Many times during my research, I have come across the importance of ethical considerations for the use of VR (both as a consumer product and a medical instrument) and about the usage of modern technology in healthcare in general. In this blog post, I want to delve deeper into some of the challenges and important lessons regarding ethics in this environment.

Using VR and modern digital technology in treatment settings introduces a host of ethical considerations. One of the primary concerns revolves around patient privacy and data security. With the collection and utilization of sensitive health information through digital platforms, ensuring robust safeguards against data breaches and unauthorized access becomes paramount. Health information is sensitive information. When protection is not set up correctly, many people can be compromised, as can be seen in [1], which is a list of the 14 biggest healthcare data breaches

Another ethical consideration is about informed consent and patient autonomy. As patients engage in VR therapy or digital therapeutics, they must be fully informed about the nature of the treatment, its potential risks and benefits, and any alternatives available. Furthermore, ensuring that patients have the capacity to provide informed consent, especially in cases involving vulnerable populations or individuals with diminished decision-making capacity, is essential. Especially regarding new technologies, patients may not know about potential risks/benefits and may be ill-informed – the goal of the professional has to be to inform the patient about these factors.

Furthermore, the equitable access to VR therapy and digital interventions raises concerns about healthcare disparities. As these technologies become more prevalent in treatment settings, ensuring equitable access across diverse socioeconomic and demographic groups becomes imperative to prevent exacerbating existing healthcare disparities. Another aspect to keep in mind are the biases of the professionals creating these services, as talked about in [2] or written about in [3] and [4]. A diverse team of people with different backgrounds can ensure that all facets are addressed and that no group of people is disadvantaged in any way.

Addressing ethical challenges requires a multifaceted approach that encompasses technological, regulatory, and ethical considerations. Implementing robust data protection measures, such as encryption protocols and secure storage systems, can help safeguard patient privacy and mitigate the risk of data breaches.

Furthermore, integrating informed consent processes into VR therapy and digital treatment platforms empowers patients to make informed decisions about their healthcare journey. This involves providing comprehensive information about the treatment modality, including its potential risks, benefits, and alternatives, in a clear and accessible manner.

Promoting transparency and accountability within the healthcare ecosystem also plays a crucial role in addressing ethical concerns. Healthcare providers and technology developers must adhere to ethical guidelines and standards of practice, ensuring that patient interests are prioritized throughout the treatment process.

Summary & conclusion

As we navigate the evolving landscape of healthcare technology, the ethical considerations surrounding VR therapy and digital interventions will continue to shape the future of patient care. As designers, embracing a culture of ethical reflection and continuous improvement is essential to foster trust and integrity within the broader community.

Looking ahead, advancements in artificial intelligence, machine learning, and immersive technologies are most likely about to revolutionize healthcare delivery and patient outcomes. However, as we embrace these innovations, it is imperative to remain vigilant in safeguarding patient rights, promoting equitable access, and upholding ethical standards. In conclusion, navigating the ethical considerations associated with VR therapy and modern digital technology in healthcare requires a collaborative effort grounded in principles of transparency, accountability, and patient-centered care.

References used in this article and for research

The notes under the links are mostly for myself, in order to have an organised overview over the content of each source.

[1] 14 Biggest Healthcare Data Breaches [Updated 2024] | UpGuard

(22) Ethical Considerations for Virtual Reality and Immersive Experiences | LinkedIn

Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders – PMC (nih.gov)

Ethical Considerations in Implementing VR and AR in Patient Interaction – Soft Skills for Healthcare (esoftskills.com)

Ethical Considerations in the Usage of VR/AR in Medical Technology (skill-lync.com)

Considerations and practical protocols for using virtual reality in psychological research and practice, as evidenced through exposure-based therapy | Behavior Research Methods (springer.com)

[3] Developer Bias – MikeSchinkel.com

[4] Biases in design | Bootcamp (uxdesign.cc)

This is part 3 of my research into the topic of immersion therapy. In this blog post, I want to explore specific use cases for this type of digital therapy.

Use cases for immersion therapy

Uses cases for VR therapy are varied. In general, a distinction between physical and psychological health problems may be considered, as these may require distinctly different treatment methods. However, it should also be noted, that physical and mental problems are often interlinked (i.e. one may develop mental health problems because of existing physical problems) and overlap frequently.
Until now, I have talked a lot about exposure therapy, which is used to treat mental health issues. However, physical problems, or the mental health problems which may arise from said health issues, may also be treated using CBT based methods. In an interview with Liana Fraenkel (MD, MPH), it was stated that Cognitive Behavioral Therapy (CBT) is as effective as other non-pharmacologic approaches such as exercise. CBT can be used to address many mental health problems, which often occur due to physical problems. Therefore, its value in physical therapy must not be understated. CBT can help treat depression, insomnia, fatigue management, and self-management, which are all symptoms of physical problems. Additionally, the techniques learned during therapy sessions can be utilized at any time, making them useful beyond the therapy sessions.

In the following section, I want to give an overview over possible uses cases. The list is roughly based from mental health problems to physical health problems:

• Depression
• Anxiety disorders
  e.g. social anxiety
• Borderline personality disorder
• Eating disorders
• Obsessive compulsive disorder (OCD)
• Panic disorder
• Various different kinds of phobias
  e.g. fear of flying, animals, insects, heights, …
  Patients can be gradually exposed to stronger, more realistic depictions of their phobia
• Post-traumatic stress disorder (PTSD)
  It is commonly used for the treatment of war veterans who suffer from PTSD. VR therapy allows them to immerse themselves in their memories and experiences in a controlled way. This can help them cope with their emotions and memories. The treatment of PTSD is an important way of helping people and preventing suicides.
• Psychosis
• Schizophrenia
• Sleep problems such as insomnia
• Alcoholism
• Irritable bowel syndrome (IBS)
• Chronic fatigue syndrome (CFS)
• Fibromyalgia
• (Partial) paralysis
  This one I know of from personal experience. As previously mentioned, my brother is partly paralyzed in his left side, especially when it comes to vision.
  One exercise was a car driving simulator using a VR headset. He had to simultaneously perform the driving actions, keep an overview over the traffic, and also deal with his trauma from his car accident.
  In another exercise, the goal was to find certain objects which were hidden in a virtual room and connect two objects with a wire.
  The goal of another training exercise was to dodge and block incoming balls which were coming toward the player.
• Pain relief therapy / Chronic pain (such as arthritis)
  One example I came across described using VR to deal with phantom pains after the patient had lost a limb. Through the sensory information and the (movement) input, the brain is triggered and sends and receives signals to/from the still existing extremities. The setup may look like as follows:
  The patient see a virtual avatar of themselves with all limbs still attached. Over certain signals/impulses, the patients can move their amputated limbs again. This can be a highly emotional experience, but it helps over 50 % of patients to reduce pains in their daily lives.
• Stroke
• Cerebral Palsy 
• Parkinson’s disease 
• Multiple Sclerosis 
• Especially for children, it can help them deal with ADHD, autism or developmental delays by supporting them in a fun and gamified way.
• and many more…

Summary & conclusion

In this blog post, we took a look at specific use cases for both mental and physical health problems and how the treatment may look like. Physical and mental health problems/conditions are often interlinked and occur together – therefore, a holistic approach should be considered to increase the effectiveness of the treatment method.

References used in this article and for research

The notes under the links are mostly for myself, in order to have an organised overview over the content of each source.

Immersion Therapy for Treatment and Support of Mental Health conditions (simulationmagazine.com)
short general article about immersion therapy

What Is Virtual Reality Exposure Therapy? (choosingtherapy.com)
a more in-depth read about (VR) exposure therapy

Immersion Therapy For Anxiety: How It Works And Techniques (mantracare.org)
a more in-depth read about immersion therapy

Immersion Therapy vs. Exposure Therapy – Healthy Minded
short overview of the difference between (VR)ET and IT

What Is Exposure Therapy? (apa.org)
good, structured overview over ET

Overview – Cognitive behavioural therapy (CBT) – NHS (www.nhs.uk)
good, rather detailed read about CBT

Virtual Reality in der Schmerztherapie: Einsatz, Erfahrungen und Potenziale (onlinesicherheit.gv.at)

In my last blog post I came across some articles talking about „Immersion Therapy“. I found this topic interesting and even though I know the basics I have yet to delve deeper into this field of therapy.
So let us do just that!

Definition of terms

Firstly, let us begin with a brief definition, which will be further expanded on in more detail in the next section. There are a bunch of terms and definitions floating around this topic. The most commonly used terms in this discourse are:

• Cognitive behavioural therapy (CBT)
• Exposure therapy
• Virtual reality exposure therapy (VRET)
• Immersion therapy

Exposure therapy describes a specific form of cognitive behavioral therapy. Immersion therapy is a more intense form of exposure therapy, where the patient is especially immersed. This can be achieved through various methods. Virtual reality exposure therapy simply describes exposure therapy which utilizes some sort of VR setup. VRET can be a part of immersion therapy, but doesn’t have to be.

In the context of this blog post, I will use the terms immersion therapy and VRET interchangeably, always meaning a form of exposure therapy which uses a VR setup to immerse the patient.

Deeper research into this topic

Next up I want to explain the four terms from above further and in more detail. The use cases for these methods will be assessed in the section „Use cases for immersion therapy“ in the next blog post #06.
I believe a strict destination between these segments helps with clarity and readability regarding this vast topic.

Firstly, let us start with cognitive behavioral therapy, since this is the building block on which all further methods are based upon. As seen in graphic 1. CBT is based on the assumption that one’s thoughts, behaviors and emotions are interlinked and can thus create a positive but also negative cycle / feedback loop. The goal of CBT is to deal with negative emotions by breaking them down into smaller parts. These can then be more easily understood and techniques can be learned how to deal with them, i.e. see them one’s problems and emotions in a new light. At the end, the patient should have a better quality of life by learning how to deal with their negative emotions. CBT is a talking treatment where patients talk to their therapist, who then can give advice on how to tackle their problems. In general, it can be said, that different from other talking methods, CBT focuses on current problems rather than searching for problems in one’s past.

Exposure therapy then builds on CBT. The goal is to help people overcome their fears and anxieties, or rather to reduce the negative reactions of people to fears and specific situations. This is done through exposure, therefore the name exposure therapy. The idea, it is predicated upon, is that people can grow stronger against their fears by willingly confronting them. In exposure therapy, patients learn how to address, process and confront their fears. Together with their therapist, patients walk through their problems, then (in a very controlled manner) expose themselves to these problems and then once again talk about their experience. This is repeated as many times necessary.

Virtual reality exposure therapy, as the name implies, is the same treatment form as exposure therapy. The only difference being, that in VRET a virtual reality setup of some kind is used. This brings some unique challenges but also advantages with it. Patients can feel way more immersed and the level of exposure can be easily controlled by the therapist. Also, patients know that they can rely on the medical specialist to turn off the VR program, should they uncomfortable or not yet ready to deal with this level of exposure.

As mentioned above, immersion therapy is a derivative of exposure therapy, which is more intense and immersive than regular exposure therapy. The patient is immersed in their traumatic experience or thought process. This is done for an extended period of time. The goal is to once again strengthen patients by providing a safe space to face their fears and problems – which ultimately leads to a better quality of life. This immersion can be done through various methods such as:

• In vivo exposure
  … facing the source of fear/anxiety in real life.
• imaginal exposure
  … trying to actively and vividly imagine the source of fear/anxiety.
• Virtual reality exposure
  … using a virtual reality device and setup of some kind.
• Introceptive exposure
  … exposing oneself to similar physical sensations which are similar to these which happen when facing the fear/anxiety. E.g. running in place to increase heart rate, similar to the sensation one with panic disorder might have, therefore training the mind to see this sensation as harmless.

Summary & conclusion

Since this topic is too big for the scope of one blog post, the advantages and disadvantages, as well as the specific use cases for this treatment method will be covered in the next upcoming blog post #06.

In this blog post I delved into the four topics of cognitive behavioral therapy (CBT), exposure therapy, immersion therapy and virtual reality exposure therapy (VRET). Both a definition and explanation of these terms were provided. Since I am not a health student, this was an unfamiliar topic and a new experience. These are hugely important fields of research and fascinating but also vast and daunting. However, I look forward to researching this topic further in the upcoming blog posts.

References used in this article and for research

Immersion Therapy for Treatment and Support of Mental Health conditions (simulationmagazine.com)

What Is Virtual Reality Exposure Therapy? (choosingtherapy.com)

Immersion Therapy For Anxiety: How It Works And Techniques (mantracare.org)

Immersion Therapy vs. Exposure Therapy – Healthy Minded

What Is Exposure Therapy? (apa.org)

Overview – Cognitive behavioural therapy (CBT) – NHS (www.nhs.uk)

image CBT