Navigating the Medical Metaverse: Using Objective Measures to Stay on Course

Cyberpsychology, Behavior, and Social NetworkingAhead of Print Free AccessNavigating the Medical Metaverse: Using Objective Measures to Stay on CourseBrenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:21 Dec 2023https://doi.org/10.1089/cyber.2023.29304.editorialAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Sasha is terrified of flying. She didn't always feel this way, but since an especially turbulent descent on her way to a wintertime business meeting, she's been unable to set foot on a plane. In fact, her intense anxiety forced her to rent a car just to get home from that conference. Sasha hates that she is limited in her career and personal life because she can no longer travel by plane, and although she refuses the concept of real-world exposure therapy, she reads about a virtual reality (VR) treatment clinic two states over and decides to give it a try.After driving 11 hours to the clinic, she completes several in-person sessions working with a therapist to build her relaxation skills and become comfortable navigating a neutral virtual environment wearing a VR headset and physiological monitors. After this initial set of sessions, Sasha has acclimated to the technology and can return home to continue teleVR therapy with just a smartwatch and headset (over HIPAA-compliant Zoom). From the comfort of her couch, Sasha meets up with her therapist's avatar to stroll through a virtual airport in the metaverse. Because her therapist can see both the environment that Sasha is exploring and the physiological feedback from her watch, the therapist is able to coach Sasha to use her new skills to lower her heart rate and calm her breathing, allowing her to conquer increasingly challenging scenarios.Once Sasha has worked with her therapist to build self-confidence and self-efficacy on a virtual flight in the metaverse, boarding a flight in the physical world feels like a much more achievable goal. What's more, Sasha can seamlessly continue to use the same smartwatch to monitor her anxiety in the real world, employing her skills to slow her heart rate and calm her breathing as a plane whisks her to her overdue dream vacation to Europe.TaxiingFor those of us who pioneered VR therapy three decades ago, the ability to incorporate in-person VR, teleVR, and the metaverse to allow patients to access effective VR treatment wherever they are located was a distant dream. This tribrid VR therapy1 modality is only possible now because technology has flown so far, so fast.In the 1990s, by monitoring and replicating objective physiological findings during exposure, researchers were able to demonstrate that the emotions experienced in VR can be as authentic as those in the real world.2 For example, I first noted the advantages of physiological monitoring and biofeedback during early VR treatment sessions in 1996.3 And in the first issue of this journal 2 years later, we published a paper examining the early success of the incorporation of objective metrics from physiological monitoring when using VR as a psychotherapeutic tool.4At the time, it was evident that certain cumbersome technologies (e.g., heavy headsets; sticky, wired sensors; and image lag) could cause discomfort, sometimes limiting session duration or reducing the sense of immersion required for effective treatment. In addition, the expense and size of some VR and monitoring equipment limited accessibility to what was clearly becoming a valuable, effective form of treatment.TakeoffDespite these limitations, therapists and patients alike sang the praises of VR therapy. Research accumulated, and popularity increased. VR therapists liked the fact that, unlike traditional visualization exercises that occur inside the patient's mind, with VR they were able to see exactly what the patient was seeing in real time and then match that input with the patient's physiological responses, generating insight into what was triggering emotional responses and how effectively the patient was engaging with the stimulus provided.Moreover, physiological monitoring enabled therapists to ensure that patients did not become overwhelmed or re-traumatized during exposure therapy. These measures helped providers develop personalized protocols that progressed at each patient's pace, creating a safe space to process complex emotions.Objective metrics also become especially useful during treatment sessions with patients who—due to factors such as trauma or neurodiversity—struggled to identify or express their emotions accurately. In addition, allowing therapists to access objective data on measures such as skin conductance and heart rate could improve treatment efficacy by giving the clinician insight into a patient's emotions during a session without having to interrupt the therapeutic flow.In FlightNow technology has evolved to include smaller, more comfortable sensors and feedback devices, allowing clinicians to both provide stimulus and collect physiological data from their patients in a less invasive way. Contemporary monitoring devices are smaller, less invasive, more accessible, and more connected than ever before.Metaverse wearables, some as comfortable and unobtrusive as a common wristwatch, can collect heart rate, skin conductance, respiration, and other biometric data and give real-time feedback about an individual's physiological reactions. Beyond that, while most traditional VR and extended reality systems provided only visual and auditory input, wearable devices worn on the human body can not only monitor dynamic information, including gestures, eye movements, and the posture of the human body, but also provide seamless and natural sensing, including tactile-perception or haptic feedback.5Because hands and fingers provide a highly developed sense of touch and allow for the perception and interpretation of textures, shapes, and temperatures, hand-worn haptic devices in particular could allow for particularly sophisticated interaction and feedback in the metaverse.5 A thin electronic sticker made of a pressure-sensitive material is available for detecting body motions, and wearable sensors and cameras can also be used to analyze gait for diagnosis and rehabilitation purposes.Neurologists have also found that eye movements can reveal information about our thought processes. So, glasses and contact lenses can act as effective wearable tools.6 Eye tracking can assist therapists in understanding where patients are directing their attention and focus, helping them to identify triggers or areas that perhaps need more work, again enhancing and individualizing therapy. Smart glasses even have the potential to detect microexpressions that are difficult to perceive with the naked eye, collecting information that can augment a therapist's understanding of their patient's emotional state and responses to specific stimuli.Other potential opportunities to incorporate physiological data include sensors that perform voice analysis to look for changes in speech patterns as indicators of emotional states, and sleep monitoring to determine whether poor sleep is contributing to a patient's emotional stress or lack of resilience.Finally, incorporating environmental sensors during treatment sessions to record conditions such as lighting, temperature, and ambient noise could assist the therapist in building an ideal therapeutic environment for each individual patient.The LandingAs usual, advancement doesn't come without a bit of turbulence. While the metaverse offers a more interactive and participatory digital world, it is also a world in which users are vulnerable to surveillance, perhaps in ways they don't yet understand. Because the metaverse promises more personalized, comfortable, and effective treatment options, it is important to prevent this intimate connection from lulling patients into a vulnerable position.Physiological data can contain much more personal information than a user generally realizes. Eye-tracking data may reveal information about a user's “biometric identity, gender, age, ethnicity, body weight, personality traits, drug consumption habits, emotional state, skills and abilities, fears, interests, and sexual preferences.”7 Some eye-tracking measures could even be used to diagnose specific physical and mental health conditions.Companies are counting on the idea that users will hand over such personal information without hesitation. Meta, for example, has already patented technology to build both eye tracking and facial expression monitoring into their optical equipment.6 And while lawmakers in the European Union are taking steps to protect users with their Digital Markets Act and Digital Services Act,6 there is not yet any infrastructure to follow through on enforcement.In light of this, patient education is key. Lawmakers, mental health professionals, researchers, and technology experts will need to band together with patients to ensure that therapeutic interventions in the metaverse are performed responsibly and ethically, with attention to data privacy, security, and confidentiality, forming a sort of “air traffic control” for the therapeutic metaverse. If we want to use technology to humanize healthcare we need to remember to treat patients like the humans that they are, ensuring them a gentle and safe landing in any destination.References1. Fourtané , S. The metaverse: higher education moving to a tribrid model. November 30, 2022. https://www.fierceeducation.com/technology/metaverse-higher-education-moving-tribrid-model (accessed Nov. 30, 2023). Google Scholar2. Wiederhold BK. If technology is neutral, why aren't we? Emotions in the metaverse. Cyberpsychology, Behavior, & Social Networking 2023; 26:225–226. Link, Google Scholar3. Wiederhold MD, Wiederhold BK. From virtual worlds to the therapist's office. IEEE Engineering in Medicine & Biology Magazine 1996; 15:44–46. Crossref, Google Scholar4. Wiederhold BK, Wiederhold MD. A review of virtual reality as a psychotherapeutic tool. CyberPsychology & Behavior 1998; 1:45–52. Link, Google Scholar5. Kim K, Yang H, Lee J, et al. Metaverse wearables for immersive digital healthcare: a review. Advanced Science 2023; 10:2303234. Crossref, Google Scholar6. Wheeler T. If the metaverse is left unregulated, companies will track your gaze and emotions. Time.com. June 20, 2022. https://time.com/6188956/metaverse-is-left-unregulated-companies-will-track-gaze-emotions/ (accessed Nov. 29, 2023). Google Scholar7. Kröger JL, Lutz OHM, Müller F. (2020) What does your gaze reveal about you? On the privacy implications of eye tracking. In Friedewald MÖnen MLievens EKrenn SFricker S, eds. Privacy and identity management. Data for better living: AI and privacy. Privacy and identity 2019. IFIP advances in information and communication technology, vol. 576. Cham: Springer. Crossref, Google ScholarFiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2024, Mary Ann Liebert, Inc., publishersTo cite this article:Brenda K. Wiederhold.Navigating the Medical Metaverse: Using Objective Measures to Stay on Course.Cyberpsychology, Behavior, and Social Networking.ahead of printhttp://doi.org/10.1089/cyber.2023.29304.editorialOnline Ahead of Print:December 21, 2023PDF download