Emilio Goldenhersch: VR Mindfulness Exposure Therapy for Smoking, Vaping, and Stress
Kim Bullock, Jessica Hagen, and Faaizah Arshad speak with Emilio Goldenhersch, CEO & Co-founder of MindCo Health, on XR technology for smoking cessation and mindfulness in teenagers, and on ways that clinicians can adopt MindCo's offerings.
BIO
Emilio Goldenhersch is CEO & Co-founder of MindCo Health, TEDx speaker, organizational psychologist, researcher and entrepreneur with training in mind-body medicine through a systemic and ecological epistemology. His experience is aimed at developing long-term behavior changes through the combination of new technologies in the fields of health, education and organizations. He is currently developing digital therapies using virtual reality, mindfulness, and human support, bringing accessibility to health through innovative and evidence-based methodologies.
The following is a transcript of the episode:
Kim Bullock
Welcome back to Psychiatry XR, where we aim to inspire worldwide conversations around the use of extended reality in psychiatric care. I'm your host for this episode Kim Bullock, and I'm joined by my co host, Faaizah Arshad, and Jessica Hagen. We are so happy to have Emilio Goldenhersch. Emilo is a CEO & Co-founder of MindCo Health, TEDx speaker, organizational psychologist, researcher and entrepreneur with training in mind-body medicine through a systemic and ecological epistemology. His experience is aimed at developing long-term behavior changes through the combination of new technologies in the fields of health, education and organizations. He is currently developing digital therapies using virtual reality, mindfulness, and human support, bringing accessibility to health through innovative and evidence-based methodologies. Welcome Emilio you really represent a highly creative academic and entrepreneur in the XR behavioral space and your experience as a psychologist bringing an idea to market is so valuable. We've been dialoguing a lot for many years now, and mostly with your product targeting nicotine use disorder. And I thank you so much for agreeing to come on the podcast.
Emilio Goldenhersch
Thank you so much Kim, Jessica, and Faaizah for the invitation and very glad to be here. I'm thrilled to have a beautiful conversation.
Kim Bullock
Great. I was wondering if maybe we could just kind of begin with how your career ended up in the XR and mental and behavioral health space?
Emilio Goldenhersch
Absolutely. I would say that it was a thing of faith. And also of luck at the same time. I always liked technology. I really studied also movies and TV for a while. And I always love to write— screenwriting and the like. But then I lost my father to mental health and addictions. And that turned my life upside down. And that made me get into psychology. So for the past 15 years, I kind of dedicated myself to help others realize the self awareness or power or how do you like to say, and a couple of years ago, I met with my two co-founders from kindergarten, Cristian and Nicolas. Each one of them was also working in the field of either medical devices or virtual reality. We all got together. And we decided to jump into this industry, which is mental health and virtual reality, to create accessible self empowerment tools for people so they can actually have them at their house, directly access either through their phone or through a device and start working on changing on themselves. Myself, I really love as I was telling you to write so I pour a lot of these scripts that you hear or you see, or you experience in the virtual worlds. And that's something that really kind of completes me in a way.
Kim Bullock
Yeah. Oh, wow. Yeah. Takes all your experiences together. And it sounds like you just kind of followed, what really, you're curious and interested about, but also that you turn great suffering into something. Yeah, can be so powerful. Yeah. And I didn't know that about you about your father. I too my father is still alive and has substance use disorder ended up with Korsakoff syndrome and amnestic disorder at a very young age because of it.
Emilio Goldenhersch
So yeah, in a way, I think that we all suffer a lot in the past three years due to COVID. But that's just a reminder. It accelerated the way we understood the need for mental health support and care. And I think that before that it always existed, but right now it has expanded so much that there is like a huge, huge global need at every part of the world. And virtual reality is one of those tools that has been born to get access to people that are not really close to either health insurance or anything like that. So lots of things to work on.
Kim Bullock
Yeah, and you were such a like an early adopter. Your prototype was already ready to pivot into the virtual world for a pandemic. It seemed like accidentally, but you were kind of so forward thinking I was so impressed that you had your prototype, so early on. I think we met in 2016. And you already had it all packaged together and ready to demo and ready to disseminate.
Emilio Goldenhersch
I think we were very early for the market. And I know that COVID Again, was a very difficult thing, but for the good and for the bad, it brought us acceptability and adoption to a different level. Today, all people know what telemedicine is. All people know that they can access through some digital tools through technology. And virtual reality has been just growing, growing, growing and expanding. And now with all these Meta and new devices and upcoming present future, as I like to say, this is the time, right, like the market for VR, for mobile health, for wellness, for mental health has never been with such a demand. And we all know that, for example, depression is going to be the first cause of incidents, creating medical claims at the employer level, and the insurance. So by 2030, it's projected. So we all know that there is a huge need. And when we started the company, we were early. But we took that advantage to actually run clinical trials to understand early adopters to understand how these can be used at all levels of society, not just, you know, the ones that are in clinical settings with a super nice device.
Kim Bullock
Yeah, so we have a lot of listeners, and including myself, who have a lot of ideas, kind of academic ideas. And you've been one of the few really successful academics that's been able to translate your ideas and become an entrepreneur as well. How would you suggest listeners who might want to take some idea they have in VR or XR to market? Like, are there plans? Or do use a certain strategy in thinking this through? Or where does one even start?
Emilio Goldenhersch
Well, it's a challenge for sure, there is no one easy ABC how to do it. Because in a way, startup, the world with virtual reality is different. Because the market is adopting the technology. So you have to be very focused very, very evidence-based as well, a lot of things to take care of before you launch something to the market. Because one of the comparisons or things that they always think is that we all are used to see a lot of violence in TV, you know, you access Netflix, and you go and you have these blood, blood, blood pictures. But then when you have to work on mental health with some exposure therapy, for example, or if you're working as a professional with VR with some specific, immersive situations, it’s like there is a different care there that we have to because we know that we can trigger the emotional aspects, that if you don't have the correct context to support that, not everyone is ready for that, right, which is not the same that just watching a picture. And movie. It may be similar, it may look like it's similar, but we are addressing the mind and the emotional self. So it's a very different thing. So for those that want to start some kind of venture with VR, XR, I would say that if you can create a prototype, that's where you can start. Just start with a product that you believe it will have a resonation with the patient or with the client or with the person that is in need. And just go and work it out with that. Just put it there in front of those people, so they can actually give you some feedback on that. But most importantly, once you know that there is some kind of need that you're solving with that, one of the biggest challenges is how to go to market. And it's not easy. It's not easy, because again, we have a lot of barriers that are present in the VR industry— costs is one, like, education is another one. I have been working with people all over the US and Latin America and Europe and nine out of 10 people never use VR, or even more. So that's a very difficult thing. You have to really be paying attention to the educational side of how to use the new technology. And then you have to consider if you want to provide a kind of self manage, or you want to have somebody to guide you through it. So there are a lot of aspects around the experience that you want to provide not just the VR experience, but the experience of adopting a new technology that has to be taken into account. And then the client are the one who is going to be paying for these. That's another history. So there are a couple of levels here to address. But I would start from having a working prototype. And having understood what is the best experience for the end user to actually access that. Once you've got that, then you just turn around and see who would be able to distribute that. So I would go through that type.
Kim Bullock
Great advice. All right. I'll open it up to our other co hosts to ask some questions.
Jessica Hagen
Thank you, Kim. Emilio, I want to go specifically into your technology with MindCo. MindCo is a mobile platform that utilizes Google Cardboard, correct? And it's really focused on interventions for outpatient solutions that helps treat behavioral health issues. What type of research has been performed on your offering and where has it been performed, and what has it shown?
Emilio Goldenhersch
Yeah, perfect. So we have been evolving. Kim’s mentioned at the beginning, we started out with one digital intervention for smoking cessation. Today, we extended for stress management as well. And next year, we're going to continue extending for two more verticals. So we are creating a platform for wellness and mental health to be distributed as easily as possible with mobile access. Now, we have run what I believe it's an I'm sure it's the first virutal reality, smoking cessation program study at-home with an N of 120 people, we run this in Argentina, with just urban population across the country—people that weren't educated or weren't selected by any kind of patients, so it was like literally population management style. And we publish that paper with researchers from Johns Hopkins University, from Argentina, from mindfulness institutes, and so on. In the Journal of Medical and internal research, we found to be 33% efficacy, compared to the Ministry of Health booklet, for example, that they distribute, which usually 33% for smoking cessation, I would be three better outcomes than the standard of care for nicotine patches, or just kind of CBT counseling by phone. So we published that paper that was done on 2020. And since then, we have, well, today we're running two clinical trials with Stanford. One is with the Research Prevention Center, the tobacco team, led by Judith Prochaska. The other one is with the pediatric department for vaping. prevention and cessation for teenagers, we're running that under Minecraft. So that is the first time Minecraft has been used for good in a sense for teenagers, and both of them have IRB approval, it's going to be published. We also have other ongoing trials with the UC Denver Colorado and expect to have two more with University of Miami and the City University of New York as well, for college students, for urban Latinx population, for cancer patients, for caregivers, different segments of the population, getting into the same kind of modality of training.
Jessica Hagen
That's really interesting. Can you tell me a little bit more about how you're using Minecraft in the research?
Emilio Goldenhersch
Yes, we are providing a platform for single players to get education through a game. So teenager will access. We also are able to verify their age, location, and gender so we can identify that they are themselves. And they go through the game getting into you know, some challenges, and they have to complete some tasks. And according to that they move forward and get more information and more information. And then we kind of asked, repose, what's going on. This is the first step of a multi step study as well and launching a program that can address also one of the huge epidemics that there is in this country today, which is mental health for teenagers and adults.
Kim Bullock
Wow. Yes, I love that you're really focusing on gathering the evidence before making claims, which is kind of unique for a lot of companies. How do you work with clinicians? Do you sponsor as an early startup? I would imagine it's hard to do any sponsored research and pay for the research? Do you just get clinicians excited about it and applying for their own grants? Are they just kind of doing it in their free time? Or? How are the studies funded?
Emilio Goldenhersch
Yeah, we basically get together with the labs that are literally interested. The thing is that, Kim, usually when you have a virtual reality intervention per say first, I would like to make the difference between having a virtual reality experience to have an virtual reality intervention. It's a completely different thing, right? We like having a cool time in VR for 10 minutes— it's an experience could help many, many, many people. But it's not an intervention that is a behavioral health programs built to create a long lasting change. So there is a huge difference about that. So when we actually provide an accessible and affordable for the patient tool that can be used as outpatient service or population management, with evidence base and data already, most people get excited. And we have our team that can also write grants, we call build the grant we apply for it, sometimes it’s an internal grant from the university, sometimes we are self sponsored. It depends on the aim that we have. And I'm very open to you know if after this podcast if you reach out to the audience that actually also want to run different studies. I'm very open to that. Just reach out to me later.
Faaizah Arshad
Yeah, and Emilio, I think something that's really interesting to me about your products are that you're targeting the teenager population. And I think, you know, vaping, and smoking and things like that are becoming increasingly common in adolescents. I'm curious to know if there are any risks that come with using what you've put together. Have you seen any downsides to it that you know, especially because this population is maybe more sensitive. The fact that you're using Minecraft, which is a video game? I'm just curious, in general, like, it seems like there's a lot of variables that are coming into play. And again, this is the adolescent population versus adults. Just curious if you've seen any risks or downsides.
Emilio Goldenhersch
Yeah, we didn't see any kind of downside right now. Because also, this is initial stages of what we are working on. But at the same time, there are a couple of risks that are associated with creating games, to change behaviors, right. Like we all know, there is a huge technology addiction in the population, that is adolescents and teenagers. So there are pros and cons for all these gaming related programs that we are creating, we have to be very careful about it, we have to be very aware of what we are creating the length of it and the depth of it, and how we can then always get to the end of the line to a human being. And that is something that we always take into consideration again, right now, these initial stages. So it's under a clinical trial, it's with a specific access, and it's not for everyone right now. So once we move forward with it, we'll have more information about it. But we have seen already roadblocks, when an FDA are clearly the company Akili with problems they partnered, they have an FDA approved program for teenagers. So we know that there is a way to get there. And we're also figuring out why we'll do it. Because again, this is an untapped problem, and untapped vehicle yet to be used for this. So we're pioneering as we were six years ago with VR and mental health intervention, I think we're doing the same here. And I have more to add probably next year.
Faaizah Arshad
And you're using the four dimension approach. So you have a physical kit, and then you have a mobile app, virtual training and a human coach. Have you seen any problems with adherence to using this entire approach? And maybe can you elaborate on why you've used that framework?
Emilio Goldenhersch
Yeah, of course, I’ll start with why we use that framework, and then I'll go into the numbers. One of the things that we have been working on, and I think, Kim, we spoke about this a couple of times as well, is that the theoretical framework that has been, you know, used over the past 50 years, it's different from the available technology that we can also match today. So for example, CBT. CBT, is amazing, but it's not enough, right? If CBT would be enough, we would have not this problem, right? So different approaches are very unique in the way they work. We base our theoretical approaches in science called cognitive ecology, which is the way in which we relate with the environment, an organism relates with the environment through the embodiment of their physical being embedded in the environment. And right now, we're working also on writing a piece on Science about that, because it's a very distinct way of thinking, you know, When you think about one problem, as in one solution for that problem, it’s not the same, that if you think about a problem being a network of problems, so you need a network of solutions. And when we shift their mindset from individual elemental properties for an individual problem to a network of elements, and a network of problems, that's where we are shifting our lives as well. So we are creating these from a different mindset, which is again, based on cognitive ecology. And that's why we create these different layers of engagement because some people don't like to, you know, journal in an app, and it's not natural, right, the natural thing is for us to write. So, I may be lacking that kind of information of when somebody writes something on a journal, but I cannot have it all. The idea is to give the power back to the patient not to continue, you know, relying on me or relying on our programs or just after a while after two, three years. You know, that's why we also have a platform of many, many, many, many behaviors. Because if you have an addiction on alcohol, then you're going to work on it. And then probably you're gonna start compensating differently because you still need to feel that kind of void that you have been working on with the alcohol. But then, if you are needing sleep, or if your needing smoking or if you're needing some mental health, then you can jump over from one program to the other one and continue working on yourself. This is also a truth, right? The only work that we do forever is on ourselves.
Jessica Hagen
So you had mentioned that MindCo has been around for about six years, correct?
Emilio Goldenhersch
Yes.
Jessica Hagen
How has MindCo’s offerings changed as it has evolved? And what has sparked those changes?
Emilio Goldenhersch
Well, we started with a prototype for smoking cessation, we then iterated it, a couple of times, we run clinical trials with it, then we learn a lot. Then we iterated again. And then we started working with companies, our customers, our our employers, that distribute these through the Employee Benefits departments. And that made us kind of understand better different kinds of needs, once we understood what the end user needed. And then we changed after COVID— realized that there was a huge need for mental health, so we expanded our focus to non communicable diseases, which are the biggest drivers for health related costs for insurance companies, for example. So right now, we are working on the underlying behaviors causing all non communicable diseases. And that's how we are kind of shaping our programs and our focus on what's happening in the market and the needs as well. Because we know today, there is the biggest, biggest need for mental health ever in the world. So companies like ours are able to distribute it globally. Today, we operate in 14 different countries.
Jessica Hagen
And aside from the method of delivery, how does your program differ from other addiction treatments that are on the market? And how is it effective in terms of lessening cravings and improving motivation to actually make a change
Emilio Goldenhersch
I will get back to the cognitive ecology concept. When we think of the standalone interventions, you know, chatbots for stress management anxiety, when you think about wellness coaches, when you think about meditation apps, those are amazing, they really work, and it's really good. But, again, getting back into the topic of this podcast, we work with VR, and VR is the perfect empathy machine. There is no other way to create context based learning without VR, there is none. If you're a psychiatrist, and you have somebody that is afraid of flight, you can, you know, work it a lot in the office, but then you have to get that person to the flight with you. VR gets that trouble out of the site, and allows you to get that person into contextual situations that you can train them there. So when we differentiate from other companies working on addictions, it’s because we offer social training context, this is kind of, we call it biopsychosocial training, because we approach different aspects of the same problem from different dimensions of engagement. And you know, cravings are going to be always there, you cannot eliminate them, cravings exist and will continue to exist. And that's how our physiology as human beings is made. So how we, you know, keep tabs of the cravings, keep them on the awareness side of things, and we learn to choose. That's what VR is for, you know, you also science and Kim here, you can work it out with me as well, but there has studies showing that imagery, like a picture, or a 2D video, or a VR context, is going to give you more level of presence by being in the situation. So VR is literally a technology made for that. And that's why we are different, and all other companies working in VR, they cannot be again, scalable as we are, they work on a different level of axes. And that's why I always like to say, I don't know how to surf. Right, but I would love to surf. So I see on the ocean people surfing, you know, very nice, amazing. So I would love to be there. So maybe I get you know, these smaller surfboard and I go and just be in the ocean. So most people, they don't have access to VR. They cannot surf in VR, right? But most people have a phone. So why don't we get them closer to the total, you know, using the phone leveraging the phone and why we have to wait until everybody has access five more years and the like why not do it now, that they need this now?
Faaizah Arshad
I really liked that message about how the need is now. I just want to ask you Emilio, where do you see extended reality in a few years from now and what do you think is a challenge that needs to be solved to get there? What is your vision?
Emilio Goldenhersch
Yeah, as a somatic psychology. I'm a somatic psychologist. My clinical work is with the body. And I am true believer that any kind of change starts in the body. There is no cognitive thing that can you know, bring over the body. So for me the extended reality and everything related to this kind of XR is going to take a turning point when we can sync the body sensations with our avatars. That's where everything's going to change for me, for the good and for the bad. I think it's going to bring a lot of struggle for many people, because we're going to start working and hearing a lot of deidentification process, you know, and that's going to bring a lot of trouble. But it’s going to be bringing also a lot of opportunity. Because, you know, we all are losing touch with our bodies. We're very mind people. So in that sense, I think extended reality has the opportunity to bring us back to the body. Not yet, I guess that it's going to be five to 10 years tops. But it's something that I'm looking forward to.
Kim Bullock
Great. Well, anything else that you want to share with our listeners today? I mean, I would love I could talk another two hours to you but we've got a time limit here. But anything you want to discuss or or bring up that we haven't?
Emilio Goldenhersch
Yeah, I think one thing came is what you asked me before, and I didn't answer is how we're working with clinicians. We are also in the discovery aspect of working with clinicians. So clinicians are suggesting to their clients to work with us, like as a complementary tool in, in between sessions. One of the things that we have been working on and discovering also, throughout this process is that some people, when they try to address an addiction, or any kind of problem, that is the main manifest work of the of the work at the clinic, they're usually not ready to actually address that directly. So one of the things that we have been working with clinicians is starting with the stress management program. And that's kind of you know, working on the contemplation scale there. So we have been seeing that to be very successful. So whoever is the audience also a clinician that is looking forward into bringing on these into their practice, very much open to discuss, we have these kinds of handouts. This is all subscription model for patients. So it's closer to a value based model than any other thing. There are no risks here. So it's something that could be a nice step if you want to start working with the field as well.
Kim Bullock
Yeah, that's great. Yeah, I think the more flexibility you can give clinicians to experiment to integrate into their practice, they'll start to get some ideas and give you feedback and also start to accept and adopt these interventions too. So great. Anything else?
Emilio Goldenhersch
I'm very happy to be here. And I'm very grateful. Also, this is a very nice opportunity to share also with you that you are like the expert in the field. So it's for me an honor to be here.
Kim Bullock
Oh, well, I'm just a listener to all these things going on and organizing all these conversations. I feel like it's one big network of conversations actually that create the expertise. So Well, thank you so much, Emilio, this, it's such a great conversation, and I have a feeling we need to have you back to continue it. So that's it for Psychiatry XR, and we hope you gained a new perspective on the use of extended reality in health care. And thank you so much 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. And be sure to subscribe to the podcast and tune in again next month to hear from another guest about XR and its use in psychiatric care. You can join us monthly on our Apple Podcast, Twitter, Spotify, or wherever you get your podcast Psychiatry XR was produced by Dr. Kim Bullock, Faaizah Arshad and Jessica Hagen. Please note the podcast is distinct from my own clinical teaching and research roles at Stanford University and 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.