Adam Hutchinson: New Zealand’s VR Mental Health Platform
Adam Hutchinson, founder of oVRcome, a New Zealand-based digital health startup, speaks with Jessica Hagen and Faaizah Arshad about a mobile health application that combines self-guided VR exposure therapy and CBT for phobias and social anxiety, and the long-term implications that mobile treatments have for accessibility.
BIO
Adam is the founder of oVRcome, a digital health startup using virtual reality to make mental health treatment more accessible via the smartphone. Hutchinson previously founded CamperMate & GeoZone, a travel app and location-based advertising platform helping tourists travel New Zealand and Australia, which was acquired in 2015. He is passionate about applying innovative technologies to improve lives and experiences. oVRcome is a New Zealand-based VR company, and its platform is offered via a mobile health application combining self-guided VR exposure therapy and cognitive behavioral therapy for 12 phobias – including fear of flying, heights, dogs, needles, and spiders – and social anxiety.
The following is a transcript of the episode:
Jessica Hagen
Hello and welcome back to Psychiatry XR. I'm your host Jessica Hagen, and I'm joined by my co host Faaizah Arshad.
Faaizah Arshad
Hi Jessica.
Jessica Hagen
We're excited to welcome Adam Hutchinson to the podcast. Adam is the founder of oVRcome, a digital health startup using virtual reality to make mental health treatment more accessible via the smartphone. Hutchinson previously founded CamperMate & GeoZone, a travel app and location-based advertising platform helping tourists travel New Zealand and Australia, which was acquired in 2015. He is passionate about applying innovative technologies to improve lives and experiences. oVRcome is a New Zealand-based VR company, and its platform is offered via a mobile health application combining self-guided VR exposure therapy and cognitive behavioral therapy for 12 phobias – including fear of flying, heights, dogs, needles, and spiders – and social anxiety. Adam, thank you so much for joining us today.
Adam Hutchinson
Thanks, Jessica. Great to be on.
Jessica Hagen
Can you provide our listeners with more details on oVRcome and how it's used for psychiatric care?
Adam Hutchinson
Yeah, sure. I mean, our big goal is to make mental health treatment more accessible. And so very early on, I did a lot of research to understand, why do 80% of people that have these specific disorders not get treatment, and I quickly learned that cost is a significant factor. Stigma is a significant factor. Also location, as well as just there being a lack of trained psychologists. So first and foremost started with that issue, that problem of 80% of people with these disorders don't get treatment. And it's for those reasons. So right from the start, it was about identifying and creating a solution that would sort of fit to that and those reasons why people don't get treatment. So that's why we specifically target the smartphone. So it does mean that if someone has a fear of flying, they can download the smartphone to their device, while they're at home. We send them one of our headsets, they put the smartphone into it, and then they can start the virtual reality exposure therapy for their fear of flying. And so these environments that we have predominantly filmed, we also use some animation as well. They are environments that take someone end to end in this example of fear of flying from turning up to the carpark, you know, when they're about to take a flight. And it's sort of building that anxiety, but at the same time, it's teaching them the skills and the techniques that they need to be able to manage that anxiety. So it's sort of using virtual reality, to create these environments that they have been avoided. And it takes them through this hierarchy in a really safe and convenient way. And so really started with that problem, and then molded the solution around that.
Jessica Hagen
And you've really focused a great deal of your efforts on ensuring that the experiences are scientifically proven to be effective. Can you tell us which institutions you work with and how the clinical trials have played out and what the results of those trials have been?
Adam Hutchinson
Sure. So right from day one, we really wanted to be a startup that while we release a treatment, we want to clinically prove it. We want to give people that confidence that if they start this journey with us, that there's going to be some degree of confidence that it's going to have an effect. So very early on, we partnered with the University of Otago here in New Zealand to conduct clinical trials for every single treatment that we do. And while we've started with phobias, we're just about to do our clinical trial for social anxiety. We're building more programs around other anxiety disorders. And for every treatment that we offer, we will do a clinical trial. And again, it's just proven that what we are doing works for people so that they have that confidence to be able to start this journey and have the result that they need. So University of Otago has been pivotal to our startup, they've supported us in terms of bringing in this efficacy. And we conduct these trials with every treatment that we do. So really exciting that they've come on board, and that we've got this roadmap ahead of us.
Jessica Hagen
And that's very important, because a lot of digital health applications that are available on the market, it's difficult for a lot of them to even undergo clinical trials. So that's really different that you're really standing out in that regard and ensuring that your program is doing what it's supposed to be doing.
Adam Hutchinson
Yeah, I mean, there was a report that came out recently, and I think it was around 86% of mental health apps, you know, don't choose to do clinical trials and we really didn't want to be in that camp. We wanted to be able to give people that sense of proof and efficacy. I came up with the idea during the first lockdown in New Zealand, which was in April 2020. And at that time, New Zealand government had a pretty ringfenced approached, meaning that, you know, we weren't letting anyone in, we were sort of locked out the street of COVID. And we were, to some extent able to conduct life as per normal. And what that meant is that we were able to conduct research clinical trials within New Zealand. So we were able to move pretty fast on that and continue to do this first clinical trial, which we published around sort of two months ago now. So that meant that we were able to sort of be working on this product, but at the same time be working towards this clinical trial within New Zealand here, because we had this ability to do this research. So it's a really pivotal role in a startup.
Faaizah Arshad
And Adam, in addition to doing research and clinical trials, and also working with institutions, I'm sure it's important to also have a team of experts that are helping to create these experiences. So can you maybe talk a little bit about your advisory board and who was on there, and who are those people that are helping to create these experiences.
Adam Hutchinson
We've got around six clinical psychologists that are involved within overcome on an advisory basis. And basically, for every treatment that we offer, we take at least one clinical psychologist that specializes in that particular area. And like I say, while we started with phobias, we're moving into other areas as well. But when I was first exploring and doing the research around the mental health treatment to do with phobias, there were a couple of clinical psychologists that were identified here in New Zealand that were specialists. And so they came on very early on, and helped us develop the program for phobias. So these were people that had had people come into their clinic that used virtual reality before, you know, for a number of years. And they were really interested in what we were doing, which was essentially making this treatment way more accessible by targeting the smartphone. So Kathryn Harvey is one of those in New Zealand, we started working with Kathryn, we built out the program. And we started testing it with her also, on particular people that were coming into her clinic that had these issues. So we're able to get that really early feedback very early on. And that feedback helps shape the product. Because ultimately, we are direct-to-consumer, we are interfacing with people directly, that, you know, have feedback for us. And so we take that feedback, and right from an early stage that helps shape how we deliver this treatment. And so when we can work with an individual clinical psychologist that specializes in this area, we can take that learnings and transfer them into the smartphone app and the specific program. So having clinical psychologists is imperative to what we're doing. I mean, our team, we're very strong on development, we've had a number of successful smartphone apps. So we very much bring that development expertise. But that on its own is not enough. We needed clinical psychologists to bring that efficacy. And that's what we did. So right from day one, we've been bringing in those clinical psychologists that are experts in the field, and are also passionate about the journey that we're on.
Faaizah Arshad
And do you work with clinicians continually to hone continued effectiveness over time as well?
Adam Hutchinson
Yeah, that's right. So the arrangement that we have with the clinical psychologists that come on board is, you know, there's that initial build period where we're working with them very often to build this initial product. But then we're also getting this feedback as well. And so we're continuously working with them. And it's like any software, you're continuously iterating, especially at the start to get it to a point where it's as seamless as possible. It's a great user experience. And user experience is super important to delivering this treatment, it's like you can have the treatment. But until that's a great user experience, being experienced by someone that's gone through this issue really, really well. You're not going to have the desired results. So it's a bit of a combination, you've got to bring that clinician that clinical expertise, but also pair that with a great user experience where you're capturing a lot of data and feedback to help continuously improve the product.
Jessica Hagen
So a user does this experience on their own it sounds like, right? Are clinicians on call for a user to be able to access clinicians whenever they need?
Adam Hutchinson
Yes, so we've got two channels really. And we've focused on direct-to-consumer at the moment. And so what that means is that someone finds us generally through Google, for example, they download the app, and then they start it in their own home. And it's safe, and it's convenient, and there's no therapist involved. And we know that for a lot of people cost is a significant factor. So they won't go to a therapist, for example. They just continue with the avoidance. But as we know, avoidance can lead to more serious conditions. There is some research to back that up. And so we really wanted to start with that problem first— being able to provide an affordable treatment to people in their home that they could go through as a self-help program. And we've built in various safety mechanisms into that. So for example, we capture some data as they go through the VR to understand what level of anxiety they're feeling in that particular environment and if their anxiety gets a little bit too high, if it gets over a threshold, then we sort of just pause them there in that hierarchy in that journey. If their anxiety rating gets lower, then they can progress. So it is a self-help program, it is designed around safety. And we know that the results are incredibly effective for doing that program at home. If someone wants to reach out to a therapist, we do have some capability to provide that. It's more in the form of coaching, but is very much designed around that self-help program. We have recently developed a dashboard that allows a therapist to actually log in and access all of our content and build specific programs for their client. The difference with that product is that we remove the psycho education because we assume that the relationship between the therapist and the client, that's why they go into the therapist is to receive those skills. But we do allow that virtual reality component. So that's essentially what the therapist is building is a hierarchy of VR content that we have from our massive library. And then they distribute that to their clients. So yes, it's a self-help product for direct-to-consumer but we're moving more into assisting therapists who can then have more efficient use of their time because they can set up almost like homework for their client in between sessions. And we're really getting some great feedback from that, which of course, we're using to iterate on the product as well. So it's a bit of both.
Jessica Hagen
Have you ever experienced any complaints of risks that may have been associated with using exposure therapy without a therapist that you've then responded to?
Adam Hutchinson
Yeah, in the clinical trial, what we discovered is that, you know, there were certain levels of severity specifically with arachnophobia, where people couldn't even look at thumbnails of spiders. So for example, we allow a preview of the VR content prior to initiating it. What we learned from that is that, okay, well, if someone meets this level of severity, they do not want to be looking at images of spiders, even on the thumbnails, they don't want to be tapping on them. So we took that feedback, and we made some adjustments to the user experience. So for example, we added a fade to the thumbnail so that if there was a certain severity, they would not see any thumbnails of spiders, and so they could then start the journey. And as their journey progressed, and if their anxiety ratings increased, again, they would be held there. So they couldn't go further or deeper into that hierarchy because the anxiety data that we're getting back was sort of holding them there. And that's the safety element that comes into this is that we're not just putting people into really high anxiety provoking environments, we're actually having some control over that. And that not only keeps the individual safe from feeling too much anxiety, but it also controls their treatment. So there's some personalization there, which we use data to do. So there are some learnings that we get. But safety is a really big concern for us. And we've designed the UX around that.
Jessica Hagen
And you had mentioned that you can measure the user's anxiety, how do you measure the user's anxiety while they're in the experience?
Adam Hutchinson
Sure, so we use gaze control for a manual anxiety rating. So there's a subjective units of distress scale, zero to 100. And we are getting ratings from individuals as they progress through this environment. So we use that. We also use some physiological data, we're moving more into that which is super interesting, as a bit of a signal to identify how this user is feeling right now. We're learning what they're responding to. And then we're making some adjustments to their treatment based on that data. So right now, it's a fairly manual process, the data is flowing. But we're moving into a really exciting area that that uses other signals as well.
Faaizah Arshad
And Adam, I've had the chance to look through your website and read about the offerings. But I think one thing that our listeners might be curious to know about is, what ages can use your technology. So is this for all ages? Or can you maybe specify the distinction between who can and who maybe might not benefit from the technology?
Adam Hutchinson
Yes. So we started with adults, generally from 18 years and older. And then we started getting a lot of feedback from people that were interested for their children that were maybe struggling with a combination of things, they might have been struggling with a fear of getting the vaccine, for example, or flying. And so we had a number of inquiries. And so we started to look at children, adolescents, and we took on a clinical psychologist here, Catherine Gallagher, who specializes in children and adolescents. And we developed some age appropriate programs from the age of five, five to 19, 13 and 14 to 17. So we sort of, we customize not only the psychoeducation and we make it age appropriate, but we also tailor the virtual reality content that we have for those children as well. Now the way that we designed that program is again based off advice and insight from Catherine, but also from feedback as people go through. And so the program also involves the parent. And that's who generally starts that program first, to put them in a really good position to be able to help the child. And at that point that the adult has completed that section, then the child can actually start the program as well. And again, safety is really, really important. So we start them off really slow, we teach them a little bit about anxiety, we teach them some skills, and then they are able to start that virtual reality exposure therapy. So we started with adults, but now we've moved into all ages.
Faaizah Arshad
So that addresses the clients. But what about providers? Like how can psychiatrists test your experiences to see if it's a good fit for their practice?
Adam Hutchinson
Sure. So with therapists, we allow a free headset. So what that means is that they can come onto our website, they can sign up for the dashboard. If they have an NPI number, then they can get automated free access to the dashboard, that then gives them access to all of our content. So they can start building a program, they can actually build a program for themselves as a way to test it, we send them a free headset, they can give it a go. And at that point, they can then start building for their client as well. So let's say someone is seeing a therapist. They maybe have a fear of flying. As we know, it's really hard to access those in vivo flying experiences, because you literally have to go and sit on a plane and have that experience in order to get in real life. But what the therapist can do is actually pull from our entire library, all of these environments that we have filmed and in New Zealand came on board and supplied a plane and a crew for us in order to film some of this content. So we have really, really good content. But the therapist can pick and choose from that. They might understand that their client is having a specific issue with boarding a plane, or quite often we see if someone is seated near where the door is closing on an aircraft that that's where they really struggle. So the therapist can pull those environments from all of our content and build a custom hierarchy for their client. Their client then receives the headset, and the therapist can actually connect into that VR session in real time as well, which is a really exciting feature. So it means that their client that is struggling with that environment can actually have their therapists beam into that as well and be there alongside them in real time, while they might be 100 miles apart. So it's a really interesting application of virtual reality and smartphone technology in order to initiate these environments that someone with a fear of flying actually needs to go through in order to desensitize and overcome this fear that they've got.
Jessica Hagen
And you send out these branded headsets, right? Can somebody just use a Google Cardboard instead of having these headsets or is it specifically made to be most effective with these headsets?
Adam Hutchinson
They can use another headset. But the problem is that we've essentially tailored the headset to the phone. So there is a process that someone needs to go through in terms of scanning a code, which basically customizes the phone and the experience towards that headset, so it is possible to use another headset, just the experience is not going to be the same. It might be a little bit blurrier. They might not feel the level of immersion. And so for that reason, we want to have some control over the experience. So we know the dimensions that the phone is going to be away from their eyes, for example. And so we've tailored the entire user experience around that. So by including the headset, and to the program, it sort of allows us that control. So we know that we can deliver the most immersive experience possible to the individual, which is going to mean that they have the best result.
Jessica Hagen
And to kind of move forward to the business evolution aspect. You've developed some very valuable partnerships recently. Can you tell me about your partnership with Air New Zealand and how that came about and what you hope it accomplishes?
Adam Hutchinson
Sure, yeah, so the Air New Zealand partnership is our first channel partner relationship. We know that there are people that struggle with fear of flying, especially now that we're sort of starting to move back to some form of normality, where people are flying again. But for a period of time people haven't been flying. So all of these people have effectively been avoiding this flying but now they're really confronted with it, and I think Air New Zealand interfaced with that a bit. So they have a number of people that have indicated that they're struggling, you know. And when someone goes on to a plane, and they have a fear of flying, then that's going to take a lot of time of the cabin crew, for example, because they're having a really difficult time. I don't know if any of you have sat next to anyone that has struggled with a fear of flying but it's a really tough experience for them and the cabin crew spend a lot of time with that individual as well. So they're aware of this issue around fear of flying, and they're looking for a solution. There are a few solutions out there at the moment, but generally, they're expensive. They involve an individual psychologist coming on board a plane with them, and a lot of people just can't afford it. And so with oVRcome again, what we're doing is just making mental health treatment really, really accessible, and affordable. And so we are a really nice option for their customers. So that's a recent agreement that was signed, which was really interesting. The first of many, and it came about from a meeting with their CEO, who was amazing, saw what we were doing, saw that we were going through this clinical trial, you know, waited until we had the results from the clinical trial. And then when the results came through, it was like, Okay, well, what can we do. And so this agreement was signed, and it means that we are the sort of solution to help anyone that has indicated that they have a fear of flying. So super exciting partnership. For us. I think there's a lot of scope internationally, to partner with other airlines as well. And there's a few conversations happening there, but also in other industries, as well, where there is an issue to deliver this treatment. And that's where we're focusing at the moment. So we've got a number of opportunities that are really exciting at the moment. Can't talk about them just yet. But we'll let you know as soon as they're underway, but super exciting time for us at the moment.
Faaizah Arshad
And as someone working really hard to make an impact in medical XR, where do you hope medical XR is going to be in 20 years? And what obstacles do you think we need to address to get there?
Adam Hutchinson
Yeah, I think our big goal is around reducing the hardware requirements in order to access that treatment. This is our big focus. And that's specifically why we target the smartphone. So I guess where I would like to see this going is that we can sort of broaden the reach, we can increase the number of people that can access this treatment that don't require a lot of hardware, a lot of costs in order to access it. Really love the clinical trial, the efficacy of VR at the moment in terms of we're moving into an area where XR is becoming clinically proven. We are able to show that there are results, real results happening in the real world for people. So people that were previously struggling with a particular issue, can now have a really valid solution that's been clinically proven, that can be accessed without this hardware and get the results that we need. So that's where I sort of see it going is that reduction of the reliance of hardware in order to access this clinically proven treatment.
Faaizah Arshad
Keeping that in mind, how do you think oVRcome will pivot or adapt with the changes in hardware options that arise over time?
Adam Hutchinson
Yeah, I think it's just the case of keeping an ear to the ground, looking at what is the hardware that people have at the moment? How good can we make that experience from a reduction in hardware, and again, just coming back to the fact that we specifically target the smartphone for that reason, so that we are not requiring that this individual needs to have an expensive headset that they may not be able to afford. So for us, it's just about, again, keeping that ear to the ground understanding what is the hardware that people have? Will we still be using devices? Is that moving into a different area? And where that will be is where oVRcome will focus its energy. So just keeping, you know, keeping focused on the fact that some existing hardware is expensive. And a lot of people have that we really want to target what people have already and sort of adapt the treatment to work within what they already have.
Jessica Hagen
Adam, thank you so much for your time and your insight today. Is there anything else you'd like to share with our listeners?
Adam Hutchinson
No, just thank you very much for for giving oVRcome this exposure. It's really good. We are the startup on the other side of the world. We're doing really, really great work. That's super exciting. We've got a really passionate team. So being able to engage with you guys has been fantastic. We're on a really exciting mission. Our mission is to make mental health treatment more accessible using virtual reality and smartphone technology. And the results that we're seeing at the moment are super exciting. So again, thank you very much for, for being able to chat to you. This is a really exciting time in our journey. So, you know, it's just a case of what's the space over the next few years because we're all super passionate about what we're doing. So thank you.
Faaizah Arshad
Thank you, Adam.
Jessica Hagen
Well, thank you for your time. We really appreciate it. That's it for this episode of Psychiatry XR we hope you gained a new perspective on using extended reality and health care and thanks for listening. This episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology and mental health. For more information about Psychiatry XR, visit our website at psychiatryxr.com. Be sure to subscribe to the podcast and tune in again next month to hear from another guest about XR use in psychiatric care. You can join us monthly on Apple Podcast, Twitter, Spotify or wherever you get your podcast. Psychiatry XR was produced by Dr. Kim Bullock, Faaizah Arshad and myself Jessica Hagen. Please note this podcast is distinct from Dr. Bullock's clinical teaching and research roles at Stanford University. The information provided is not medical advice and should not be considered or taken as a replacement for medical advice. This episode was edited by David Bell and music and audio was produced by Austin Hagen. See you next time!