In RECOVRY, the first demonstration product is being realized and tested as part of preventive therapeutic care for AUD patients. It clarifies whether the use of Virtual-Humans has added value and whether effectiveness and implementation differ between VR techniques (360o and CG) and between VR and AR. This allows healthcare institutions to make a well-considered choice of how to use VR & AR, with the aim of allowing the patient to develop competences and to overcome relapse situations.
Challenge It is essential to develop new forms of care, with an emphasis on Prevention, Relocation and Replacement (Health & Care Knowledge and Innovation Agenda 2020-2030). This strategy must contribute to the objective that all Dutch people live longer in good health. Mainly by removing an unhealthy lifestyle and living environment (prevention) and relocating care (prevention) to one's own living environment. New key technologies can help, but it is more important to implement them effectively and save costs by "replacing" existing methods with more personalized care.
Idea Recovry explicitly responds to these objectives and is aimed at preventing an unhealthy lifestyle due to (alcohol) addiction. The aim is to allow people with an alcohol consumption disorder (AUD) to integrate better and independently in society (“more people, less patients”). This by providing them with a Virtual Reality (VR) and Augmented Reality (AR) self-prevention tool.
Relevance Dealing with AUD is a huge challenge. In the US alone, more than 15 million adults have an AUD. Worldwide, more than 5% of all illnesses and injuries can be attributed to alcohol consumption (WHO, 2012). In the Netherlands, 30,000 people request AUD assistance every year from an addiction treatment facility (Wisselink et al., 2015). Treatment remains a challenge; Between 47-75% of AUD patients relapses in the first year after clinical detoxification (Snelleman et al., 2018). Newly accessible key technologies, such as VR and AR, provide adjuvant treatment options for AUD patients. VR and AR create patient contexts that are difficult or expensive to simulate in clinics (Maples-Keller et al., 2017; van Gisbergen, 2016), in which patients can explore challenging situations in a safe environment (Riva & Wiederhold, 2002).
Virtual Reality In Cue-Exposure-Therapy (CET), clients are exposed to triggers through objects, people and environments that arouse craving. Virtual Reality Exposure therapy (VRET) is used to experience these triggers in a realistic, safe, and personalized way. Virtual Reality is a mediated perception of being present and immersed in an environment (Steuer, 1992). This mediated environment can be animated (Computer Graphic) or recorded using 360o cameras. A combination of sensory, interaction, control and location dimensions are expected to increase a sense of ‘being in that environment’ (Van Gisbergen, 2016). In this way, coping skills are trained to counteract alcohol cravings. The effectiveness of VRET has been (clinically) proven. VR has been used successfully in the treatment of PTSD, phobias, anxiety, and alcohol addiction (Bordnick et al., 2008; Hone-Blanchet, et al. 2014; Rutenfrans et al., 2017; Ryan, et al., 2010; Son et al. al., 2015), but has not yet been developed and sufficiently tested as an adjuvant in the clinical post-detoxification phase of an AUD therapy (Bordnick et al., 2008; Hone-Blanchet, et al. 2014; Ryan, et al. ., 2010; Zoon et al., 2015). In addition, these treatment methods have been tested for effect, but not for effectiveness around different VR technologies (Ghita & Gutierrez-Maldonado, 2018). As such, VR seems to be a promising medium for treatment of addiction dependency compared to other media. VRET may turn clients from audiences to witnesses, and even from witnesses into active participants (Aronson-Rath et al., 2016; Van Gisbergen, 2016). However, as media budgets do not increase with the same speed as the rise of complementary media, the right media choice has become more important as well as more difficult. In addition, new technologies provide an additional dilemma: should we use Virtual or Augmented Reality?
Augmented Reality The rise of AR technologies raises the desire to explore the possibilities of Augmented-Reality-Exposure-Therapy (ARET). ARET enjoys the same benefits as VRET (such as a realistic safe experience). But because AR integrates virtual components into the real environment, with the body visible, it presumably evokes a different type of experience. This may increase the ecological validity of CET in treatment. In addition, ARET is cheaper to develop (fewer virtual elements) and clients/clinics have easier access to AR (via smartphone/tablet). In addition, new AR glasses are being developed, which solve disadvantages such as a smartphone screen that is too small. Despite the demand from practitioners, ARET has never been developed and researched around addiction. In this project, the first ARET prototype is developed around AUD in the treatment of alcohol addiction. The prototype is being developed based on Volumetric-Captured-Digital-Humans and made accessible for AR glasses, tablets and smartphones. The AR prototype will be based on the VR RECOVRY prototype. A prototype test among (ex)AUD clients will provide insight into needs and points for improvement from patient and care provider and into the effect of ARET compared to VRET.
Questions The VR world, which consists of a digitally created (CG) or a 360o recorded world, can represent an existing or fantasy world, which gives people the feeling of being really there (“Presence”). However, it is unclear how much realism should be added inside these Virtual and Augmented Reality worlds to stimulate 'real' behavior, and in this specific case, create experiences that stimulate feelings of craving. Within the professorship we study the effect of different levels of realism in VR. Within the Recovry project we specifically aim to compare computer generated VR worlds with 360 recorded VR worlds. Both seem to have advantages and disadvantages. It is unclear whether users (clients) will experience these types of worlds in a different matter and, as such, whether they have different effects.
Although a VR treatment can realize a powerful treatment, many organizations have doubts because of implementation and choice stress. Mainly in the field of the technology to be used (360o VR recordings or Computer Generated (CG) VR) and whether to use "Virtual-Humans". Patients report the added value of "Virtual-Humans", but this is costly, requires more of systems, is complicated and can even break the sense of "presence". A virtual human can give a treatment more effect but can also make it less effective. In RECOVRY we not only test the added value of virtual humans within VRET, but also examine the effects of different levels of realism within virtual humans being used. We compare low level avatars (relatively easy to create and as such a wide variety of avatars and circumstances can be created) with high realism avatars created through volumetric capturing (VOLCAP), which may enhance experience (realism) and as such craving.
Research Testing has been and will be conducted using a series of longitudinal qualitative experiments during medical treatment therapy sessions. Within the therapy sessions, clients will be using the newly developed Virtual Reality therapy trainer. In the news section you will be able to find more information on the studies that have, and will be conducted, as part of Recovry. RECOVRY is open to start an international consortium to study the effects in the long term (especially around preventing relapse).
A research to the worlds that need to be created in order to stimulate and reduce craving A pilot study to test the concept and receive recommendations on how to improve A pilot study towards the amount of personalization needed in the worlds Experiment testing Recovry on experience, craving, self-efficacy, negative effects, intention to use A pilot research to the effect of adding digital humans to Recovry
Concept VRET: for the first time in the world an avatar is used in a 360 VRET environment to help cope AUD.