Can Virtual Reality Help Heal Addiction?

Interviewer: I’m here with Noah Robinson. Thank you so much for your time today.

Noah Robinson: Thanks for having me.

Interviewer: All right. To start, let’s have you tell us a little bit about your personal story and how you got introduced to video games because I know that’s a big part of why you’re doing what you doing now.

Noah: Right now, just for some background, I’m currently a doctoral student studying clinical psychology at Vanderbilt. I’ve always wanted to be a psychologist since I was 10. At around the age of 13 I realized that I was gay, and so then I started to– I developed feelings of shame and things like that and started to play a lot of video games as a way to escape that negative emotion that I was experiencing.

I started playing this game called RuneScape which is basically like World of Warcraft or one of these games where you log into this massive environment and there’s other people that you can talk to and do activities with and those kinds of things. From the age of 13 until about 18, I played RuneScape. I was logged in for about 8,500 hours.

[laughter]

Interviewer: What does that work out to?

Noah: It works out to a 40-hour-a-week full time job for almost four years.

Interviewer: Wow.

Noah: I was a professional gamer, in some sense. Then I came out of the closet when I was 18, and then I didn’t play RuneScape anymore. I didn’t feel that need to escape into this virtual world. Basically,– I’ve always had been interested in technology because that was a huge coping mechanism for me. I think that my addiction, I do think it was an addiction although I didn’t have withdrawal–

Interviewer: To video games?

Noah: Yes, I think I was addicted. I didn’t withdraw from them or anything like that, but I did have a need to regulate my emotions via some kind of external source that I was relying on. After I came out then I resolved those negative feelings of shame and guilt and things like that. Once I had a more competent sense of self, then I didn’t need to escape into a virtual world because I could live in the real world and be happy and fulfilled and things like that.

Interviewer: Could you talk a little bit more about that immersive escapism element of gaming?

Noah: Yes. I mean basically, I was able to remove myself from my own thoughts and feelings and go into a world where I can interact with other people. I was able to go on quests and get 99 strength through training and things like that. There was leveling, there was validation, there was reward. Sexuality wasn’t a component of the interactions because it was text chat with other people. I created a clan of 400 people that I led and things like that. It’s like a whole– I was at leadership and–

Interviewer: [laughs] It’s really fulfilling a lot of things that we all want from the world.

Noah: Yes. A sense of meaning and purpose. I saw barriers to feeling a sense of meaning and purpose in real life because at that time I couldn’t reconcile the idea that I was different and gay and I could have a family and kids. I was able to escape that and create a sense of self that was fully reliant on this virtual fictitious world. There are parallels to how anyone who’s using mood-altering substances trying to change their mood and escape those feelings and those thoughts that are negative and trying to regulate that negative emotion. That’s my experience with technology.

Interviewer: Trying to maybe be someone different than who they are, or experience a different life than what they’re living, right?

Noah: Yes.

Interviewer: Cool. Then it sounds like that meant a lot to you growing up, and then eventually, you came into contact with VR, virtual reality. Could you describe how you first encountered that?

Noah: Yes. After college, I went to University of Maryland and graduated, and then for two years I worked at the National Institutes of Health as a research fellow. When I was there I just sat in a lab, I was actually doing work on meaning and purpose in life for people who have rare and undiagnosed diseases. I was learning about what drives people and what motivates them to change and things like that. I basically was sitting in a lab where my desk, I don’t know.

Interviewer: Take time.

Noah: While I was at the National Institutes of Health, I was sitting in a lab, that wasn’t the lab I was actually in but I just happened to be there. The engineer behind me had a virtual reality headset and he’d just brought it in and he let me try it. The second I tried it, I was blown away because there’s this feeling of leaving your current environment and being put into another one.

Interviewer: Kind of an amplified version of what you experience was with RuneScape.

Noah: Exactly. I realized, “Wow, this is huge for psychology,” but I wasn’t quite sure how. Then I purchased a headset, bought it home, and started learning how to build virtual environments.

Interviewer: What year was this?

Noah: This was 2015 or 2014.

Interviewer: Okay, so really early in VR.

Noah: Yes. When I said VR to people, they’re like, “What’s VR?” People didn’t know what it was. I always had to say virtual reality. That’s a big difference now as people really hear about it. I just started creating my own environments which in and of itself was a pretty cool thing because you’re using this visual program like Photoshop and you’re building an environment, then you put on the headset and you’re in it. You’re looking around all around you and you’re in this whole thing which is–

Interviewer: Did you ever experience building, I don’t even know what you would call that. Is that like coding? [laughs]

Noah: Yes, it’s more like Legos than coding, actually, so you can just drag a tree instead of landscaping. It’s pretty easy. It gets more sophisticated, but the program that you learn to build things on is easy to learn, hard to master, kind of thing. Then I started trying that. I also experienced putting on the headset and being transported to a social environment where I can talk to other people. That was really powerful for me. I was alone in my room and I’ll put on the headset and then I was with others.

Interviewer: There are real other people who also are on headsets?

Noah: Yes, from around the world who were connected via the internet. That was through an application called VRChat that has now grown a lot. When I first did it, there was almost no one there, like 15 people or anything, and now there’s thousands of people logged in at any time. That’s a kind of sign. It’s like this movie Ready Player One that just came out. They have this thing called the Oasis where people can log in. I wonder things like that, how much that would mitigate drug use. If someone had a way to have an escape but they’re escaping into an environment that’s actually treating the reason that they’re escaping in the first place.

What if, for me, RuneScape instead of being a game, what if that could treat my underlying problem kind of thing?

Interviewer: Sure. What were some of the first things you looked at when you started experimenting using VR for like your psychology work that you were doing?

Noah: Basically, I started working at JourneyPure and they– Basically, we had a patient in the detox unit and they had a really intense intake interview. We do a little intake interview and ask them what their reasons were for using and everything. Afterwards, I asked her, “Do you want to try virtual reality?” All I knew was that it’s fun, and I told her, “We haven’t done this with a patient before, but if you want-”

Interviewer: You just tried yourself up until that point?

Noah: Yes.

Interviewer: Also, could you describe, because people may not know what JourneyPure is, is that inpatient or outpatient, or whatever it is?

Noah: As part of my clinical training at Vanderbilt, we learned how to do therapy, and so my practicum placement is at JourneyPure, which is an inpatient rehab facility. They also have outpatient facilities as well. My supervisor Brian Wind is really into technology. JourneyPure uses an app to follow patients for a year after they leave the facility and keep connected to them. I knew that, and so really when I first met Brian at this practicum fair, I approached him and said, “Hey, I heard you guys are into technology. I’d love to bring my virtual reality and figure out a way for us to collaborate.”

I hadn’t been working in the addiction space at that point. This was a year ago, I was doing social anxiety. I built this whole experiment to try to help people with social anxiety learn how to interact with others in a more positive and healthy way, but–

Interviewer: You’ve been testing that at Vanderbilt?

Noah: Yes. This isn’t even as intimidating- I’m not nervous. When I was interviewed for local TV, that was nerve-racking because they put such a big camera in front of me. Okay. Where was I? I was saying–

Interviewer: You had just talked about the social anxiety and the work you’re doing.

Noah: I hadn’t done addiction work by the time when I started my practicum placement at JourneyPure. Bryan and I were thinking, and I asked him, “Can I bring the virtual reality?” He said, “Sure.” I brought my virtual reality and I do this intake interview with a patient. She was in detox and she had just gotten there. As with most people who come to detox, she had gone through a lot to end up deciding to get to rehab. She actually hadn’t really decided. She had attempted suicide, had been transferred to the hospital, and then transferred to JourneyPure detox and was telling me about this whole experience that she’d had and was crying. It was really intense.

Then afterwards, I asked her, “Do you want to try virtual reality?” She said, “Sure.” I put her in the headset and I started this little tutorial that has a British robot that walks you through everything, and she instantly starts smiling and laughing. She was really excited about this. We saw this transformation in her affect. She was really excited about it and we saw this transformation in her emotions. Her whole experience went from being withdrawn and sad and very negative emotionally to positive and excited and interested.

This was a really exciting observation that we had. The therapist who was supervising me and I looked at each other and we were in shock when we saw her laughing after she had just been telling us about her experience. [coughs] Sorry. That was our first patient.

Interviewer: To back up one step, as you’re getting into your practicum, you could have decided to focus on any number of applications for different technologies and even other applications for VR. What made you decide to see if this can fit into addiction treatment specifically?

Noah: Well, I was always interested in addiction given my own history with video games and things like that. I also did some research on addiction previously during college. I was just interested in that, but, really, the biggest reason was that it was at practicum site, JourneyPure, that was already using technology to stay in communication with their patients. I saw that they were already open to using technology because some practicum sites and places are not using much technology so they may not be as open to new technology.

Interviewer: When you were bringing this idea up to people in your program at Vanderbilt, for example, was there some skepticism about VR and using it in this way?

Noah: Some would be an underrated term. Basically, I got accepted to Vanderbilt to work with a professor who actually moved to a different university before I got here. I had to decide whether or not to go with him, and I decided not to. Then I had two mentors. This is co-mentorship and they were great mentors. The only issue was that I don’t think that they were as interested in exploring the potential of virtual reality, as they wanted to train me in a more traditional scientific way.

They wanted to train me in this more traditional scientific way which is, basically, you need to find a problem that occurs in psychology and then develop a hypothesis and test it. Really, with this virtual reality, there’s something here that’s pretty powerful. We don’t know exactly– I feel like we’re holding this tool that’s really powerful psychologically. It’s been proven to treat PTSD, phobias, things like that really, really effectively. For me, I felt like I needed to explore how virtual reality can be used. I wasn’t sure, I couldn’t develop a hypothesis right then last year. I wanted to see, where can it fit and where can it be applied?

That was a bit challenging because right when I started this practicum at JourneyPure and saw this reaction with this patient, I brought that back and that wasn’t very well received by my mentors. They were– I don’t know. They were upset that I had even put the patient in virtual reality. They’re asking why had I done that and that kind of thing. I realized that I had to– Honestly, at that point, I had to say, “I don’t think this is a good fit,” and I started looking for a different faculty member to work with. I had to take the risk of getting kicked out of the program, actually, in order to stick to what I wanted to do, which was really hard.

It was weird because everyone outside of the program is really excited about it and there’s people inside the program who were too– There’s just this two people that weren’t as excited, I guess. Then now, I’m now working with a mentor. His name is Steve Holland, Dr. Holland. He is a protege of Aaron Beck who created cognitive behavior therapy. He hadn’t taken a student in 15 years, but he decided to work with me. He was on my committee the first year, so he got some exposure. He’s been really excited about it.

He came down to JourneyPure to see, how are patients reacting? We interviewed a couple of patients that I’ve been doing therapy with and he said, “This really surpassed my expectations,” after he observed. He observed one patient change. One patient was having panic attacks and couldn’t participate in therapy at all at JourneyPure. She was about to leave against therapeutic advice. Then I put her in virtual reality. We went into VRChat together, so we had two VR setups and we were connected through the internet and talking. We explored all these virtual worlds. We went to an art gallery, a random guy from Copenhagen joined us. He just happened to be logged in and we got talking.

Before she went into the VR, her hands, she was so sweaty that the controllers that she was holding were dripping with sweat. Afterwards, she sat down and she said– She was calm, you could just tell that her whole mood was different. She said it felt like she had taken benzo or benzodiazepine but the difference is that this felt an like authentic mood change whereas the benzo just numbed her. After my mentor saw that, Steve Holland, he saw that and later he said to me that he came to JourneyPure to be supportive of what I was doing but he said his expectations were blown away, and that he really thinks that there’s something powerful here.

This is a guy whose whole career has been devoted to developing novel treatments for depression, improving treatment, randomized controlled trials. It’s really exciting to have that kind of support. This year has felt like everything clicked into place. I’ve had a lot of support and guidance on how best to implement this. I was yelled at last year because they said, “We’ve never had a grad student come in and just say this is what I want to do.” I took a risk when I wrote my personal statement for graduate school. People told me not to talk about virtual reality because they said–

Interviewer: You’d scare them off?

Noah: Yes. Then no researchers were really doing this that I applied to so they said, “Don’t.” I said, “I don’t want to spend six years doing research on something when there’s this huge potential with virtual reality.”

Interviewer: Right, and the timing is so right for that.

Noah: Yes. I had to stick to my instinct. I don’t know. It’s been an interesting journey to get here but now, we’re seeing– Basically, we’re starting detox and we have this patient react in this really positive way. Then I started putting other detox patients into virtual reality.

Interviewer: I was going to ask, what are the typical responses that you’re seeing? I know you’ve mentioned a couple.

Noah: The first response, she took off the headset and said– This same person took off the headset and said, “All my anxiety is gone,” which is a pretty– It’s a pretty incredible thing to hear someone say that after we didn’t put any– They didn’t have any pharmacological intervention, they just had this headset that they wore. Then I had the next patient. I put them in and they started laughing and smiling. They take it off and also say that their anxiety goes down from like a 9 out of 10 to a 1 out of 10. This keeps happening over and over again. At one point, the nurses came to me and said, “What are you doing to these patients because they’re leaving, they’re miserable, they come back, they’re smiling, laughing and happy.” Then of course–

Interviewer: They were seeing the changes long after.

Noah: Yes, for hours. Then of course, once you change someone’s mood like that then all of their– They’re more pro-social. They’re interacting with the staff, the other patients, and so there’s this positive feedback loop that keeps happening. Patients who were lying in bed all day were all of a sudden able to get up and talk and be active and interact with others. It was just an unbelievable change that we were seeing, but I realized that I was just standing there while the patient was in the virtual reality.

I was putting them in, I was handing them these two hand controllers.

Also, just something that clarify is that this virtual reality is not the phone-based mobile virtual reality, the portable one that’s lower quality. This is desktop computer-based virtual reality where you have to plug it into a computer with a really sophisticated graphics card. The whole setup is about $1,400.

Interviewer: It’s different than what people may have experienced on their smartphone?

Noah: Exactly. Yes, because people think, “Oh, that’s virtual reality.” That’s not virtual reality. It is but it’s not at the same time because– If we’re competing with heroin here, you need something that’s really, really immersive and effective, so we’re using the top-of-the-line stuff. I realized, though, I was just putting the patient in the virtual reality setup, and I wasn’t actually with the patient, so I brought my own second computer and headset to JourneyPure. At this time, I was just using my own equipment. I basically went into virtual reality with the patient and into VRChat. I was guiding them around and talking to them.

All a sudden, we were seeing that the effects that we were seeing in the beginning of the person being in virtual reality alone, that’s helping to regulate their emotion, it’s increasing their positive emotion and decreasing their negative emotion. On top of that, if I went in with the patient and started doing therapy, cognitive behavioral therapy with them, we found that for some reason they were more receptive to the therapy than if you try to do it in person when they’re feeling anxious and negative and not receiving it as well.

Basically, this past year has been to explore, how can we deliver therapy in virtual reality, and take advantage of the fact that the virtual reality helps to reduce that negative emotion? When someone’s in a more positive regulated state, teach them the skills and CBT. Basically, teach people on how to analyze their own thoughts or change their behaviors, and take a step back from their negative emotion and realize that they have control over negative emotion, or that not all their thoughts, those negative automatic thoughts, that negative self-talk that people might have like, “I’m worthless,” or things like that, that those things are not actually accurate.

When we teach someone those skills, if they’re in this virtual reality and they’re immersed and they’re more regulated, they’re able to learn these things, and so when they take off the headset and as those negative events start to happen, or as that negative emotion starts to come back, they’re able to visualize the model that I just drew for them in 3D, and then apply it to those situations. What we’re seeing, and this is just anecdotal at this point, is that after one or two sessions of this kind of therapy, patients are at the point that would normally take five or six sessions of a in-person therapy for them to get to that point.

Interviewer: You’ve described a little bit of this, but looking at the program itself, how do you describe to people what they’re going to experience, what they’re going to see when they put on that headset?

Noah: It’s very difficult to describe. I just explain that we’re going to go into a virtual world, we’re going to explore a little bit together after I do a tutorial. We’re going to explore a little bit together and then we’re going to some therapy. What happens is that I basically take them to these really abstract, beautiful worlds, swirling colors all around, or we can go to the Titanic or we can go to the moon. You can really go anywhere, you go to the beach. We just explore and I help them– Really, it’s a mindfulness experience. They just get calm and are immersed, and they’re not thinking about their kids or their parents or why they’re in rehab, they’re not even thinking that they’re at rehab.

Interviewer: It makes them more present where they are.

Noah: Yes. Then I take them to a room and I say, “Tell me about the most recent time you felt negatively, even at the rehab center.” We use it as a jumping point to teach them the skills of cognitive behavioral therapy.

Interviewer: You’re going in there and they see you as an avatar?

Noah: Yes, we move with avatars. I actually have a 3D scan of myself from a conference. I’m there. I need to get another 3D scan in more casual outfit because I have a blazer and things like that on.

Interviewer: A little professional. [laughs]

Noah: Yes. I’m there and I’m moving my hands and my hands in the virtual environment are moving. I move my head and my head moves so we can nod, and you blink. [crosstalk]

Interviewer: Perhaps some of that’s non-verbal communication.

Noah: Yes, exactly. It feels very real, but the patients report that they’re able to talk about things that they wouldn’t feel comparable face to face talking about. In our first session, I had a patient talk about sexual abuse that she had experienced, and she was really surprised afterwards. I interview patients after about their experience and she said she was really surprised because she didn’t think that she would talk about that. There are all these advantages that it seems that the virtual reality can provide for delivering more effective therapy.

Interviewer: What’s your theory about how and why these visual and sensory immersive elements impact the user’s thoughts and behaviors?

Noah: Basically, the basic model in cognitive behavioral therapy, you imagine a circle, that’s our environment, and within that circle, wherever we are in our environment, we have thoughts, feelings, behaviors, and then also whatever’s happening in our body, our bodily experiences.

With virtual reality, what’s happening is that– Typically, in cognitive behavioral therapy, what you want to do is teach someone that they can change their thoughts or they can modify their behaviors or they can adjust their physiology. They can take medicine, sometimes illicit drugs to change their physiology. The idea being that you can’t actually change your feelings directly. It’s hard for us to just decide not to feel anxious, but these other things, the thoughts, the behaviors, or the physiology can all affect our feelings because if we change the way that we’re thinking then we might not feel as anxious. If we engage in a different behavior and go out and do something fun, we might not feel as anxious or if we taking anti-anxiety medication or heroin also can make you feel less anxious temporarily.

The thing that virtual reality does is that the whole circle that these things are occurring in the environment completely changes. This is a new fourth way that you can actually change someone’s feeling by completely changing the context that they’re in.

Interviewer: Like putting a filter over the whole circle.

Noah: Exactly. Just plucking the person out of their own environment and putting them in this completely novel abstract environment. Then all of a sudden, all of that negative feeling goes away, and then positive feelings starts to come back.

Interviewer: What are some of the measurable outcomes that you’re either looking at all ready or hoping to measure and test?

Noah: This past semester that just ended, I recruited eight undergraduates at Vanderbilt and they were running patients at JourneyPure in virtual reality for 56 hours a week total. We did about I think 250 30-minute sessions of virtual reality. Our outcome measure was this questionnaire that asked for self-report positive emotion and negative emotion. We had people do this before and after the virtual reality sessions, and then also every evening and morning while they’re at rehab.

Right now, my master’s thesis this summer, because I’m in a PhD program but it’s built into the PhD program, my master’s thesis is going to be to analyze that data and actually see, how long does this effect last? How much change is there? We’re already seeing that there’s a big increase in positive emotion and decrease in negative emotion right after the VR session. People are reporting that this lasts for the whole day, that they’re feeling completely differently. I mean people are saying, “I really want to do the VR again. I really want to do–”

What they’re doing in this experiment this semester is what I started out in detox doing which is just individual environments. They’re just playing games. They’re playing Ping-Pong, they’re playing Guitar Hero, things like that. These are immersive. I mean you’re in a stadium doing that kind of thing. Fruit Ninja, things like that. It’s really immersive, and it’s all around you. We’re measuring how that changes their emotions.

The next step is going to be to actually do cognitive behavioral therapy in a virtual reality environment and measure that outcome, which is a little bit harder. It’s little bit harder to measure the skill acquisition of, how do you actually know someone’s able to identify negative feelings and reframe their thoughts and things like that? But there is a measure we’ll be using where we give little vignettes and see if the person’s able– if they’ve developed the skill set required to identify that someone’s having a bias in the way that they’re viewing the situation and things like that.

Interviewer: They’ll respond a certain way and it’ll let what’s going on underneath?

Noah: Exactly. Eventually, we could actually do that in virtual reality with an automated computerized avatar and have them respond, but that’ll take a little bit more programming and things.

Interviewer: I read that you also recently presented at Harvard about this. Now that you’ve started implementing the VR program, you’re seeing some results with real patients in the real world, how is the academic and clinical community responding to your work? What’s the response you’re seeing when you’re talking about it now?

Noah: People are really excited about it. Everyone– My title at Harvard and some other places has been Treating Addiction with Virtual Reality. Everyone thinks I’m talking about one specific thing, that the most obvious application here is, let’s put people in situations where there are drugs and then teach them how to refuse the drugs. That’s called exposure and response prevention. That’s important but I don’t think that’s what’s actually going to prevent relapse. What people are excited about is that we’re seeing that there’s a way that virtual reality can actually change people’s emotions and provide emotion regulation to people, which is also why people are seeking [unintelligible 00:30:44].

Interviewer: [unintelligible 00:30:45] there’s underlying stuff.

Noah: Yes. It’s really interesting. Aaron Beck, my mentor’s mentor who created cognitive behavior therapy–

Interviewer: That’s the Beck Institute.

Noah: Yes. I’m reading his book on substance abuse treatment, CBT for substance abuse and it’s really interesting because he makes the point that basically, if someone’s having a craving and have the urge to use a drug, that using the drug is a behavior, an automatic behavior that they’ve learned. Not using the drug is a cognition, a thought that the person has to have and this thinking of, “Okay, I’m not going to use the drug. I’m going to reason through this. I know that I shouldn’t. There’s all these consequences.” You’re really trying to stop someone from engaging in a behavior and encouraging them to just think, just to not do the behavior.

I don’t think that that’s actually necessarily going to prevent them from using, but if they have an alternative behavior, which is picking up a virtual reality headset and putting it on, all of a sudden there’s not– you’re not pitting a negative behavior to a thought, you’re pitting a negative behavior to a positive behavior, so something alternative. That’s what Alcoholics Anonymous or Narcotics Anonymous or any kind of social support– I mean, someone’s like, “Okay, I’m not going to use my drug. I’m going to text my sponsor. I’m going to do this other behavior. I’m going to do this thing.”

Virtual reality might just be the natural extension of an alternative behavior. It’s not like you’re telling the person, “Instead of using your drug, you need to go in and put on the headset and go to a bar and pretend to refuse a drink,” you’re going to put on the headset and be in a beautiful world and explore and talk to people and get the intervention and level of care that you need from home that can treat the underlying anxiety or depression or reason that someone might be craving the drug in the first place.

Interviewer: Right, because that gets back to the escapism we were talking about earlier. They could go to a bar and escape with a drink and escape from their real life, them themselves or they could go into what you’re just describing, into a beautiful world, and that’s still escape. That seems like it’s filling the same void.

Noah: Yes. The key, because a lot of people ask, “What if everyone’s addicted to virtual reality?” Well, one thing, virtual reality can’t kill you, so if we have a virtual reality epidemic on our hands, that would be a big improvement from where we are right now.

Interviewer: [laughs]

Noah: The other thing is that people will be– They’re not just escaping, they’re going to be escaping into an environment that’s meant to treat the underlying reason why they’re escaping. That’s really important is that I’m not trying to monetize. Facebook has virtual reality and they’re going to be trying to do anything they can to keep you in their virtual environment and keep you escaping, but what we’re trying to build is a environment that’s actually treating the person’s underlying psychopathology.
Interviewer: Going beyond just the escape, but once they’re in that environment where they, as you described, where they can feel like they can open up or let their guard down a little bit more, then you can bring in some positive interaction.

Noah: It’s interesting because some of the literature on mood-altering substances to use in psychotherapy so LSD-assisted psychotherapy or MDMA-assisted psychotherapy that people read about, this is just a theory right now, but potentially, some of the mechanisms that we’re seeing are similar in that LSD and MDMA both modify the mood and help people see their own problems from a new perspective. Potentially, that’s what we’re seeing with the virtual reality as well is that it’s altering people’s mood and allowing them to see their own problems from afar and things like that.

Interviewer: What are your plans for the next step or next couple of steps in your work, in studying the application of VR in this way?

Noah: I just got a small grant to basically go out and interview different rehab centers and patients and things like that about how they would use this technology and how we could commercialize it. For me, it’s really important not to– I don’t know, I don’t want to go through the health insurance industry. It’d be great if health insurance can reimburse some of the cost of this equipment, I mean the desktop experience of VR is the same as one and a half days of inpatient rehab, and they can be sent home with a whole setup. I really want it to be accessible to people and that’s really important.

This summer, I’m going to be trying to interview people to understand, what are their needs, what would be a reasonable way to implement this? Then also try looking at the research to eventually build up to randomized controlled trial. That’s the most important thing is to have the scientific evidence. I also think that there can be a beta or a preliminary distribution of something that people can try and get feedback on. JourneyPure is very interested in helping me to build this up and all that stuff.

These two main next steps is one, to talk to people, rehab centers, and patients and see, what are the needs, how can we create something that fulfills those needs and keeps people sober? The other thing is to prove the science behind the intervention and understand the underlying theory, and conduct a randomized controlled trial. I’m really interested in doing a trial that has a bunch of– Trials have arms or, basically, different groups of people that you’re comparing the efficacy against. I think that we might need to do something with medication-assisted treatment for opioid use disorders. There’s all this talk about buprenorphine and medication-assisted treatment and that it’s like this holy grail.

It’s good but we need to compare it to other psychosocial interventions. I’d like to see some randomized controlled trial that’s treatment as usual, buprenorphine-only, virtual reality-only, and then buprenorphine and virtual reality to see, what is the most effective method of intervention? What if virtual reality is 75% as effective as buprenorphine? Then you don’t have to have people on the drug for the rest of their life. That could be a good potential alternative intervention.

Interviewer: This seems like a big calling for you. Do you see yourself spending your career in this space, in this interaction between VR and treatment?

Noah: Yes, I think so. Clinical research. I’d ideally like to have some intervention going and conduct a research off of it, and to faculty position somewhere or stay in academia and continue down this line. Increasing our knowledge of how virtual reality can be used, we’re only at the start of it. There’s amazing researchers out there, but there’s only a handful of researchers who’ve been doing virtual reality behavioral research.

As the technology proliferates and as more people adopt it and researchers realize that there’s this huge population of people and you can collect all this data and learn and improve treatment, there’s going to be a lot of potential to develop. A lot of people will spend their careers on this and step on something they want to do. I finally convinced my academic– I’ve gotten academic approval, so to speak, of pursuing virtual reality in this way, so it’s very validating.

Interviewer: As we’ve said, VR is in its infancy in a lot of ways. As you look at the bigger picture, how do you see it growing over the next few years? How do you see it expanding into other parts of our lives?

Noah: Virtual reality, once people have it in their homes, it’s going to be standard for so many different things. Education’s going to be a huge application. Once there is a home school virtual reality world that someone can go to and it’s proven to be as effective as a $50,000 a year private school, that you could have– Just as Uber fit in the taxi industry, there could be a virtual reality home school that threatens the private education industry.

Learning about mitosis and going into the cell and seeing the division and all that stuff, or going back to the civil war or whatever. You can really be in these places and learn about them and experientially develop memories of these events. That’s going to be really going to be powerful, and it’s going to be more effective than the way that we teach things now through-

Interviewer: And take it to farther places they wouldn’t have accessed.

Noah: Exactly. Education, training, healthcare, surgery, things like that but also really any training, whether you’re working at the deli counter at Walmart, which is already happening, people are giving training for that, or you’re training police on how not to shoot so quickly or you’re training prisoners on how to re-enter society and things like that, all these things are already starting to happen. It’s going to be a huge thing. Also, there’s a lot of concern that I have on– I’m getting chills right now thinking about it because we’ve had all these shootings.

I’ve run the Nashville virtual reality meetup and it’s the last Thursday of every month. Just yesterday, there were some children who they love the army, they come every month. It’s really cute because they get excited about it and ask all these questions, but they were playing this game called Superhot with a gun. You’re holding a controller, that’s the gun, and you’re ducking and you’re moving and you’re dodging and you’re learning how to hold up a gun and aim it and shoot it. It’s motor memory that’s being formed. It’s motor learning–

Interviewer: It’s like military training, basically.

Noah: Yes. I’m really worried about that because as these shootings continue to happen and as there’s this unintended training simulation about how to do shootings, how to dodge, it’s very different than just clicking a button on your Xbox controller to shoot things. I think that that’s going to make people better at murdering people, which is really scary.

Interviewer: And to normalize it, “Hey, it feels like I’ve done this before, this isn’t a big deal.”

Noah: Right. If this same kind of simulation can treat combat-related PTSD, you put someone in virtual Iraq or Afghanistan and after one or two sessions of VR therapy their PTSD is treated, it’s going to also train people, exactly military training, for civilians on how to commit these kinds of things. There’s a lot of positives of virtual reality and that’s what I’m focusing on, but I also want to warn people about the potential risks and negatives.

Also, people think Cambridge Analytica is bad with Facebook and data. Facebook with the Oculus Rift now collects all of your movement data, what you’re looking at, they can collect what you’re saying and who you’re saying it to, and they don’t even have eye tracking yet. Once they have that, they’re going to be able to infer our cognitions and what we’re thinking, basically, by where you’re looking, how long you’re looking at it, all those kinds of things. It’s going to make Cambridge Analytica look antiquated, a joke kind of thing.

The ability to manipulate and control people is going to be very, very high. I just mentioned these things not to be a downer. I’m very excited about virtual reality.

Interviewer: You look at cars, you look at the Internet, they’re huge downsides, even as they’ve become a big part of our lives.

Noah: Yes, and that’s really important for people to remember. It’s also important not to just let children use virtual reality. We don’t know what the effects are. It’s very powerful. We know that because it can treat these disorders really powerfully, which means that it could also create a lot of problems for people that parents don’t really realize. There’s a lot of exciting things, but it’s also important to remind people that getting a virtual reality headset is not necessarily this cure. Another thing I also wants to remind people is that everything I’m doing right now, and I just feel really important ethically to just hammer this, is that none of this has proven to be an effective intervention. We haven’t done a randomized controlled trial to prove it. I don’t want people out there to think that they can go out and just buy a virtual reality headset and all of a sudden have-

Interviewer: Cure themselves.

Noah: Yes, but I do think that buying virtual reality and using it could be a helpful tool for them, but it’s not proven as an intervention and there’s still– People need therapy and rehab and things like that. It’s a really-

Interviewer: It’s part of a larger picture.

Noah: Exactly. I just think that’s important because I don’t want to make it seem like I’m saying, “Oh, yes, go out and buy a headset and this will cure everything.” There’s a lot of research that needs to be done. I’m also happy to– I don’t know if you can put up a website and the link or something, but if people want to contact me, there’s a form there and I’m happy to talk to anyone about any questions that they have or things like that, I’m happy to answer any.

Interviewer: Cool.

Noah: There’s been a lot of interest in this.

Interviewer: Man, very exciting look into something that is just emerging and getting started. Thanks for taking the time to be with us, Noah.

Noah: Thanks.