Could a VR monster help you battle anxiety?

Have you ever felt an uncontrollable pang of anxiety? Your heartrate increases for some unforeseen reason, your breathing quickens and sweat begins to build on your palms. But what if you had been training yourself through a VR experience to take control of that anxiety?

How gaming and mental health came together

n 2017, an unlikely pair came together to create a gaming experience that would go on to win five gaming BAFTAS. That pairing was: Professor of Health Neuroscience, Paul Fletcher from Cambridge University and game studio, Ninja Theory. The game they created was Hellblade, which featured a central playable character who has psychosis. Now, one of Fletcher’s PhD students, Lucie Daniel-Watanabe is taking the learning from Hellblade even further, to create a virtual reality (VR) gaming experience that could help people to manage their anxiety. ?

Ninja Theory and Fletcher received high praise for their depiction of psychosis in Hellblade, with many who experience psychosis themselves acknowledging the accuracy and sensitivity with which the condition was handled in the game.

This success, has now inspired a new generation of students who studied under Fletcher, one of the most ambitious being Daniel-Watanabe, who has been given funding by Ninja Theory as well as the opportunity to continue their previous collaboration with her work.

Why focus on anxiety?

There are so many different mental health conditions that could be helped by an immersive VR experience, but this new VR ‘game’ , currently still under clinical trial, chose to focus on anxiety.

Speaking about this to Cambridge University’s news team, Daniel-Watanabe said :

“Anxiety is interesting because it’s something that occurs in everyone. It’s not just anxiety disorders that have high levels of anxiety, almost every mental health disorder has an aspect of anxiety in it, or it's very common at least – it goes across diagnoses.”

Daniel-Watanabe has been utilising the VR experience to test how people respond to stress, from putting people in situations such as: in a forest at night, on the top of a high building, getting ready to speak in public, or confronting them with stressful experiences such as interactions with spiders.

During these VR experiences, Daniel-Watanabe measured participants breathing, heart rate and pulse, to prove that is possible to cause real-world reactions to VR stimuli.

Now, Daniel-Watanabe is branching out, to not only cause these somatic responses in the body by stimuli in the VR world, but to test whether we can be trained by gaming mechanics in VR, to take back control, calm our anxiety responses, and in doing so, manage and reduce our anxiety levels.

How does the VR game work?

Writing for Cambridge University’s news, Craig Brierley walks the reader through the experience of ‘playing’ the finished product of the Daniel-Watanabe, Ninja Theory collaboration.

Once the VR headset is on and a pulse oximeter has been attached to your finger, the game begins.

The basic aim of the VR experience is to teach you a breathing exercise and then to test if you can use that breathing exercise in an anxiety inducing, stressful scenario.

The game starts with the player sat in a rowing boat on a calm river, while a voice guides you in a breathing exercise: breathe out for five seconds, hold for five seconds, and then breathe out for five seconds. This exercise is repeated over a five-minute period.

This relaxing exercise will be recognised by many as a simple mindfulness technique, designed to calm your nervous system and encourage the feeling of being present.

Daniel-Watanabe then explained the second phase of the experience, which, suffice to say is not relaxing at all.

“The second part is, we put people in a very scary stressful situation and we ask them to try and remember that breathing technique. It’s teaching you this regulation mechanism and then asking you to apply it in a very stressful situation.”

The “very scary stressful situation” Daniel-Watanabe is referring to is as follows:

“You’re here in a dungeon with a monster wandering around, but the monster can't see, it can only hear you. The only thing it can hear is your heartbeat. There's a little dial in the top corner of [your vision] that has a green and amber or red light, and the closer you keep your heart rate to the baseline – that's what it was when you were on the boat – the light will stay green.”

But this is only if you do manage to keep your heartrate down, “if it increases by however many beats per minute, it’ll turn to amber, then if it increases again, it’ll go red and that shows how much danger you’re in from the monster.”

This might feel like a familiar game mechanic for those who play games, especially horror games, that often show some kind of measure of the playable character’s physical, or mental state in response to the distressing or scary things that are happening.

The aim of the game is to use that exercise you learnt at the beginning to control your heartrate, which will invariably control how anxious, scared and stressed you feel.

Daniel-Watanabe and Ninja theory have tested the VR experience on two dozen people, with the hopes to reach 100 participants before they move onto the next stage of their study.

As well as taking part in the VR experience itself, participants also complete a questionnaire that has been designed to allow Daniel-Watanabe and her team to see whether certain traits or factors allow people to cope better with an anxiety provoking situation: for example, do people who like horror films find it less stressful?

One of the key aspects that makes a VR gaming experience so uniquely effective is incentive and drive, Daniel-Watanabe said:

“With mindfulness and a lot of these meditative apps, there's no incentives, there's no drive. You have to be self-motivated enough to want to do them. Gaming has that intrinsic motivation built into it.”

The work on VR as a tool to be used in managing or possibly treating mental health alongside other traditional treatments has just begun, but Daniel-Watanabe can see a future where this experience could be rolled out at GP surgeries, hospitals for those pre-op and in other clinical settings.

Speaking to the BBC , Daniel-Watanabe said:

“I don’t think technology should replace a mental health service, but I do think it could play a role in helping with some of those low lying things, like teaching people some basic emotional regulation, or maybe even just getting people to a place where they’re literate enough about their mental health to go and seek help.”