people are able to do this
00:07:41
Speaker
on their own with technology that it could be damaging as well as helpful. Yeah, and I think he talks a reasonable amount about how this should be a tool for a therapist rather than a self-help kind of thing where you can just download it like a game and say, okay, I'll go through the
00:08:05
Speaker
I'll go through the systematic desensitization program myself. I'll just get it on Steam and I'll cure myself of a phobia. So doing that without the guidance of an actual trained therapist could cause some serious damage. Right, yeah, exactly. And so there's a big question about, in my mind, about how effective the actual underlying treatments are to begin with. So obviously virtual reality might help
00:08:35
Speaker
But it's only going to help if the fundamental underlying treatment modality is effective to begin with. So if systematic desensitization is not effective as a tool, then it's not going to help you. It might be worth thinking a little bit about what that actually might look like, what that might be like for a patient. So do you want to, I guess, just imagine it a little bit.
00:09:00
Speaker
So I was just thinking to a lecture that I saw with Skip Rizzo a number of years ago where he was talking about treating post-traumatic stress disorder in soldiers coming back from Iraq and Afghanistan. And basically he would set up a situation, a war fighting situation, for example, like a city in
00:09:28
Speaker
say Iraq and the soldier would be able to explore the environment and approach whatever situation it was that caused his trauma or her trauma and explore that in a safe way and be gradually exposed to it under circumstances where they're, I'm not exactly sure. As I say that loud, it sounds like a bad idea. Right.
00:09:57
Speaker
I think that's basically what they're doing. Maybe they're doing something. Well, I guess, I mean, maybe one of the ideas is that you can stop it at any time. Right. So in other words, you can, if the therapist is looking along and going in as a partner to the, to the soldier that as soon as things start looking like they might be triggering something,
00:10:22
Speaker
then you can stop it and use that as, okay, so why did this happen? How can this be redirected in some different sort of a way? And maybe understanding specifically what kinds of things are triggering it. And I guess that makes some sense. Yeah. Yeah. I mean, I guess it does make some sense. And if you can, yeah, just become habituated to it. That's the idea, right? You have this recurrent thought that you're sort of reliving this experience.
00:10:52
Speaker
and it's anxiety producing and you have actively trying to inhibit the thought and that's causing more cognitive load and anxiety. And if you can just habituate to that, then it can be less triggering in the future, perhaps. And particularly if there's no negative consequence associated with it, that it's in a supportive setting, I suppose.
00:11:18
Speaker
When it gets triggered, you don't have that negative consequence afterwards and repeat it, then you just sort of reduce the amount of trauma that could cause. Right, exactly. Yeah, exactly. And so I think from that perspective, you can think about how important is it that it is virtual reality?
VR's Potential vs. Historical Technologies
00:11:37
Speaker
Probably makes sense to talk a little bit about what virtual reality is in the context of this discussion. According to the authors, they mentioned the fact that
00:11:48
Speaker
virtual reality could be, it's basically anything where there's some technology that's simulating reality. So it doesn't have to be a particular technology, but it typically nowadays means that you're wearing those glasses. The head mounted displays. The head mounted displays where
00:12:12
Speaker
You've got some stereoscopic input, you've got input into both eyes that is simulating a 3D environment and everything else is blocked out. That's the other key thing is that you're occluded from your actual immediate environment. I think that's an important part. And you can also add in auditory cues, et cetera. I like that.
00:12:36
Speaker
When I think of VR, usually what I immediately think of is it's sort of a sensory substitution that you're overriding any kind of sensations that you're getting from the environment by something that just gives you an immersive experience in vision or hearing. But one of the things that I liked about the way that this paper talks about this is
00:12:59
Speaker
They say VR can be seen as an advanced form of human-computer interaction that allows a user to more naturally interact with computers beyond what's typically afforded with standard mouse and keyboard interface devices. So in that way, it's not thinking about it as a way to feed perception. It's more a way of interaction. So you might think of watching a movie in VR. That doesn't really describe
00:13:28
Speaker
VR according to this article because there's not that sort of interaction. So key to this is that a person is able to interact with a particular program and more easily plug into the program. I guess in a way it's sort of like getting a little closer to the matrix so they can operate in a computer system. Yeah, I think one of the key things there is probably being able to turn your head. And when you turn your head,
00:13:58
Speaker
the environment moves as though you were in that environment. Unlike if you were playing a console video game and you're looking at a TV screen, as you turn your head, obviously the image on the screen doesn't change. You have to move your avatar using your joystick or whatever to have the environment change. And it's just a level of human computer interface interactivity that is the next level up and being realistic.
00:14:28
Speaker
immersive. Yeah that the movements of your of your body are an input to the computer. Yeah and so I think at the extreme of the matrix you're basically stepping you're putting on this technology putting on this head-mounted display and you're essentially
00:14:55
Speaker
stepping into this virtual world where this completely cannot be distinguished from reality. You can be completely confused. You can completely suspend your disbelief that you're actually in that world. That would be the ultimate of virtual reality. And that's Descartes' brain in a vat scenario where you really cannot distinguish
00:15:19
Speaker
what is part of the actual world and what's just in your mind. And there you go into some philosophy, I suppose, or philosophers have talked about that the most. And it should probably be clear that VR as it exists right now is nowhere near that point. Absolutely nowhere near that point. I mean, you put on the VR glasses and you're very aware that you're playing a video game.
00:15:47
Speaker
The overwhelming experience is that of trying to get used to this very odd sensory input. And you can become immersed in it. But it is in the same way that you can become immersed in watching a movie. So you can really feel a connection with the thing that you're seeing on the screen. And that can come through narrative, or it can come through good visual effects, something like that. And you just get more of that. What you're really adding with
00:16:16
Speaker
the head mounted displays is just stereoscopic vision and really an immersive field of vision and maybe some more immersive audio too. But you're not getting in any way a complete perceptual substitution for a virtual world. Yeah, I think it's interesting too. I think a lot of the hang up is related to this stereoscopic display.
00:16:46
Speaker
the idea that you're trying to get two different views on the world into your two eyes. So that is more like being in the quote unquote real world. I always, I get hung up on this because I don't have very good stereoscopic vision myself. I have kind of like a pretty amblyopic right eye. So
00:17:10
Speaker
It doesn't really work for me very well. Any kind of stereoscopic stuff generally, I can do it. It's not like I don't have stereoscopic vision, but it doesn't add much for me. And nevertheless, I walk around the world and it's perfectly 3D all the time. Yeah. And I mean, it should be sort of stated as a caveat that we both study vision and psychology. So this is an area that we're both pretty familiar with. I think part of the point here is that
00:17:39
Speaker
your sense of immersion in the world comes from all kinds of different things. And stereoscopic vision, just seeing from two different eyes is only one of the many, many, many cues that you get. Motion around the world is certainly one. Yeah, that's where being able to turn your head and have the world turn. That seems to me like probably like the biggest key element to have it be immersive. Yeah, that is a big one.
00:18:07
Speaker
I think as that gets better and better, and as the models get better, and especially as the lag is reduced and it's more real time as you move, you really see the world move as it should, I think that probably helps make it more realistic. I don't know if this is a good time for that kind of digression, but I think it's also worth thinking about what some of the issues with the technology
00:18:35
Speaker
are as it exists right now.
VR in Education & Training
00:18:38
Speaker
And one of the issues is you don't get input from all of your senses. So you're not, you know, you're not interacting with your whole body or you're not getting feedback from your whole body. So it's not yet a holodeck experience.
00:18:52
Speaker
Even within vision and stereoscopic vision, there are a couple things and people that get headaches when they put on a VR headset know this pretty well. Most people have some sense of disorientation or you feel a little weird after having a VR headset on for a while. One of the big reasons for that is because there's a mismatch of cues for virtual reality. And the biggest mismatch is between
00:19:19
Speaker
vergence cues and focus cues. So the lenses of your eyes focus in on something. Another way of seeing depth is that your eyes converge towards each other. So when something is close, your eyes are crossed a little bit. When it's farther away, your eyes un-cross a little bit. In current virtual reality setups like the Oculus Rift, these things are entirely decoupled. So
00:19:46
Speaker
What you're focusing on, especially when it's something close isn't going to match up to where you're where both of your eyes are crossing to look at it. And whenever you have two cues like this that are out of sync with each other or don't give the same kind of input.
00:20:05
Speaker
have some conflict in your brain and it's going to be a little difficult to resolve and it's not going to give you a perfect sense. That's one problem to be solved in virtual reality is figuring out how to sync up these cues and make displays that can take advantage of this. So I don't know, what are your thoughts about that? No, I think that's definitely an important point there with thinking about the way that the cues visually line up or don't line up. How would that work
00:20:35
Speaker
to have the virgins cues and the focus cues come together? Yeah, I don't know. The most I can- Do you like to tilt the screens or something? The displays, would that work? If you had some- Oh, I don't know. Well, we'll have to research that a little bit more. Well, I know that some displays are, they try to use eye tracking
00:21:03
Speaker
So a couple of recent advances that they're working on, though it doesn't seem as though they'll be perfectly implemented. So trying to use some eye tracking so that you know exactly where your eyes are looking and you can compensate for that. You can sort of trick the focusing, the accommodation system of the eye. One thing that can help is just getting older. Right? As we get older, yeah, our ability to accommodate
00:21:32
Speaker
focus on things that are close or focus on things that are far away. So it just doesn't matter. Goes away, yeah, this disappears. I just got my first, not bifocals, what are they called, the good bifocals, the progressive lenses. Oh, yeah, yeah. Yeah, so as your actual reality begins to deteriorate, it's easier to have virtual reality. That's right, that's right.
00:21:57
Speaker
We could just remove everybody's crystalline lenses and replace them with, is perfectly focusing at one distance and then just always wear the virtual reality glasses. Well, I mean, there are already those neural prosthetics for restoring vision in the blind that send arrays of electrical impulses that go straight to early V1 in the brain.
00:22:21
Speaker
They've had some very limited success. Some limited success. Sending signals directly to B1. Basically, you can barely see some very, very broad forms, some huge letter E in one orientation versus another. Maybe like Atari 2600. Yeah, exactly. Exactly. I think retinal press feces are a major area of research. I have not really
00:22:49
Speaker
produced much so far. It's just very difficult from a biomaterials perspective. Putting this piece of metal that's sending electricity through it on the back of your eyes is pretty damaging to that tissue.
Implications of VR on Society
00:23:04
Speaker
Yeah, it turns out the eye itself is a really good mechanism for turning light into electrical signals. It is. Yeah, it's tough to beat. It's tough to beat.
00:23:17
Speaker
thinking about the role of VR in this, in what situations would it matter that it's more like super realistic? In other words, what is the benefit of immersion in this way versus just say, for example, playing a video game, or in the case of even from a clinical perspective, just imagining the situation. So the way that this works clinically is just to think about it, just think about the situation, approach it,
00:23:47
Speaker
in your imagination, and that's the way a lot of this research has been done before. What's, you know, then you could imagine presenting it on video screen, on a computer screen, or, you know, and then what's the advantage of laddering up the level of immersion? This is one of the first questions that I had, and I was thinking about it, like the 1850 version of this article, and I was thinking, was there someone who said, is black and white photography ready for a
00:24:17
Speaker
prime time for clinical psychology. So it's just a picture. I mean, a picture is a step up and was amazing technology at one time, seemed like it was representing reality better than anything else could. And for something like, you know, systematic desensitization, all of a sudden you have a picture of the actual thing, that seems amazing. And in what way is virtual reality qualitatively so different from pictures, the simplest version I could think of, but you're suggesting video games or just something on a computer screen,
00:24:47
Speaker
without adding stereoscopic vision, but imagining, of course, that's the quickest way to construct the most relevant world to the patient. Yeah, visualization. I think to me, it speaks a little bit to this idea of transfer. So another application for virtual reality, the couple that we've talked about here,
00:25:15
Speaker
One is purely clinical, which is this idea of systematic desensitization or flooding to basically habituate you to any fearful experiences or thoughts or phobias. Another one is training, some sort of training. So we talked about the idea of flying. So flight simulators, where you're getting an advantage from the fact that you're able to simulate an environment
00:25:42
Speaker
that could potentially be dangerous and get a chance to practice in that environment. Basically though, any kind of situation where you're getting a chance to practice cognitively and now with virtual reality, physically challenging environment could be an application. So if you're, for example, you want to get better at playing football, being a quarterback, you could imagine using virtual reality to simulate
00:26:12
Speaker
that environment. And to what level of immersion do you need in order for it to transfer across and become effective in the real world? Exactly, exactly. That's I think a super interesting question. Theoretically it makes a lot of sense that the closer the experience is to the real world experience, the more transfer there will be. But I think
00:26:40
Speaker
It really gets to the, you have to understand a little bit about what's important for the real world performance to know which variables will be important to simulate accurately and which ones will not be important to simulate accurately. Yeah, absolutely. I mean, that's the big, that's a big question. You could imagine that if it was perfectly immersive to the point of the matrix where you're basically playing football
00:27:08
Speaker
and getting crushed by these huge linebackers. But you don't actually have to get the concussions. And you're actually able to move around and all that kind of stuff. And it's perfectly realistic right up to the moment where you get destroyed. That could be a huge advantage when you actually go to play football because there's only so many times you want to get crushed by a big linebacker before
00:27:37
Speaker
You know, it actually, the practice is no longer helpful. Let's take another example. What about public speaking? If it's something that you're terrified of and you don't want to, if you're going to be a public speaker, you have to speak in public and that's the end goal. How do you desensitize yourself to that? I think in the article he mentions even a VR program that's designed for public speaking.
00:28:08
Speaker
What are the things that you'd want to replicate or represent in a public speaking program? What would be relevant so that you could get a crowd in front of you, maybe some positive reinforcement from the crowd, be able to handle if somebody's kind of mumbling in the
Cost Impacts of VR Content
00:28:25
Speaker
crowd? What is it that's going to make you feel comfortable in an AI program that's going to transfer to you being able to go out there on stage and feel pretty confident in speaking in public? Yeah, I think that's
00:28:36
Speaker
It's a little difficult for me to think about what would be important. I feel like the most important piece of it is actually knowing that you're in front of people, that there really are people there. It's just the knowledge of that and that you will, in fact, have some sort of reaction from these people who you're talking to. Right. So if that's the case, then any situation that you know you're not really in front of a crowd of people is not going to be helpful.
00:29:07
Speaker
Right, so I guess it's an empirical question then whether it works for people. I guess sometimes, again back to the idea of visualization, one of the techniques that you're taught when you're learning to do public speaking is to visualize speaking in front of a crowd when you're practicing your speech or when you're practicing whatever it is you're talking about.
00:29:33
Speaker
I don't know how effective that is though. I don't know if there's like really a lot of research on that. I mean, that was one of the things that I took away from the paper as well, which is that there's not a lot of really great, large, double blind randomized control trials in any of these areas that we're talking about. So when you think about what is the benefit or lack thereof of virtual reality for these different clinical tools, it's clouded by the fact that the clinical tools themselves are not
00:30:03
Speaker
sufficiently well studied. Part of the problem is that the things that they're doing are idiosyncratic. One person might be afraid of spiders, but only a certain kind of spider, and only in a certain type of situation, another person might be scared of heights, but again, it could be contextual. And it could be extremely idiosyncratic, like you're scared of a particular person. Everyone has a complex psychological history, and by nature, if you're creating a
00:30:32
Speaker
VR simulation, you have to create it for a mass market. And you can't personalize these things. You can't have all of the details that if you're talking to a therapist in a private setting, you can lay out what is individual and what is personal about your case. And in a VR program, I guess one of those issues is it really, it can't be individuated in that same sense to that degree.
00:30:58
Speaker
Certainly under the current funding environment, it would be very difficult to have things personalized in that degree. I think that's part of the problem with the technology development and on the research side is that there hasn't been funding for large enough trials also. So even when it's possible to have a large enough trial, there hasn't been enough
00:31:24
Speaker
to actually do the research, I think that's been kind of a constant challenge in the space of any of these applications of technology for psychology, right, is that it's very difficult to find someone who's willing to fund the research at the scale that you need to do it to really prove out the point of whether it works or doesn't work for a certain use case. And even really production costs for making a really good
00:31:53
Speaker
virtual programs. So a triple-A video game title costs in the $100 million or more. Yeah, exactly. And this is what maybe a lot of inspiration for these things come from. Look at the possibilities that video games have. But these are extremely high production value products. And there isn't that much money to be made in it, I would suspect.
00:32:23
Speaker
That's a lot of money to recover, I think. Yeah, exactly. You're never going to make $100 million back on your virtual reality systematic desensitization program. That's just never going to happen. So I think that is just the reality that these things will be side effects of the development of the technology for video games and other applications that are more entertainment oriented, right?
VR in Cognitive Training
00:32:49
Speaker
Well, this is where I think maybe Jeff Bezos can come in. If he has an extra $100 million and happens to be listening to this, maybe he could fund the development of a really good therapeutic program. Yeah, that would be awesome. Just back to the idea of transfer as we think about the use of VR, how similar or different the environment is to the real world is super important as we think about the effectiveness of the transfer of the training.
00:33:19
Speaker
And it gets, this is important when you think about education of any kind. So you could imagine a VR educator, for example, where you're basically learning all of the things that you learn in a classroom just by putting in, just by stepping into this virtual world. And so you could actually- Give an example of that just to make it a little more concrete. So for example, if you wanted to teach someone about, for example, history,
00:33:49
Speaker
You could imagine going into a history classroom, sitting down in the history classroom, and getting that experience of hearing the lecture from the professor. But then you could also actually go into the historical situation. Simulations of Waterloo and. Yeah, exactly. Yeah. And then at that point, you don't really even need the classroom at all, do you? I mean, it's not especially useful at that point.
00:34:21
Speaker
I don't know. Yeah, that's a good question. You might need the classroom to contextualize things because a lot of what history does is giving context to events that happen. So actually being present at the Battle of Waterloo is probably a completely disorienting experience. And you really have no idea what the meaning of it all is. Yeah, I think you're right about that. I think you're right about that. What you're learning is the
00:34:51
Speaker
is the myth-making that we're creating, the story that we're telling about what happened. And having some interactivity with it, too, so that you can ask questions of the professor and work on contextualizing things. And that you can't get as much from an enhanced perceptual representation of it or enhanced virtual reality. It has to be something more of an intellectual engagement
00:35:21
Speaker
As technology develops and as the machines that we're interacting with get smarter, the things that you're going to be wanting to learn actually start to blend into the interaction modes that you're having in virtual reality. When you're learning, so for example, I was thinking about this in the context of flying. So when you're flying a plane,
00:35:45
Speaker
The reason why the flight simulator works so well as a tool for training pilots is that you can actually create an environment that's rather similar to sitting in a cockpit in a simulator. You have screens around you that sort of give you the visual input that you would be getting. Yeah, pretty much all of the input that you'd be getting too, yeah. Sound, yeah, you could even have the ones where the seats move.
00:36:10
Speaker
and shake you and stuff. So as you're getting better at playing that video game, you're actually getting better at the task itself because the task itself is so much like that video game. And as the world around us becomes more automated, so we're driving a car, for example, is more and more controlled by the machine, actually then the simulator becomes more and more like
00:36:39
Speaker
the real environment because the real environment is becoming more like the simulator. So if you think about that in the context of education, the fact that what you're not getting with a virtual reality simulation is the social interaction. Maybe that doesn't matter because the world that you need to master from a professional standpoint is more and more like that simulation and less and less like the social environment. Interesting.
00:37:07
Speaker
Well, I mean, in terms of piloting, I suppose the obvious one there is just drone piloting where you could be perfectly trained as a drone pilot because your training would be almost identical to your actual controlling of the plane. It would be exactly identical. It would be exactly identical. And the only difference is that something is not really actually happening. And if you were told that something was actually happening, your experience of it would be identical.
00:37:36
Speaker
Yeah, and that's pretty high metacognition. Everything else is the same. Yeah, so then I guess if you wanted to get that really awesome public speaking immersion, you would basically need to convince the person that they were in fact speaking in front of public. Yeah, so okay, so how do you go about doing that? Maybe you have, I'm not trying to solve this problem, but maybe you have
00:38:05
Speaker
Maybe you have it just sort of a random half, okay, the first time you go in front of there, there's only a 1% chance that you're gonna be in front of a real public, virtual people on the other end anyway. And 99% chance that there's no one there. And by the end, you can go in front of it when you know it's 100% of the time it's gonna be a real public. Yeah, that seems not helpful. No, it's the right idea, but it seems,
00:38:34
Speaker
There's something about this. I guess the issue is deception here. Yeah. That's also just like at that point, it's like you might as well just go speak to people and just do it a bunch of times, join Toastmasters or whatever. Toastmasters that exists already. Exactly. Exactly. I guess where it comes up more and where it would be useful is when it's really dangerous, when the situation is really dangerous.
00:39:01
Speaker
And you don't want to fuck it up. So you want the first time you go out really do it to be perfect at it already. Yeah. And so I think military applications to that are pretty obvious. And so that gets back to the whole thing about why inevitably all technologies of this magnitude are always developed first by the military or by the entertainment industry. Those are the two places where these things get developed. You know, one is market.
00:39:31
Speaker
the market demands and the other is defense or just the Department of Defense that that has almost unlimited funding. Exactly. So you're basically your two applications of VR that are really going to be pushed are building the super soldier. That was actually a call for funding that I think I actually applied for one of those grants. Wait, are we on to the dystopian future part of the podcast? Sure.
00:40:01
Speaker
Maybe there should be a segment. We could just time box it, just keep it only to like two minutes. What's the worst case scenario given what we've talked about? Well, the other thing that I was going to say that I think we probably won't want to include in the show, but it has to be discussed, is that the other real application of this is pornography, obviously. Why does that not have to be discussed in the show? Because we could discuss it in the show. It's just, you know, that is where
00:40:32
Speaker
You just have to imagine that this is going to be profitable. Yeah. I mean, that's probably what could drive a lot of technology forward. Yes. And then also, to the dystopian thing, what ends the human race? Pornography. Oh, no. I mean, if you're able to perfectly simulate the sexual experience,
00:40:57
Speaker
you know, that is essentially arbitrary in nature with no consequence. You know, would people ever actually go out and do the real thing? You know, why bother? And then, you know, then you don't have, then you don't have babies. Yeah. And I think that applies. I mean, I think it applies not, not just to pornography, but to the entire human experience. So if you can, yeah, why are you interacting with other people? If you can get a simulation?
00:41:27
Speaker
of a person who activates those same good feelings, but yet is just a little nicer to you? Yes, exactly. And yeah, you can simulate that social environment and what happens to that social environment as it becomes partly experienced through the simulation and then partly usurped by the simulation. It's not the case that
00:41:54
Speaker
It's type two chaotic, right? Because... Type two chaotic. Yeah. So in type one chaos, it's like, you know, the system is highly interactive from a set of initial conditions that are so many complex interactions that it's difficult to predict what's going to happen in the future. There's always random events. I guess that's probably the chaotic system that I'd be familiar with. So what's type two chaotic? But type one is not
00:42:24
Speaker
affected by the measurement of it. So type two chaotic system is it is affected by the measurement. So the fact that you're seeing the scenario play out and then your experience is what you are trying to simulate, but your experience is tied up with the simulation itself, it's very difficult to predict what's going to happen.
00:42:52
Speaker
Because as soon as you start, so to your point of the social interaction, you start to interact with people who are nice to you in the interaction model. But that's based on what your culturally derived beliefs about what nice is. So as more and more of your experience is based on the virtual world, that's going to change pleasing or nicest from another person.
00:43:22
Speaker
Yeah, you're going to come to expect that. Exactly. And then how does that affect? You could end up in some pretty weird corners. Yeah, I mean, there is no end to the dystopian future as possible with virtual reality, I guess. No. But on the positive side, practical applications, one of the things that we both worked on
00:43:52
Speaker
is the idea of cognitive training. Simulations are things that are sometimes used for different kinds of trainings and cognitive training is one of the things that comes up in virtual reality research as well and came up in this paper. So he was talking about the context of the virtual kitchen. So this is a situation where
00:44:14
Speaker
for people who are suffering from cognitive impairments, they're essentially doing training in the virtual kitchen. So they're able to cook meals and basically engage their cognitive systems in that way in a challenging environment that is also practical, with the hope that this could somehow
Conclusion: VR's Readiness for Clinical Use
00:44:36
Speaker
transfer to the real world, both in the context of the very specific
00:44:41
Speaker
near transfer of being better at cooking, which could be obviously practically useful. But then the hope is that it transfers beyond that as well to more generalized cognitive abilities. So what do we think the hopes are for that for VR and for those purposes? Yeah, that's a really interesting question. I think it may depend on the
00:45:09
Speaker
for implementing some of these kinds of training programs because there's more potential for virtual reality than there is with something with less fidelity. So there should be, it should be that you can recreate a situation that would be transferable and that could give you real world skills. It just sort of stands to reason that the more immersive it is, the more you can map one situation onto another situation.
00:45:38
Speaker
the virtual kitchen with cooking, it seems much more reasonable that you would be able to transfer to actual cooking. It does. That's why I think it's a cost issue is because these things would have to be tailored to a lot of individual kinds of interaction, a lot of situations, and they'd have to have realistic kinds of worlds. So, let's make a kitchen.
00:46:07
Speaker
seems fairly straightforward, but a lot of situations might be more complicated and get to be a little messier and a little harder to come up with and produce in the right sort of way. Right. And I think it also gets into this zone where the kitchen to me gets into the zone of, all right, do you really need virtual reality for that? Why don't you just put them in a kitchen? Yeah. Right.
00:46:36
Speaker
I mean, a kitchen could be dangerous, but if there's, I mean, are we talking about a situation that's supervised or unsupervised? If it's unsupervised, it's hard for me to imagine someone who's really cognitively impaired being able to navigate the interface to be able to even plug into that kind of training. And then if it's supervised, well, then just supervise them in the actual kitchen, right? Yeah, I mean, yeah, this goes back to your point about
00:47:05
Speaker
the most useful kinds of applications are the ones that you can't just jump right into, but a kitchen is certainly one that you can jump right into. Yeah, so the near transfer then becomes questionable in terms of its utility, and the far transfer becomes questionable in terms of whether it works or not. I mean, does getting better at doing a cooking task help you in other tasks in the real world? And what would those tasks be, and how would you measure that?
00:47:33
Speaker
Measurement is an interesting one because if you think about it from a transfer perspective, you could do some pretty interesting tasks in a virtual reality situation that would be hard to do. And just like a warrior, the kind of cognitive tasks that are computerized, they're usually just pretty direct implementations of what used to be a paper and pencil test.
00:48:00
Speaker
You know, so connecting a bunch of dots in a numbered order or switching between numbers and letters. Trailmaking, yeah. Trailmaking, yeah, exactly. You know, it's a pretty basic task that is implemented on a computer. But if you want to understand what real transfer would be like, virtual reality could be an interesting environment to repetitively be able to put people in situations that, and test them on their performance.
00:48:27
Speaker
in a way that's hard to do in the real world because the situations just don't always come up. Okay, so here's a middle of the middle of road example. So what about a chainsaw simulator? Yeah, that's a good one. It's not necessarily, I mean, it's not necessarily that you're a soldier going in and trained to kill, but it's also more than learning. It's more than learning where the refrigerator is and stuff in the kitchen.
00:48:56
Speaker
What sorts of things would you need to get right in a chainsaw simulator? Because what you don't want is someone to feel confident that they've picked up all the skills of using a chainsaw, go out, start up a chainsaw, and then find out how different it is to have that real experience. Yeah, the chainsaw simulator is definitely one where you need to have that haptic feedback, the weight of- You have to have the right kind of weight, yeah.
00:49:24
Speaker
and the right vibration, those are two big elements. Kick back, all that kind of stuff. Right, that's where the spins from the tree, yeah. It starts to feel like that's not gonna be useful at all because it's easy to imagine, you take the chainsaw, take the chain off. Yeah, there you go. Fire that bad boy up. That would be a better chainsaw simulator. Yeah, exactly. A point like a rubber tooth, what is the actual saw part called?
00:49:54
Speaker
Chain the chain. Yeah, I put like a rubber chain on there and just You know fire that thing up and then yeah, that would be better Yeah, cuz you have to build that anyway You know, it's a little bit like yeah, he started getting into that rock bands world right where it's like all right, you just built like a guitar and like a
00:50:20
Speaker
Trump's drum kit. So it's like, all right, what's the benefit here? Yeah, I think the benefit in games like that is giving people an inflated sense of confidence that they can actually produce music. I think, yes, it is. And from a fun perspective, entertainment perspective. And that's where the challenge is abridging the entertaining game to like something that's actually useful beyond the game. So the game itself is useful because it's fun.
00:50:50
Speaker
But I think if you want to, what's cool about that is that making music with a guitar, drums, keyboard, it's difficult. It's challenging. And there's a lot of pieces to it. And it's challenging to get started. In other words, to make any sounds that are in any way appealing, it's hard to get started. It's hard to get that, to get a toehold.
00:51:18
Speaker
And then each successive step, it's difficult to find the right increment of challenge as you increase the challenge level. It's difficult to get that level right. And then to the point where you can start doing it with other people, it is a challenge as well. And so the simulation should be able to, in a smart way, take you from a very easy
00:51:47
Speaker
initial mode where you're only doing this, you're doing very simple parts of it. And then as your interest grows, then you move toward understanding how to really produce a real sound from an actual guitar. Exactly. And then as a very patient teacher, simulated teacher can work with you to actually interact, you can really start to learn how to play music without having to
00:52:17
Speaker
Do all the boring stuff, yeah. Yeah, and do all the boring stuff. Yeah, I mean, I think it should work, right? The challenge is, again, is it better enough that it's worth it? Or will it always just be better just to have a person teach you? And I think the challenge there again is, so there's a game, Rocksmith. Do you know this game, Rocksmith? Is that the one where it can listen to you playing and give you feedback? Yeah, you plug in a real guitar and
00:52:47
Speaker
You know, you feed your guitar directly into the device, PlayStation, I think it is. You plug it right into the PlayStation and it can basically identify the notes that you're playing and give you feedback in real time as to whether or not you're hitting the right notes. And they've basically set it up so that they have different
00:53:12
Speaker
levels of difficulty of the tunes, so that it starts with just the most basic chords that you're playing, only certain parts that are giving you the skeleton of the song, that make it sound like you're playing part of the song, but in a very easy way. And then they ramp that up over time in a way that would be similar to a way that you'd be taught how to learn that song if you're playing with
00:53:38
Speaker
with an instructor. JoyTunes is one that they have for the keyboard, the piano. And that one is because the piano sounds are so pure. Yeah, you can instantly get a note out of the piano right away. Yeah, exactly. So you don't have to plug it in. You can actually just put your iPad right on the piano and it can hear it. And that one works really well. Well, that's a good example where technology can be a good augmentation for a teacher
00:54:08
Speaker
Right. You can maybe extract a little more out of lessons if you have some technology that's kind of helping you get along. Absolutely. Yeah. The wrote parts of the homework, right? The parts where a teacher sends you home with some sheet music and tells you to play it. That is effective, but you're not getting the real time feedback. Yeah. And I took piano lessons as a kid and I
00:54:37
Speaker
like the actual lessons but I never practiced. I can see the potential there because I would love to be able to play great piano without it being a chore to do that. Just to bring this back around to VR and clinical therapy, so initially we were sort of addressing the question
00:55:05
Speaker
Is it always going to be most useful to have the intervention of a therapist or someone guiding things or is it possible that VR can do most of the work for you or most or all of the work for you so that you would eliminate the need for that therapist? Right. And I think maybe we can sort of wrap it up here.
00:55:30
Speaker
I think it's a great place to sort of wrap, which is the paper asks the question, is clinical virtual reality ready for prime time? And part of the question of that is, in terms of the utility, is, you know, how much of this is replacing the clinician and how much of it is augmenting what a clinician can do, and how useful is it in either situation?
00:55:56
Speaker
In terms of being able to help a clinician, I think the challenges in terms of whether this is ready for prime time right now are really related to the challenges of producing high quality content and technology for a limited audience. And I think that is the reason why the answer to this question is no. Clinical virtual reality is not ready for prime time.
00:56:26
Speaker
if it was, people would be using it all the time everywhere. And it's really just kind of like a, you know, it's just a niche academic topic. It's certainly getting a lot of papers for Skip Rizzo, hundreds and hundreds of papers. And he's doing some cool demonstrations, but really not even any big clinical trials to speak of. So I think there's some practical reasons why it's not ready.
00:56:54
Speaker
Well, maybe it's something that comes on wave three of virtual reality. So if, you know, virtual reality goes through some cycles of, you know, hype and then some reality, one of the things that he mentions in this paper, which I thought was, it certainly rang true, is that, you know, in the nineties, when people are really excited about potentials of virtual reality,
00:57:16
Speaker
Almost all of the academic papers were proof of concept kinds of things. So it's just something like this could work, given enough resources. And it wasn't a thorough investigation of things. And maybe that's one of your gripes with this now, too, is that it still feels a little bit like a proof of concept, that yes, technically, the technology exists to do some good, but in reality, it's not
00:57:46
Speaker
quite ready for the kind of implementation that would really realize that kind of thing. And I tend to agree with you there. I think that's probably the case, that it's maybe still a little bit in the hype phase, but there is steady progress and there is some movement towards the kinds of things like this. And certainly if you believe in the march of
00:58:13
Speaker
technological progress as being sort of inevitable, something like this is going to happen eventually. And just like AI, just like you're going to get AI that improves immeasurably and can overtake humans in most respects eventually. But it's hard to envision exactly the path from where we are right now to what that perfect implementation would actually be.
00:58:41
Speaker
One of the things where I did think there was some, he made an interesting point here, which is the usefulness for the therapist of using virtual reality. So I had thought of it mostly in terms of what's the usefulness for a patient? So how much, how could it improve something like systematic desensitization or depression or something like that? But as a tool for the therapist, I thought it was interesting to consider
00:59:10
Speaker
the idea that a therapist can observe you and your interactions with your virtual environment. I like that as well. I thought that was really pretty cool, especially if it was like a phobia situation or some sort of other dynamical situation where if they can see what you're doing,
00:59:34
Speaker
when you're encountering that spider or standing up in front of the crowd speaking, then that person can potentially step in and help you a little bit. Yeah, and it gives a lot more information than just a talk session about what their fears are, that an observation of that could be useful. So I saw some potential there. Yeah, absolutely. And I think the last point that I wanted to make with regards to this was one of the reasons why
01:00:05
Speaker
clinical virtual reality is not ready for prime time, is that a lot of what's happening in clinical psychology is human beings making very, very nuanced and difficult human decisions about how to respond to another person's suffering often. It's often about suffering or discomfort.
01:00:33
Speaker
We don't know enough about what works and doesn't work or why it works or doesn't work. That it really does require a trained but also empathetic, critically empathetic human being to make psychological therapies effective. And we just don't know enough about what makes someone empathetic or how someone can be empathetic or what those decisions that they're even making are to be able to put those into a machine. And I think that's,
01:01:03
Speaker
way far into the future. Yeah, that's a really good point. Yeah, you really have to understand some of those things before you're going to get to the point where you can suggest that it's going to be a useful therapy. Yep. So clinical virtual reality, not ready for prime time, but still cool and definitely some exciting prospects for the future.