A Solution for Telemedicine-Based VR Exposure Therapy

More than 1 billion people–including 14% of the world’s adolescents–are living with a mental health disorder, according to the World Health Organization1. Phobias and related anxiety disorders are especially pervasive mental health disorders that affect 1 in 10 adults2 and are estimated to cost $122 billion each year3. The gold standard treatment for phobias and anxiety is exposure therapy, which reduces fear and avoidance by gradually increasing a person’s exposure to their fears in a safe environment and under a therapist’s supervision4 (American Psychological Association).

In response to the evolving landscape of healthcare, Doxy.me Inc., a global leader in telemedicine solutions since 2014, sought to revolutionize how healthcare professionals connect with their patients. In partnership with Lucid Reality Labs, funding support from the National Institute of Mental Health, and research collaborators at the University of South Florida, Doxy.me created a cutting-edge VR mental healthcare suite that pioneers realistic, remote interactions and empowers providers with enhanced treatment capabilities to bring the benefits of XR technologies to people around the world. The result is a secure, remote, synchronous VR clinic that is currently undergoing a trial with real-world patients.

The VR solution is aimed to enhance the largest telehealth platform in the world, Doxy.me, and the more than 1 million healthcare providers who use its solutions.

Doxy.me VR has been developed under the supervision of clinical researchers and an advisory panel of mental health experts to seamlessly incorporate into providers’ workflows and practices. It brings proven treatment techniques to patients around the world for a range of conditions such as phobias, post-traumatic stress disorder (PTSD), and panic disorder evidence-based interactive exercises.

Follow the patient and the therapist’s path when using the Doxy.me VR solution.

Immersive Environment

In working with phobias, there’s no need to rush. The first and most critical step is for the therapist to immerse their patient in a comfortable environment to establish trust and safety.

The Doxy.me team and its research-driven discoveries advised Lucid Reality Labs at every stage of design and development to ensure the most realistic and comprehensive solution for telehealth providers, as they will meet with patients in this VR environment across days, weeks, or longer for this intensive therapy.

When a patient wants to meet with their therapist in VR, the patient starts the Doxy.me VR app and enters their therapist’s lobby–a bright, cozy, friendly therapy room where every detail was created and revised with the feedback of experts in the fields of design, research, and clinical mental health care. The purpose was to create an atmosphere of peace and relaxation, where trust can be built and effective therapy sessions will be conducted.

From the soft lighting to the shape and position of the furniture, and even to the box of tissues next to the client–every detail was decided with the input of patients and providers to reproduce the best practices of in-person care for this VR therapy space.

The room is spacious, bright, and airy so patients can “breathe freely” and feel at ease. A large window offers views of a beautiful natural landscape outside, with a plethora of greenery inside the room, to help visitors relax and reflect during sessions.

For the clinician, this carefully constructed environment allows them to observe their patient throughout the session to closely monitor reactions.

While the environment creates a real-life feeling of meeting in the therapy room, the experience was designed with a semi-realistic aesthetic on purpose. It aims to provide proven therapeutic techniques in a way that feels less stressful than a typical mental health care visit. Behind the scenes, this design decision also makes the VR experience fully customizable and can be modified to the needs of any therapist or patient when required.

Customization & Personalization

When first opening the Doxy.me VR app, patients can choose from a range of predesigned avatars or customize their own. The exposure therapy session begins by leveraging evidence-based practices within the immersive environment to enhance outcomes.

Doxy.me VR currently offers a tranquil clinic room for providers and patients to meet and interact in immersive, fully remote VR as an engaging alternative to traditional videoconferencing. Doxy.me VR presently provides VR exposure therapy solutions for specific phobias related to small animals–dogs, snakes, and spiders. In the near future, Doxy.me plans to expand their VR content to offer evidence-based modules for other phobias and anxieties related to driving, social anxiety, and trauma.

For small animal phobias, clinicians can choose from a wide range of stimuli:

🦮 14 breeds of dogs

🕷️ 6 kinds of spiders

🐍 8 kinds of snakes

The 3D animals are fully realistic. They come in small, medium, and large varieties. The therapist can choose to animate the animals to different tempers–idle, calm, energetic, or aggressive, each with realistic behaviors and sounds. Therapists can easily control the stimuli to meet the needs and progress of their patients.

Accessibility & Control

Doxy.me’s award-winning telehealth solutions are renowned for their ease of use and are adored by more than 1 million users globally. They have created Doxy.me VR to be seamless for therapists and their patients to meet for synchronous therapy in VR, as well as for patients to practice exposure exercises on their own.

Therapists use intuitive and responsive interfaces to select phobia stimuli, manage spawned objects, and control the intensity of exposures. The provider controls the visibility of the stimulus, its position in the room, and its behavior depending on the patient’s preparedness and reaction.

The therapist can choose to hide the stimulus at any time, move the stimulus closer or further from the patient, and control animal behavior states easily to ensure the appropriate level of exposure for their patient. Patients can also leave the session at any time if needed.

Tech Features

At the heart of this innovative solution lies the powerful and proven techniques of VR exposure therapy. Allowing therapists to track the behavior and movement of their patients, hear each other’s voices in 3D audio, and speak with each other realistically with lipsynch technology ensures that the interaction feels as close to an in-person meeting as possible. In the future, advanced features like eye and face tracking can add an even deeper presence for therapists and their patients.

• Core Features: Synchronous and Personalized VR Session: Establishing a virtual environment where patients and providers can interact in real-time, fostering a strong sense of presence and connection.
• Spatial Object Interaction for Specialized Treatments: Empowering providers and their patients to utilize virtual objects for tailored treatment strategies, enhancing engagement and effectiveness.
• Emphasis on Simplicity and Security: Prioritizing user-friendly experiences and maintaining the highest standards of data security and privacy.

Doxy.me VR was developed for the Meta Quest 2 and is perfectly compatible with the latest Meta Quest 3, with possible expansion to other VR devices.

Analysis

Doxy.me VR can be instrumental in defining vital trends and insights. Demand for therapy is at unprecedented levels, especially for phobias and anxiety disorders in the fallout of COVID-19. The lessons learned from this federally-funded research will provide invaluable discoveries into what works for patients in telehealth-based VR therapy, what doesn’t work, the most used and rejected experiences, customizations needed by therapists, and feedback from users to refine and scale VR-based solutions for the future of telehealth.

Data Security

Robust, enterprise-grade security is ensured by compliance with global security standards, including GDPR, PHIPA/PIPEDA, and HITECH. With Doxy.me VR, patient and provider experiences are kept anonymous and secure, with no data logging, and are protected following international best practices.

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The Outcome

In response to the evolving healthcare landscape, XR provides revolutionary opportunities for healthcare professionals to connect with their patients for efficient, secure, and comforting care. The result is a cutting-edge, telehealth-based VR solution to facilitate the vital practice of exposure therapy for phobias and related anxiety disorders. Researchers are currently conducting a feasibility trial with Doxy.me VR to evaluate how it works for real-world phobia patients. Doxy.me VR pioneers a new form of immersive, realistic telehealth that is ready for further research and development of innovative care and evidence-based therapies.

Doxy.me, together with Lucid Reality Labs, envisions Doxy.me VR as a platform to deliver a comprehensive suite of evidence-based therapies using new and emerging immersive technologies. In addition to their ongoing trial of telehealth-based VR exposure therapy, they are exploring other XR-enhanced therapies to redefine remote healthcare ranging from physical therapy, to mindfulness and relaxation, to healthcare simulations, and beyond. Through this transformative leap, Doxy.me aims to empower healthcare professionals and make the best healthcare accessible to patients worldwide.

References

1. WHO. (2022, June 8). Mental disorders. WHO. https://www.who.int/news-room/fact-sheets/detail/mental-disorders.
2. Wardenaar, K.J., Lim, C.C., Al-Hamzawi, A.O., Alonso, J., Andrade, L.H., Benjet, C.D., Bunting, B., De Girolamo, G., Demyttenaere, K., Florescu, S.E. and Gureje, O., 2017. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychological medicine, 47(10), pp.1744-1760.
3. Konnopka, A. and König, H., 2020. Economic burden of anxiety disorders: a systematic review and meta-analysis. Pharmacoeconomics, 38, pp.25-37. 4. APA. (2017). What Is Exposure Therapy? APA. https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy