An Introduction to Virtual Reality in Psychiatry

Milton P Juang, MD
Associate Director, Psychiatric Informatics Program; Lecturer, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Norman E Alessi, MD
Director, Psychiatric Informatics Program, Associate Professor, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

Media and popular culture are presenting images of virtual reality (VR) as a high-tech device that makes a person feel like they are in a different world for purposes of work or entertainment. In many of these portrayals, it is used to divert or manipulate the mind of the user. Current VR technology is certainly not as powerful as the movies depict, yet it is now being applied to help change the behaviours and cognitive patterns of people with mental illnesses. This paper defines this term and illustrates current VR technology, focusing on mental health applications. We also briefly comment on the drawbacks of VR and mention some of its future potential.

Definition and Examples

VR—or the preferred term in the literature, “virtual environment (VE)”—is a simulated or artificial world that interacts with the user by appropriate stimulation of the user’s senses based on the physical actions of the user. Psychologically, a successful virtual experience will make the user become involved in the world to the point where he or she experiences a sense of “presence” in the virtual world or “really being there” (1). Such a definition includes “text-based worlds,” where one sits at a computer and reads messages about an imaginary place and types in messages about the actions one wants the “avatar” or computer representation to enact. Some people find these computer-based experiences engrossing and even life-changing (2,3), but in this paper, we use the term to refer to sensory “immersive” VEs. This refers to virtual worlds that are experienced through the senses of vision, hearing, touch, and smell, and immerse the participant in the simulation.

Perhaps the most familiar examples of such devices are the aircraft or spacecraft simulator and the first-person video game. In these cases, a computer creates visual images that reflect the user’s choices of motion through a 3-dimensional map as indicated by a steering wheel or other control

device. The intensity of the interaction contributes to absorption in the experience. More formal VR technology increases this feeling by more direct stimulation of the user’s senses and monitoring of the user’s actions. The most popular device for this is the head-mounted display (HMD). This is a helmet-like apparatus worn on the head that places a video screen in front of each eye and earphones over each ear. A tracking device measures where the head is located and the direction it is pointing in at all times. This information is then sent to a computer that keeps track of the user in the virtual world, extrapolating what should be seen by each eye and heard by each ear, then creating the appropriate images and sounds. If you walk toward a virtual tree, the image in each eye grows larger and the bird singing in the nest grows louder, although in reality you may just be walking toward a wall.

Other types of VR equipment are available and deserve mention. “Haptic” equipment simulates “force feedback” so that an operator feels an appropriate pressure when handling an object. Thus, a stick with computer-controlled motors can become a scalpel when one sees the appropriate instrument and body on a table through an HMD, if the motors present the appropriate amount of resistance for penetrating different layers of tissue when you manipulate the stick. Projective virtual equipment dispenses with the HMD, instead placing the user in front of a screen that creates a 3-dimensional image through the use of lightweight 3D glasses. The images of the VE are projected on the screen, based on data from a head-tracking device. The most sophisticated form of this type of device is the Cave Automatic Virtual Environment (CAVE™), which places the user in a room where the walls and floor are all such projections, fully immersing the user in the virtual world (4)(figure 1). Other technologies include olfactory “displays” or body suits that monitor more-detailed physical motions. Such advances help make the illusion of virtual reality more complete.