One of the best ways to help people get over their fear of something is to expose them to it. Technologies like virtual reality have made it possible for therapists to safely immerse their patients in fear or anxiety-inducing scenarios, but this modern approach to treating mental health disorders hasn’t always been affordable or accessible for most.
Based in San Francisco, Limbix designs virtual reality software that therapists can use to simulate a variety of public environments for patients, coach them through these experiences and teach them various coping techniques.
In this episode of HealthRedesigned, we chat with Tony Hsieh, Co-founder and Product Lead at Limbix.
Facing fears safely
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What is exposure therapy and how does it treat anxieties?
Exposure therapy is a component of a treatment used for a lot of different issues like anxiety, PTSD (post-traumatic stress disorder), phobias and OCD (obsessive-compulsive disorder). When you have anxiety, for example, or a fear of flying or driving, the worst thing that you could do is avoid experiencing it. Exposure therapy has been researched for decades and has been proven to be an effective way of helping people get over their anxiety.
If you have a fear of public speaking, for example, exposure therapy gradually exposes you to more intense scenarios of public speaking. You start out with something easy, maybe talking with no one else in the room to see how you feel. Then it progresses to a few people in the room and they're all smiling and nodding at you. Once you’re comfortable with that, you move on to the next intense point where you'd feel the most nervous or afraid. The idea is to expose you to those different scenarios.
The really interesting thing with virtual reality is that we can now have a patient experience all these different scenarios and scenes directly in a therapist's office.
Is this where Limbix comes in?
Yes, exactly. We're building the software and content for all these different scenes and filming them in 360-degrees so that therapists can put patients in these different scenarios directly in their office.
For example, with fear of driving, you can drive in all sorts of different locations from residential streets to highways to bridges to tunnels and you can do it as many times as needed in a therapy hour. The therapist can actually control different settings in the scene too. The software that we're building allows therapists to do that with patients in their office.
One of the really powerful things of virtual reality is that when you put on the headset and someone's looking at you, you feel that level of anxiety or your heart starts beating a little faster—it just feels so real.
Extending virtual reality as a treatment
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How has the VR space evolved over the years?
It's amazing to see where this technology has gone in the last few years, especially with Oculus making the technology mainstream enough to be powered by a desktop machine. From that, we’re seeing that move towards using smartphones with the headset—that’s all that people need today to experience virtual reality.
It's really come a long way in terms of the technology and its application in mental health. A lot of research originated from Skip Rizzo, a professor at the University of Southern California. A lot of the earlier research he did was to figure out how virtual reality could be used to help veterans with PTSD.
Being able to place them in different scenes where they're back out in combat or seeing a traumatic experience of someone getting injured or hurt and working with that with the therapist in an office was really powerful. The research has now extended beyond PTSD into anxiety, phobias, OCD, eating disorders and even substance abuse and it’s shown how virtual reality can help with relapse prevention in those areas.
For example, a patient can put on a headset and be placed into a virtual bar with their friends. It's a social, fun environment and the bartender can ask if they want a drink and they can practice saying, “No”. A person wouldn't really get that same feeling or trigger to want to drink if they're just sitting in their therapist's office trying to imagine it.
There’s been tons of progression in terms of where virtual reality has gone as a technology and where its application in the mental health space is going.
A prime time to transform mental health treatment
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Both you and your co-founder, Ben Lewis, worked at Google and Facebook previously. How did you go from working at these two tech giants to starting Limbix?
Ben and I started out at Google together and he’s been a very successful entrepreneur. He started two other companies and I joined the second one—it was called Karma Science and we got acquired by Facebook. That's how we both ended up there. Ben joined the Oculus team after Facebook acquired them.
After some time at Facebook, both of us were excited about virtual reality and starting a company together. But we were most excited about applying virtual reality in the mental health space because of the personal experiences we've had. Also, the research behind it showed us that it was a really exciting opportunity and we felt that with the technology being affordable and easy enough to use now, it was a great time to take this technology out to individual therapist offices and clinics out there.
Did you envision it to be the software that it is today?
We've learnt a lot since talking to hundreds of therapists and patients and getting feedback on what people like and don't like. We're actually doing a few different things. A lot of what we’ve talked about is a therapist-guided experience, where a therapist is in the same room with the patient in a session. But we've actually seen a demand by patients for a self-guided experience.
These are 10 to 15-minute experiences that patients can put on their own at home and go through before or after a session. They can revolve around mindfulness exercises, practising different skills or even psychoeducation. We've definitely seen a need and demand for these kinds of experiences to augment the actual in-session therapy. That's definitely one thing that we've learned along the way that we didn’t see in the beginning.
We're actually working with a research group and professor at Stanford, who’s part of the psychiatry department. We’re working with him on the experience for social anxieties or for people to talk to strangers or go through job interviews. There'll be a virtual coach in the experience who talks to the patient and asks them how anxious they're feeling on a scale of 1 to 10.
If starting to feel comfortable, then they’re moved on to the next level of the program. We're creating that experience with him now and it's almost like a 'Choose Your Own Adventure' experience.
How do you produce the different scenarios seen in the software?
Right now, our process starts with identifying the top researcher or expert on a particular issue. Then we work with them to create the right protocols which are recommendations on experiences and education to go through in each session. Once they've listed out the protocols and the content, we work with filming companies and various content creators to create those scenes and film it.
What’s the process like for therapists who want to use Limbix?
Right now, any therapist can go to our website and sign up for free. We're in the phase of letting them try it out and give us feedback. What they need to get started are a Google Daydream headset and a compatible smartphone. We'll eventually put together a VR kit that’ll come with everything bundled in one package with standalone headsets that don't require a separate smartphone.