Employing Synergistic Interactions of Virtual Reality and Psychedelics in Neuropsychopharmacology

This theory-building paper (2018) proposes the benefits of integrating virtual reality (VR) experiences with psychedelics in order to provide the most effective intervention for certain mental health disorders. The authors discuss three main benefits of integrating these interventions: 1) increases in the efficacy of each individual intervention, 2) increases in specificity and 3) the therapeutic effect can be achieved while using lower doses of a given psychedelic.

Abstract

“The increased prevalence of various psychiatric disorders continue to concern. Promising results are starting to emerge from recent experimental interventions employing VR, and psychedelics, individually. We propose that for certain pathologies researchers need not bother themselves as to which medium offers greater hope. Instead, we hypothesize that the most effective interventions shall necessarily come from a composite approach utilizing both. Traditional medicine adopts similar such synergistic strategies. Combining codeine and acetaminophen increases the analgesic effect. While research into the therapeutic effects of novel interventions using VR and psychedelics, independent of one another, is still in its infancy, we believe that the increased utility of a dual approach justifies closer examination without delay. We posit three main benefits from this integrated intervention. Increases in the efficacy of each individual paradigm due to synergistic coupling, and increases in specificity due to the ability to tailor bespoke therapies for particular individuals and groups, are achieved directly. Such increases in efficacy consequently lead to the third benefit of allowing a therapeutic effect to be achieved while using lower doses of a given psychedelic compound.”

Authors: Matthew Moroz & Robin L. Carhart-Harris

Summary

A BSTRACT

We propose that the most effective interventions shall necessarily come from a composite approach utilizing both VR and psychedelics. This approach has three main benefits: increases in the efficacy of each individual paradigm; increases in the specificity of therapies; and lower doses of psychedelic compounds.

1 I NTRODUCTION

The dawn of highly immersive virtual reality (VR) has coincided somewhat with a renewed acceptance of psychedelic medicine research. VR offers similar promise to psychedelic medicine, and in many cases an optimum solution necessarily incorporates both techniques.

Psychedelics can be used to increase the psychological perception of ‘being in’ the virtual environment. This can lead to increased usefulness of virtual avatars due to a leveling out of the uncanny valley.

Psychedelics and VR can be used to create powerful bespoke treatment solutions. The individual interventions complement each other and have the potential to increase the efficacy of the other.

Current upward trends in prevalence for various psychiatric disorders are of great concern, and we must explore all therapeutic solutions, however novel, which offer hope to those individuals and communities increasingly impacted.

2 T HE I MPORTANCE OF S TIMULUS

Technology allows for fully immersive VR simulations, and the sense of presence is maximized when incoming sensory stimuli closely match expectations within the brain.

3 M UTUAL I NCREASES OF E FFICACY

Psychedelics increase sensitivity to virtual reality, which in turn increases immersion. Interactive technologies shall further boost immersion and presence, but lack the ability to directly suppress the brain’s natural reality-testing circuits.

Treatments employing psychedelics to reduce symptoms in psychiatric disorders may be improved by using VR. The real world set-up shall remain almost unchanged, but the patient may be taken to a far more effective VE.

A carefully constructed VR simulation allows us to strategically guide the experience in order to evoke a specific cognitive response. By targeting a given pathology, we may attempt to alter perception in a precisely defined way.

4 C ANDIDATE PATHOLOGIES

Certain psychiatric disorders may not require specific sensory stimulation. However, the synergistic fusion of VR and psychedelics offers an optimal therapeutic solution for breaking the delusion.

Phobias and body dismorphic disorder (BDD) can have a debilitating impact on the lives of sufferers. VR and psychedelics can be used to target the offending misconception directly, offering hope for the treatment of these conditions.

5 B ESPOKE I NTERVENTIONS

Specific classes of psychedelics show greater potential as solutions for specific classes of psychiatric disorder, and VR simulations may fit some disorders better than others.

In treating PTSD, we expose patients to a virtual experience (VE) that closely mimics the trigger situation of their condition. Providing a tailored sensory stimulus in order to guide the experience grants both possible symptom reduction in those still resistant to treatment, and a potential temporal improvement in symptom reduction for all patients.

A pre-rendered VE featuring a real-world Vipassana teacher may be used to induce a mystical-type experience in a patient. This experience may facilitate further long-term improvements in mental health.

Virtual reality exposure therapy (VRET) is well-established and has shown promising results when applied to phobias such as agoraphobia, acrophobia, vehophobia, claustrophobia, aviophobia, social phobia, and arachnophobia. However, maximizing immersion and presence is key to maximizing efficacy.

Psilocybin offers far more promise as a potential partner to VRET than SSRIs such as sertraline, and may be able to help patients break free of their pathology. VR simulations may be able to help patients realize their misguided mental representation of their body image.

BDD has been associated with abnormal connectivity in the brain. A composite psychedelics/VR intervention may mitigate the effects of such abnormalities.

6 C ONSIDERATIONS , C OUNTERPOINTS , AND M ITIGATIONS

We must consider the infancy of the research we discuss and look to combine, and the restrictions previously and indeed currently put upon such research.

Combining VR and psychedelics may cause concern, but we shall restrict dosage of psychedelic compounds to levels below the levels currently used and detailed in the accepted safety guide. This shall facilitate immersion and presence in the prescribed VE rather than one generated in the patient’s own mind.

One might argue that taking a patient out of the sterile medical laboratory setting and into a VE risks a decrease of expectation and subsequent loss of any associated placebo effect.

7 C ONCLUSION

We propose a novel combined therapeutic approach for a wide range of psychiatric disorders, including body dismorphic disorder and phobias.

We begin by developing flexible simulations that offer the most effective sensory stimulus. Avatars offer guidance and support while the patient navigates their psychedelic experience.

We shall decide drug, dosage, and simulation combinations in a similar way to drug-only combinations, and shall rate the expected potency of various psychedelic compounds using the German VR Simulation Realism Scale. Patients who previously responded well to drug-only interventions shall receive the combined treatment.

Whether the adoption of psychedelic medicine proves to be straightforward, now is not the time to resist progressing the knowledge of such novel interventions.

The increasing prevalence of reported diagnoses of childhood psychiatric disorders is described in several studies, including K. Adhikari, A. S. AlaAldin Al-Hussaini, S. X. A. Dorvlo, J. Dhananjay Chavan, S. A.-R. Vimal Purecha, and A.-A. Samir. Researchers have found that reality monitoring and psychotic hallucinations can be treated with ketamine, and that mdma-assisted psychotherapy using low doses can be effective in treating chronic posttraumatic stress disorder. LSD enhances suggestibility in healthy volunteers, R. Carhart-Harris, M. Kaelen, M. Whalley, M. Bolstridge, A. Feilding, D. Nutt, and H. V. Curran studied the use of psilocybin with psychological support for treatment-resistant depression. R. L. Carhart-Harris, L. Roseman, M. Bolstridge, L. Demetriou, J. N. Pannekoek, M. B Wall, M. Tanner, M. Kaelen, J. McGonigle, K. Murphy, et al. investigated the therapeutic potential of psychedelic drugs for treatment-resistant depression using functional magnetic resonance imaging. Depression and modernization, W. M. Compton, K. P. Conway, F. S. Stinson, and B. F. Grant, J. Diemer, G. W. Alpers, H. M. Peperkorn, Y. Shiban, and A. Muhlberger. J. Difede, J. Cukor, N. Jayasinghe, I. Patt, S. Jedel, L. Spielman, C. Giosan, and H. G. Hoffman used virtual reality exposure therapy to treat world trade center post-traumatic stress disorder. White matter microstructure in body dysmorphic disorder is related to clinical symptoms, and virtual reality can be used to study and treat schizophrenia. Distraction: an assessment of smartphone usage in health care work settings, and virtual reality in mental health, are discussed.

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