More people need mental health treatment today than ever before, but there simply aren’t enough therapists to meet the growing demand.
In 2020, it was estimated that approx 41.4 million US adults received mental health treatment or counseling. Only about 106,500 psychologists are currently licensed in the United States.
A flood of digital health apps has hit the market. However, many are designed to be low-intensity, low-touch; they are mental health apps and tools that guide mindfulness and meditation or that do not require the contact of a clinician. And while telehealth has helped provide comprehensive access to high-touch treatment, virtual care is still limited by a shortage of therapists.
Virtual reality is the “golden deal” the mental health sector has been waiting for, says Risa Weisberg, chief clinical officer at mental health technology vendor BehaVR, a licensed clinical psychologist and an expert in cognitive behavioral therapy. She is also a professor of psychiatry at Boston University School of Medicine and an assistant professor of family medicine at Brown University.
Healthcare IT News sat down with Weisberg to discuss what telehealth can’t do to cure the therapist shortage, how virtual reality works in mental health care, why she believes VR is the best answer to the staffing problem, and how virtual reality can provide access to alternatives to pharmacological treatments such as opioids.
Q. Telehealth has certainly made mental health care available to many more people. Where do you think telehealth falls short?
A. Telehealth can remove potential access barriers for patients, such as geographic location or transportation to an appointment. As such, telehealth can often make it easier to find a therapist, as any therapist licensed in the state in which the patient now lives may be a possible fit.
Further, it can increase access for patients with busy schedules who may have time for a 50-minute appointment but not to travel to and from a therapist’s office, as well as for patients with mobility difficulties.
These are all really positive contributions. Unfortunately, what we’re facing in the behavioral health space right now is a huge shortage of professionals, something that telehealth doesn’t solve.
As a psychologist, I can personally attest to how difficult it has been to find colleagues open to new patients over the past few years. However, the limited number of trained therapists, especially therapists trained to deliver empirically supported psychotherapies, was a problem long before COVID-19.
We have simply never had enough providers to meet the demand. Now, due to the pressures of the pandemic, the need is greater and the supply may decrease as many therapists are leaving the field due to burnout.
There simply aren’t enough of us to meet the current demand for quality mental health care, which leaves many patients desperate to find a provider or facing months-long waiting lists for an appointment.
Telehealth may ease the burden of traveling to your therapist’s office, but it doesn’t create new capacity within the industry. What we need are new, sustainable solutions that will bridge the gap between the growing number of patients seeking mental and behavioral health treatment, and the number of qualified professionals trained to provide that care.
Q. What is virtual reality technology and how does it work in mental health care?
A. Most digital health experiences are now two-dimensional. When we’re interacting with our smartphone or laptop, our brains process those experiences the same way, meaning, it’s not happening to me – it’s something I’m reading or watching.
Virtual reality replaces your sensory input, creating an immersive experience that the brain processes more like a whole new reality. It’s like everything you’re seeing and hearing is actually happening to you. This level of engagement means that experiences in VR are processed by your brain in the same way as actual experiences.
The ability to activate neural processes in this way is incredibly useful for applying well-understood therapeutic techniques to address mental health and behavioral concerns. VR gives us the ability to transport someone to a quiet and peaceful place for a meditation session, removing distractions from the outside world and increasing the focus of attention.
Importantly, we can also create environments that are intentionally designed to arouse and challenge individuals as part of exposure therapy. In fact, exposure to frightening situations, including flying, heights and even combat, is one of the most studied and applied uses of VR for mental health.
Q. You’ve said that virtual reality is the “golden” mental health care need. Please elaborate.
A. We’ve seen tremendous growth in digital health solutions aimed at closing the mental health care gap over the past few years. Many companies have created platforms for finding and delivering telehealth psychotherapy sessions.
These solutions are tangible in that although personal care is not needed, there remains the need for a licensed clinician to be present synchronously for all patient care and thus, they do not extend the reach of our boundary. mental health workforce.
Solutions at the other end of the spectrum, such as smartphone apps, have also proliferated in recent years. Many of these companies are doing fantastic work and, like telehealth, have played an important role in the space.
Most of these phone app solutions are designed to be used independently, often without any supervision from a clinician. Thus, these low-touch solutions do an excellent job of addressing the shortage of mental health practitioners by providing individuals seeking mental and behavioral health help options that do not require a provider.
However, because most of us can be easily distracted when using our phones, and because the applications we engage with on our phones are not fully immersive, the impact of these interventions may be limited for individuals who need more more than low intensity. careful.
VR experiences built on the foundations of empirically supported psychotherapies may provide an ideal solution. These experiences, because they are fully immersive and processed as if they are actually happening to you, promise to potentially show clinical effectiveness that may be more comparable to that of some personal therapies, but with the flexibility to be used without a clinic. present.
Whether it’s wellness products that individuals use entirely on their own or prescribed VR programs in which a clinician is involved in the care but doesn’t need to be synchronously present during all sessions, VR can be the golden solution. or hybrid, which the industry needs. to scale mental health services without adding new burdens to current providers.
Q. You also suggest that virtual reality could provide access to alternatives to pharmacological treatments such as opioids. How?
A. First, it’s important to note that virtual reality will never completely replace medication or in-person therapy. There are use cases that may require pharmacological interventions and/or traditional in-office psychotherapy. However, for some individuals and for some behavioral health indications, VR interventions may prove to be equally powerful treatment options.
One such area is that of pain care. VR interventions can be effective in addressing and reducing pain, both as a stand-alone solution and as an adjunct to physical therapy and other pain management methods.
A good amount of research has explored the use of VR to provide distraction and/or relaxation during episodes of acute pain, making it a promising alternative to the use of opioids in acute and postoperative care.
In a 2021 review of VR applications in military and veteran healthcare, researchers reported, among other findings, a 39% reduction in the total dose of opioid medication used for patients who received a VR intervention during burn wound care . The authors suggest that VR may provide a scalable, non-opioid pain relief solution for soldiers recovering from combat injuries in the future.
Further, solutions have recently been developed to treat chronic pain through VR interventions. These programs often include mindfulness strategies, calming environments, and/or breathing techniques to activate the patient’s parasympathetic nervous system and bring about pain relief over time.
VR interventions have also been developed to help individuals better understand their chronic pain and reduce their tendency to catastrophize their pain and/or encourage exercise in patients who have developed a fear of pain and movement.
In the midst of the opioid epidemic, VR interventions for acute and chronic pain can reduce the amount of opioid medication prescribed—and potentially lead to fewer drug use problems in the future.
Additionally, VR interventions are being developed to directly address opioid use disorder, using evidence-based treatment methods.
Overall, I think we are in the midst of a major transformation in the way most people view their mental health and access to care. The pandemic has taught many of us how important our mental health is and shown us how difficult it is to access high-quality, evidence-based care.
Similarly, VR as a technology has grown rapidly in recent years with greater capacity to create fully immersive experiences and at a more affordable price. I believe the synergy of these two changing fields will lead to more powerful solutions and a plethora of behavioral healthcare scenarios to which VR solutions can be applied.