Virtual reality's promise, risk loom large for health researchers

SAN FRANCISCO – The  increasingly vivid virtual world has the power to help veterans overcome post-traumatic stress syndrome and heroin users kick their habits. But for all the health benefits, risks loom — namely, that overexposure to virtual reality may generate its own trauma.

That’s the upshot of conversations with a variety of researchers working in VR-focused university labs around the country, where excitement mingles with concerns over the complex clinical effects of what may be the next big global tech phenomenon.

“The question seems to be, if VR is so real it can be used for treatment, then can it also create experiences that are traumatic?” says Mayank Mehta, a neurophysicist with the University of California-Los Angeles’ Center for Neurophysics whose research on lab rats reveals that VR causes the brain to react differently than it would to real-world stimuli.

Those unknowns, however, stand in contrast to virtual reality's ability to take patients safely into worlds that otherwise would cause deep anxiety. Patrick Bordnick of the University of Houston is using VR to generate the craving response that a familiar setting can trigger – in this case, a realistic heroin shooting gallery in a rundown house – and gradually coach the patient to resist that physical response.

“If you’re exposed to stimuli without giving your body reinforcement (in the form of drugs), you kill the link, which in psychological terms is called extinction,” says Bordnick, associate dean of research at the university’s Graduate College of Social Work.

At the University of Southern California, pioneering VR researcher Albert “Skip” Rizzo has developed Virtual Iraq and Virtual Afghanistan VR software that is being used at dozens of VA facilities to help veterans plagued by PTSD.

Instead of avoiding any association with their traumatic war experiences, patients are gently guided back into realistic Iraqi settings in order to “unlearn the association between the stimuli and its consequences,” says Rizzo, director of medical virtual reality at USC’s Institute for Creative Technologies, where Oculus Rift founder Palmer Luckey once interned.

“We try to address the trauma and activate a memory, and it’s hard medicine for a hard problem,” says Rizzo. “But the point is to learn that the present can’t hurt you. For anyone saying that we’re re-traumatizing people, we say this is better than having them see Middle Eastern garb at a Walmart and freaking out.”

OCULUS RIFT, GOOGLE CARDBOARD

For more than a decade, such university VR research relied on five-figure headsets typically reserved for military applications. And patients visiting Bordnick's Houston lab can even walk into a sophisticated VR "cave" that consists of huge screens whose images jump to life via 3D glasses.

But as with most technology, VR gear is getting better and cheaper. Labs are now doing much of their work on products such as Oculus Rift ($500), and researchers suggest that soon patients will be able to access trauma-reducing programs through smartphone-based VR gear such as the free Google Cardboard device.

Helping patients overcome difficult experiences is far from the only new use of VR. The technology's powerful impact on the brain can also be used to generate realistic levels of empathy, tangible reductions in pain and cure phobias, say researchers at Stanford University’s Virtual Human Interaction Lab.

In a demonstration of a diversity training simulation, the user at first appears in a virtual mirror as a white male, and then in the blink of an eye as a black female. Moments later, an animated white male is screaming obscenities. When you raise your hands in self-defense, your arms are that of a black woman. The idea is to truly feel the impact of racism, even if temporarily and virtually.

“There’s tremendous potential for VR to do good,” says Jeremy Bailenson, founding director of Stanford’s lab, who is partnering with Rizzo on new VR pain studies. He describes one such application, where a burn victim is placed into a snowy VR landscape, which reduces the pain inherent in changing bandages. “Mind over matter," he says.

RISKS AND LAB RATS

With VR technology in its early days, so too is any research into its negative affect on the brain.

“The truth is we don’t know what VR does to the brain yet, in part because the best brain studies require MRIs where the head needs to be still, and that’s not happening with VR,” says Bailenson.

“But I can tell you that after working in VR for 20 years, I never spend more than 20 minutes (with a headset on) at a time,” he says, noting that it is typical to feel somewhat ill after being deprived of real-world stimuli for long periods of time.

At UCLA, neurophysicist Mehta's lab rat studies indicate that when the animals walk down a corridor in VR, 60% fewer neurons fire than when the rats walk the same hall in reality.

“Is this good or is this bad? It’s not clear yet,” he says. “But these are very surprising things in that we haven’t really seen the brain behave this way. I’d be happier if more studies were done to test the consequences of VR.”

Mehta says he has reached out to a variety of headset manufacturers with his research. Some have expressed interest in the results, but he has yet to get any to help fund more in-depth research. VR headset makers Oculus Rift, Sony and HTC declined to comment for this story.

In fact, with the coming onslaught of commercial products such as Oculus Rift, HTC Vive and others, VR's first wave of gaming-focused users may prove to be the technology’s inaugural lab group. When video games first came out, there were similar concerns about its negative psychological impact. But successful research on the power of video games to help some conditions such as teen-age depression suggest that VR could well be an even more powerful psychological counseling tool.

In fact, if there is one big strike against VR it is found in the occluded nature of the gear itself. But the fact that you can't see out of the headset and to the real world beyond is also changing fast as companies continue to develop augmented reality goggles. Unlike VR, in which the viewer is fully immersed in a different world, AR glasses allow a virtual world to be overlaid over a reality the user can still see.

Companies such as ODG and Microsoft, which may roll out its HoloLens this year, have made significant strides in AR, and Google has tasked Nest founder Tony Fadell with re-imagining the company's pioneering if unsuccessful AR-focused Glass product. Industry advisors Digi-Capital estimate that AR ultimately will make up $90 billion of a $120 billion VR/AR market by 2020. The thought is that virtual reality will truly reach its commercial apex when fully enclosed and somewhat cumbersome VR goggles turn into lightweight AR glasses.

“Never in history have we been able to captive the eyes and ears with such realism, and in being able to trick the brain you disarm it and render it vulnerable,” says Doug Magyari, CEO of Immy, a company that has long made AR and VR gear for military applications but is developing products for the consumer space as well.

Easily escapable VR – such as handheld Cardboard devices – lessens the potential health risk, says Magyari. In short, until we know more about the impact of virtual reality on the brain and psyche, it may be prudent to procede with caution.

"I don't know if you've read all the (warning) labels that come with a lot of VR gear, urging users to take frequent breaks and suggesting it not be used by children under 12," he says. “Those labels aren’t there as a joke."

Follow USA TODAY tech reporter Marco della Cava on Twitter @marcodellacava.