Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy

Abstract

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.

Therapeutic frameworks in integration sessions in substance‐assisted psychotherapy: A systematised review

“…Virtual reality (VR) has been proposed as a potential facilitator of the psychedelic experience given its synchronistic qualities with SAPT (e.g., relaxation, reduced anxiety and the promotion of mindfulness and mystical states). While VR does not represent a psychological framework that would be intended to partner with SAPT, Sekula et al (2022) argue that VR can be used as a full‐spectrum tool built to capitalise on the innately therapeutic aspects of the psychedelic experience. In this way, VR is proposed to be used for two purposes: to modulate the dosing session environment and to revisit these settings during the integration phase of treatment.…”

Mystical experiences in virtual reality.

“…Beyond the priming of altered states of consciousness (Vaitl et al, 2005) as may be accomplished through surrealism and more explicitly “psychedelic like” stimuli, Sekula et al (2022) suggested that features of VR that are relevant to psychedelic responses and, indirectly, mystical experiences, broadly include those promoting relaxation, buffering, mindful presence, peak state augmentation, therapeutic alliance, and self-efficacy; their position also receives some empirical support in the current research that VR-P was rated higher than EC-I for contentment (serene, peaceful) as experiences of relaxation, observing (perceptive, aware) as an experience of mindful presence, excitement (exhilaration, elation) and rapture (ecstasy, bliss) as arguable forms of peak state augmentation, and pride (confident, self-assured) as an experience of self-efficacy. More, while most prior research has involved comparing subjective responses to VR with those to psychedelics, Sekula et al proposed the alternative therapeutic approach of augmenting clinical responses to psychedelics through VR during the various phases of expansion, transition, cohesion and, as may be needed, rescue; their proposal awaits research to evaluate its safety and efficacy (Sekula et al, 2022). Indeed most recent studies of response to mystical experiences produced by psychedelics include preparation and integration phases that were not included in the present study; while our results suggest that the preparation (pre-) and integration (post-) phases may not be necessary to induce mystical experiences using VR, even more intense experiences might have been possible if such phases had been included, which could also be evaluated in future research.…”

Cyberdelics in context: On the prospects and challenges of mind-manifesting technologies

“…The field's growth has also been fueled by the rising interest in VR technologies and in VR therapy in particular. Recent years have seen growing interest in the use of VR in the preparation and integration phases of psychedelic therapy, and possibly during psychedelic sessions (Aday et al, 2020;Gómez-Busto and Ortiz, 2020;Sekula et al, 2022). The two experiences have been described as overlapping, synergistic and complementary in their effects (Aday et al, 2020;Sekula et al, 2022).…”

“…Recent years have seen growing interest in the use of VR in the preparation and integration phases of psychedelic therapy, and possibly during psychedelic sessions (Aday et al, 2020;Gómez-Busto and Ortiz, 2020;Sekula et al, 2022). The two experiences have been described as overlapping, synergistic and complementary in their effects (Aday et al, 2020;Sekula et al, 2022). Strikingly, both psychedelic therapy and VR therapy are suggested as treatments for the same types of mental health problems including depression, anxiety, trauma and eating disorders (Gómez-Busto and Ortiz, 2020).…”