We’re living in a time when depression and its impact on the lives of sufferers and those around them is finally becoming more widely recognised and understood. In the last few weeks, reports have been released in the UK showing that funding and treatment for mental health on the NHS are not adequate and that reforms are necessary. In light of this, a new virtual reality therapy developed by researchers at University College London could provide invaluable treatment for sufferers of depression by teaching them to be more compassionate to themselves. I spoke to study lead Chris Brewin to find out what the therapy involves and how it works.
Talk to us about the basic concept for this technology.
Chris Brewin: Well, there’s no one sort of virtual reality therapy (VRT). For example, it’s being used in the treatment of PTSD (post-traumatic stress disorder) to create an analogue of the threatening environment that the person found themselves in to help them to desensitise them to the reminders of frightening events. That’s been the major type of VRT, but that doesn’t involve this new concept of embodiment. I think that we are really the first people to specifically use this process in order to address psychological disorders like depression.
How did you come up with the idea of using VRT to help people with depression? Where was the leap from treating people with PTSD to the idea of embodiment and treating depression?
Chris Brewin: I attended a talk by my colleague, Mel Slater, who is one of the co-authors (of the report), and he was talking about embodiment and explaining that in VRT people can, when they embody themselves in an avatar, take on characteristics of that avatar. It changes their perception and attitudes quite unconsciously. So I thought this could be very useful for people who find it difficult to be compassionate towards themselves, and might resist conscious suggestions by a therapist to do this. People who are depressed often feel that they don’t deserve to be self-compassionate, it makes them feel very uncomfortable. We thought we could bypass this resistance by allowing them to experience these things automatically within virtual reality.
Could you go into a little more detail on this idea of what the link between being compassionate towards oneself and alleviating the symptoms of depression is?
Chris Brewin: People who are depressed tend to be very self-critical and they also have a sort of critical interior monologue that sees them putting themselves down and telling themselves that they are unlovable or worthless. They often feel very bad about themselves in ways that are often very hard for an outside observer to understand – they can’t understand why that person would feel that way because they often feel quite unlike how they look from an outside point of view. So it’s not just depression that this sort of self-critical interior monologue is present in, it’s also quite common with a lot of psychological disorders. So one of the other recent developments is to try to help people to be more self-compassionate. Rather than criticising themselves so much, they learned to accept the things that go wrong, the things that they don’t always do so well at and to respond to themselves with compassion rather than harshness.
So how exactly does your VRT work?
Chris Brewin: This is a very experimental approach so we were just trying to get some sort of VRT scenario that might achieve this objective. So we had the idea of starting with the person who was the subject of the experiment embodied in an adult avatar and expressing compassion towards a distressed child avatar. Depressed people are often good at being compassionate towards others, they’re just not very good at being compassionate to themselves. So we trained them in how to speak to the distressed child, what sort of tone of voice you use, what sort of things to say and then got them to act this out. Then we re-embodied them in the child avatar so that from the perspective of that child avatar, seen through the eyes of that child, they then saw themselves speaking with compassionate words, they heard compassionate words and gestures from that position of someone in distress.
Do you think that the person hearing their own voice, rather than an outsider’s voice, soothing them was a key part of it?
Chris Brewin: Well, in the first study which we did with healthy but self-critical volunteers, we had a control condition in which people were not embodied in the child avatar but simply watched what had happened between themselves as an adult and the child from an outside perspective. So they went through exactly the same procedure: they used the same words, they heard the playback, they heard their own words during the playback, but they weren’t embodied in the child avatar. We found that this didn’t result in the same increase in self-compassion as when embodied in the child avatar. So that’s evidence that perhaps it really is important to be embodied in the child and experience it as though somebody was talking to you. But we haven’t done that control with the depressed patients yet.
What were the findings of your tests?
Chris Brewin: In the group of 15 as a whole there was a gradual reduction in self-criticism and depression over the three sessions and continuing to one month later. There was a consistent increase in self-compassion over this period. About nine reported positive changes in depression that were unlikely to be caused by chance, and four had much more substantial improvement of the kind that as a therapist you would think ‘this is something really interesting happening here’.
Do you see this sort of therapy being something that would work instead of traditional therapies or alongside them?
Chris Brewin: I think there are some people for whom this might be enough – people whose major problem is with self-compassion. In the future, when this is developed further – because we are only in very, very early stage – this could be something that would be a standalone treatment for a proportion of depressed patients. Often patients have other problems or other things they are finding difficult so this would be used alongside other treatment components. We aren’t saying this is going to treat everybody with depression but we think there is probably a subset of people for whom this could be an adequate treatment.
How do you hope to see this progressing? Would you like to see it prescribed by the NHS?
Chris Brewin: I think it could be used in the NHS but I think it could be very useful for people who aren’t going to go near the NHS or any therapist because it’s a terribly demanding thing to do to go and see a therapist to admit you need outside help. So hopefully this could reach a lot of people who are highly self-critical but don’t want to talk to anybody else about it. So they might try this sort of experience at home and learn from it. For example, it could be downloaded from a website. They could experience it in their own homes under their own control. We’re hoping it could mean that we don’t have to rely on the health service or professional therapists all the time, but we can still do something that people will find helpful.