Emmanuella Michel: Virtual Reality for Education Engagement with At-Risk Students
Emmanuella Michel, Ph.D. candidate in Education Technology at Université Laval and Founder of Cogni XR Health, joins Kim Bullock and Jessica Hagen to discuss her journey into the XR space, the need for diverse voices in innovation, and leadership skills that can break down stigma around mental health in the workplace.
BIO
Emmanuella Michel is a Ph.D. Candidate in educational technology with over 15 years of experience working clinically with youth with severe behavioral issues and on the autism spectrum in Canada. She is an assistant researcher with a research interest in utilizing virtual reality in the school engagement context as the use of AI in health. She was selected by Facebook Oculus Launchpad where she discovered virtual reality and developed the Cogni XR Health platform to expand mental health care through Virtual Solutions that can help providers scale therapy access and wellness results.
The following is a transcript of the episode:
Kim Bullock
Hello and welcome back to Psychiatry XR. I'm your host, Dr. Kim Bullock, and I'm joined by my co-host, Jessica Hagen.
Jessica Hagen
Hi, everyone!
Kim Bullock
We're so happy to be joined by Emmanuella Michel, and she has over 15 years of experience working clinically with youth with severe behavioral issues and on the autism spectrum in Canada. She's currently a Ph.D. candidate in Education Technology at Université Laval in Quebec, Canada utilizing virtual reality in the context of school engagement of high risk high school students in the social universe domain, which combines history, geography, and citizenship education classes. She is also a research assistant at Université Laval for a project on AI and health. And as if that wasn't enough, she was selected by Facebook, Oculus Launchpad, and developed and founded the Cogni XR health platform to expand mental health care for virtual solutions that can help providers scale therapy, access, and wellness results. Emmanuella thank you so much for joining us. We're so honored to have you.
Emmanuella Michel
Hi, Kim and Hi, Jessica. It's so nice to be here.
Kim Bullock
Wonderful! So, we'd love to start off by hearing about how you actually first became interested in XR for mental health, and why you maybe founded Cogni XR, and what exactly your company offers?
Emmanuella Michel
Yes. So, my story with XR started when I started my Ph.D. program in Educational Technology. I took a game design class, but mostly we worked on serious game mechanics. And from there, I developed a game card prototype and digitalized it. And then I noticed that I was able to test it, and I actually got the opportunity to go and show it on a TV program. It's like the Shark Tank of Quebec in a way. And I had just finalized it and it was a dare from my friend that told me, you know, “I dare you to go there.” And then I just had the game and I was like, “You know what, I'm going to try,” and I got accepted to go, although I didn't get a deal. But then they still provided me with support in terms of like doing validation and product market fit in a big world game event in Montreal. Well, from there, I started to feel like “Oh, wow, there is a need,” because many teachers were curious about, you know, leveraging technology to support students or to support at-risk students. And after that when I digitalized the game, there was this program with Oculus Launchpad, and I was selected among 100 content developers. I knew nothing about XR before that. So, the program was about, you know, taking 100 people to Facebook offices, and providing us with a bootcamp that would introduce us to XR. And also part of the program was to learn a little bit of coding, which I still don't manage coding. I do mostly like instructional design and conceptualization of like the environments before I send them to the designer. But before that, they gave us that little program, and for part of the program we had to create a project in relation to XR, and some of them would be selected for the Oculus Store. When I tested the Oculus headset, well the VR headset, for the first time, first I was scared. And then second, I was like back in the days when I was working as a group home manager— I managed two group homes for kids with severe behavioral challenges, mostly youths from 14 to 25 years old— and I said to myself, “Oh my God, if I had that tool back in the days, when we had de-escalation grid, I could have used that at the first level of my de-escalation grid and be able to use different environments to help my clients reduce their anxiety, use mindfulness environments to, you know, breathe and use a breathing exercise, so that they could calm down so that they don't go up to a full blown crises and for me to have to use a PRN before it happens.” So, when I saw that, I said to myself, “You know what, I'm going to create a project to support mental health providers with clients that I had back in the days.” And so that's where Cogni XR Health was born. And I would say that Cogni really is about expanding and democratizing mental health care so that more people have access to care that are self-guided, assisted, and also group within a 3D environment. But then again, as we went along our journey with Cogni we realized that, you know, not everybody can use VR, and some people enjoy the whole immersive side of VR, but don't necessarily want to put the headset. So, we are now moving towards web XR, so that we could provide a responsive platform to our clients. Well, I would say mental health providers, patients, our clients, depending on how they call them, they use it for exposure therapy, they can use it for self-guided therapy in between their sessions with their patients, and then also for group therapy.
Kim Bullock
Wow, I love that! Your background, you know, starting at the sort of bedside, or you're, you know, in the trenches with real clinical expertise, knowing the problems that are really out there in the wild, and then also having your academic background, and then this entrepreneurial spirit. You're like just a renaissance woman. So, I love this. You're the perfect innovator. So, I'd love to start off hearing about maybe what your projects are currently, and maybe what you're most excited about.
Emmanuella Michel
Yes. I want to start by saying I am very new to the academic. I'm still like getting used to it. Because when you're used to being a clinician, and then you go towards, you know, research, it's a different ballgame.
Kim Bullock
Yeah.
Emmanuella Michel
Because I'm used to seeing things and then describe them as I see them. And now I have to mostly use things that were validated, you know, researchers that said this, and then I can base it on this. So, I'm not used to thinking like that. So, I had a lot of challenges being a clinician and seeing things on the floor with clients, and then now using research to validate what I have seen is the most difficult thing I've ever done.
Kim Bullock
That's new. Yeah. And I love how quickly you are able to integrate and get into the XR space. That's really hopeful for a lot of us.
Emmanuella Michel
Yes.
Kim Bullock
And I'm sure our listeners that you can do it quickly.
Emmanuella Michel
Yes, it is. It is. And if you love it. You know, if you love supporting your clients already, especially if you are a mental health provider, and you have that love for what you're doing, then when you get to XR it’s like a new challenge that you love also because it helps you get your clients to a certain level— I will say in the therapeutic pathway— a little bit faster than what you could have done if you weren't in the XR environment. In other words, like you had asked me, you know, what am I doing currently as a project, so besides, you know, my thesis and experimentation that I will be starting with students to examine how VR can contribute to at-risk engagement, and therefore improve their academic success, I'm very focused on my Cogni platform. We are right now doing product market fit and pushing forward how we can leverage web XR because we have had the platform, we had 10 environments in Unity, but we realized that adoption was so hard that we needed to do a switch. And to use web XR is a way to help us also correlate with AI, especially to save time and money because compared to what we spent in developing environment, nowadays, there are so many things being developed to support us in terms of like developing 3D environments faster. So with web XR, we are actually at, I would say, the forefront to be able to leverage that. And for us being able to support providers individualizing treatment pathways for their clients or patients, it's very key, because it will help them actually improve engagement. And we also used to spend so much time in developing programs. Now from our assessment, we're able to identify the severity of the needs of the patient. And then we kind of like took the environments that we had and turned them into wellness programs for different sessions. So that means that from the assessment, the provider knows what's going on with their patient, they understand the severity so that they could quickly decide, “You know what, is this patient someone that I could refer directly to self-guided, you know, scenarios with VR, or just using videos that are scripted within a 3D environment? Or is this patient moderate or has severe conditions that I need to assist them in a one-on-one session, and then in between our sessions, they could be redirected to self-guided care so then they could sustain their program.”
Kim Bullock
Well, I just thought of another question. How much overlap is there between your research Ph.D. and your company and what you're doing in there? Is there a lot of overlap? Are they pretty separate? Or is there synergy there?
Emmanuella Michel
I would say engagement— because of the engagement part, they’re synergies, because all the data that we're going to get in terms of like engaging youth or at risk students is going to serve. But my research director really made sure that I didn't do research that had too much synergies with my business, because one thing that he said was like, “You cannot be the researcher, and at the same time being the founder, because the bias will be too hard.”
Kim Bullock
Yeah.
Emmanuella Michel
She rather that I did it on education, with a population that I don't necessarily work with right now. So that's why my platform is for providers, and my research is for high school students.
Kim Bullock
Got it. And your consumers for your company, which providers are you focused on?
Emmanuella Michel
So, we are focusing on providers that are supporting– well, psychiatrists, psychologists that works in clinics and hospital. Like right now, we have been talking with the Mental Health Institute of Montreal, to kind of see how we could do product market fit with them. But providers that are working with clients, especially on anxiety disorder, and I would say depression and trauma.
Kim Bullock
Great, all right. And I have one more question before I let Jessica, come in. So, one of the things that we're thinking about, as you well know, probably the research on excellence and the correlation between diverse perspectives and innovation. And so how do you think that we can promote gender equity and diversity and have more underrepresented individuals with diverse backgrounds and characteristics really join the medical and mental health XR space? I feel like that's what we really need. And do you have any thoughts on that?
Emmanuella Michel
Yeah, well, thank you for this question. When I read this question, I was really like happy because as a woman of color in tech, who doesn't code, I think it's important that new innovation considers our diverse perspective. So that innovations are not bias, and they capture our reality and needs. And when I see us, I'm talking like, you know, Blacks, and then all other people from diverse communities, I got into the tech industry, you know, coming from a sector where I saw many people that look like me. Like in mental health, I can say, as a clinician, I see many people that look like me. But getting into tech or XR, it was different. I would say in the US, I see more people that looks like me, but in Canada, not so much. So, the idea for me to democratize mental health also is part of that. So that people like me, feel less stigmatized, because you know, if we are real about it, not many people can afford or feel welcome in spaces like this, right? Like I remember when I first emailed you, I saw the program online about the virtual reality program that we meet monthly. And I was like, “Oh, my God, am I enough for this program? Are they going to accept me?” And I wasn't sure about applying, so when I sent you the email, and I saw how welcoming you were, and then I had to read again your title, because I was like, “Oh, my God, this is a psychiatrist and look at how she's talking to me as if like, you know, ‘Yes, join us. And we would love for you to be part of it.’” You did a good job at creating an inclusive group where everybody feels heard, even whatever you bring to the table is accepted, and also how I was able to demo my platform. I think that this is valuable, and spaces like that are really important and valuable, because sometimes we feel as people that are coming from diverse group, as imposters coming in. Although we say we want to have a chair at the table, but we don't necessarily think that people are going to be welcoming or they're going to welcome our opinion. Is it going to be a group with diversity of opinion? So sometimes we get fear, and we feel like imposters.
Kim Bullock
Yeah.
Jessica Hagen
It's so important to have those different opinions and those different viewpoints. And with this type of emerging technology, especially with XR and then AI, you have to ensure that there's not going to be bias within these technologies, right? And having those people at the table and allowing them to feel free to deliver their viewpoints is only going to make the technology better. So, I'm so glad that you felt so welcoming at the SPIT-C meeting and of course Kim did that because she's amazing, but yeah!
Kim Bullock
And I think this podcast is about that too. We need to reduce stereotypes.
Jessica Hagen
Absolutely.
Kim Bullock
We all feel like imposters for different reasons and having that inclusivity and creating spaces. So yeah, and you're doing that Emmanuella. And we all are.
Emmanuella Michel
Yes.
Kim Bullock
Thanks. You're a great example of this. Jessica, you had a whole bunch of questions, too.
Jessica Hagen
Okay, so I'm going to back to, I'm going to circle back to you being a Ph.D. candidate and educational technology. So, what ideas do you have about ways that XR can be used within instructional environments to improve learning in youth? And then how about for students on the autism spectrum, since you have worked clinically with those students?
Emmanuella Michel
Yeah, for me from the educational technology standpoint, when I think of XR, I think of experiential learning, learning by doing like, you know, if we think of the work of Dewey or Kolb, the whole pedagogical approach emphasizes on learning to experience reflection and taking action. So Dewey would stand with the idea that, you know, learning should be based on real world experience. So, for me, XR brings close to our real world experience, although if it's in 3D and we are in Avatar, it brings, you know, students so close to the reality that they can live and experience that and then learn from it. In that experience, they could create action, they could get engaged. And within that experience, also, they could co-construct things. And that is very important to learning and changing behaviors.
Jessica Hagen
Yeah, absolutely. Especially within the autism spectrum disorder community, having that real world, immersive technology to be able to really allow them to feel as though they are in a certain circumstance is so valuable. And it's much more effective, correct?
Emmanuella Michel
Exactly. Like I remembered back when I operated a group home, one of my clients was autistic. And back then I didn't know about VR. So, when she would go to school, it would be difficult when her anxiety would go up, so she would be sent back home
Jessica Hagen
Right.
Emmanuella Michel
So then, I decided, “You know what, let's try text messaging.” She had a cell phone, and then she would often text me. So, I said, “You know what, instead of like sending her back, send her to a room, she will take her cell phone, and then we will recreate that experience over texting.” And she would send me a text telling me, like “This is going on, and this is what happened.” And then we would go through the experience, she would reflect on what happened, she will tell me what was her part in the conflict, if it's a conflict with a friend or a teacher, or what she perceived as being a conflict that wasn't really because she's autistic, and then the fact that she was using a tool, she was talking about it, she came out of class, she was able to stay in school. Although sometimes you know as she gets into her own environment, now she allows herself to have the crisis, but most of the time, she was able to keep it down and kind of like use her strategies, come back, breathe, and count to 10 in her head and then be proud that she was able to use those strategies and not have to take a PRN so that she doesn't get into crisis.
Jessica Hagen
You've been able to accomplish so much. And with Cogni XR, I'm going to circle back to that now. So, one unique aspect of Cogni XR is improving workplace and organization wellness, which can mitigate employee burnout. Can you explain what kinds of activities or content the VR and AI therapies have that improve performance and wellness in employees?
Emmanuella Michel
Well, one of the things that we did— we did a validation test with an organization in Canada, and this organization is CDN Canada, where they support entrepreneurs actually from Caribbean communities in Toronto. And during COVID, they wanted to find a way to break isolation for their members because it's a nonprofit organization. And then we are able to collaborate, and I created an environment called Ubuntu for them. And Ubuntu meaning like, you know, “We are because we all are,” so focusing on the collective while one person is feeling better, right, but then you need the power of the group. So, I would say the same thing for employee wellness. When employees have challenges and the employer gets tools or starts, you know, working on the culture of the workplace so that they feel it's okay to communicate what they feel, to communicate also about what they feel is triggering them in the workplace, it’s very important. And using our tools can help with self-guided, mostly ondemand. I would say for workplace wellness we often use self-guided, on demand tools, so that employees, if they want to just walk around the beach during lunchtime, they could put in their headset and then walk around the beach, relax, and then come back when it's time to work after the lunchtime. And they could also do it from home. So, I would say that VR gives them a way to transcend to a happier place so that they could take care of their stress, their daily stress or work stress also.
Jessica Hagen
Have you found that you've received positive feedback from employers who are offering this to their workforce?
Emmanuella Michel
We are currently actually in the process of testing it with employees. And I would say we tested it with three groups: one that was a group of entrepreneurs that was— they were employees themselves. But then what we did is like, we had a group of psychotherapists that each had four clients, which were from members of the group. And then they supported them for like four sessions. And what we've noticed is that mostly it was used for not necessarily exposure therapy, but then they went through their therapy, and they used it at the end of the therapy to give the patient a way to close the therapy with mindfulness therapy, in an environment that would help reduce their anxiety. But mostly for mindfulness, they said they use it and that it was really, really working for them. And also, in talk therapy within the environment, like walking with their therapist within the environment, it also helped and providing them quick tools to face what they're feeling in the reality.
Jessica Hagen
That's fantastic. Absolutely.
Kim Bullock
Yeah, I'd love to pivot now to leadership. You know, it's kind of linked to everything we've talked about here. And I know, in a lot of School of Medicine locations, you know, leadership for physicians is a big ticket item to reduce burnout. And definitely, my organization focuses on that. And then I noticed in your recent blog, on Cogni XR Health website, you talked about how leaders play a key role in breaking down stigma in the workplace and mental health. And just wondering about what leadership skills you think are super important for prioritizing mental health in employees? And also, just what leadership skills do you use to just be so awesome, and so productive? So, anything on leadership that you can, you can share with us would be awesome.
Emmanuella Michel
So, what do they say like when they do a commercial, and then they put “Kids don't do this at home” for some of the things— “Don’t try this at home.” Besides that, as leadership skills, I would say that, you know, good communication, empathy, flexibility, adaptability, and also modeling. Because, you know, if you are a leader or a manager of a department, and then you don't take care of your own self-care, it's hard after to preach that at work.
Jessica Hagen
Right, right.
Emmanuella Michel
You know, like, now I was reading an article, and many organizations are looking for CHO's. And I was like, “What's a CHO,”— its Chief Happiness Officers. And that person is in charge of workplace happiness and employee well being, isn’t that great.
Kim Bullock
That is great!
Jessica Hagen
It's pretty good.
Kim Bullock
I want to be one of those. That's so great.
Emmanuella Michel
It’s like this new role that they've created that has been developed actually by startups in North America, and it's growing like to Europe. And what they're focusing on— it's like, you know, to find other factors of individual and collective performance. So, it's not just, you know, focusing on one person, but it's to look at the job as a collective thing. Right? So, if John doesn't do well, in our department, well, his burnout may affect each one of us, somehow.
Jessica Hagen
Right.
Emmanuella Michel
So, it's important to put a lot of emphasis on work environment, the climate, and make sure that people communicate because it's essential for leadership skills, especially for good work environment where employee can develop a sense of belonging and feel comfortable to ask for help when they need. Then empathy can help also create that safety net around them—
Kim Bullock
Yeah.
Emmanuella Michel
So that they feel comfortable looking for help without being stigmatized or having a chip on their shoulders after they've said that they weren't feeling well on one week.
Jessica Hagen
Right.
Kim Bullock
Yep.
Emmanuella Michel
So, adaptability, and also for the leaders to practice what they preach. So, if they're saying that, you know, people should come and then work on their mental health and they're putting tools for that, then they should prioritize their own mental health and put a lot of emphasis on taking control over their own self-care, setting positive approach to wellness at work, so that their employee you can also follow.
Kim Bullock
Yeah, if you say, you know, don't email on the weekend, but you're a leader emailing people on the weekend— Yeah, you got to practice what you preach.
Emmanuella Michel
Exactly.
Jessica Hagen
Absolutely.
Emmanuella Michel
Did you experience that Kim?
Kim Bullock
I'm not going to say, but I'm sure many people have experienced things like that.
Jessica Hagen
Oh, I’m sure, I’m sure!
Kim Bullock
Well, one thing I wanted to ask you that I ask all the guests that come on here, because after starting this now, I think we're almost into a year here, we're noticing even though we call this Psychiatry XR, there's a huge absence of psychiatrists and a gap in the discipline of psychiatry and its role in XR. Like, we haven't met any companies that actually have psychiatrists on their board or even on their advisory committees. And so, what do you think: what is the best role for psychiatrists? And how can psychiatrists play a role in advancing XR and mental health? Do you have any ideas on where we fit in as psychiatrists?
Emmanuella Michel
Well, already, like know, this platform that you've created with your team is wonderful, I think that this is going to change, you know, the way we think about XR, and especially for us entrepreneurs. Like, I went on the website, and I was writing about, you know, product market fit, and I was writing about, you know, positioning Cogni. And I'm listening, I listened to one of your audio and I was like, “Oh, my God, please tell me more.” Because it also helped with hearing about people like psychologists using XR in their practice, for us to kind of like tell people, you know, this is not just a dream that we have and we woke up. So, I guess that psychiatrists have this role, where they can help us design what they need to support their patient better. So yes, they should take part on startup advisory board to share their expertise on how technology like XR and AI can support them, especially with you know, diagnosis, because sometimes, you know, what they do that takes them hours or weeks can be reduced using technology. And if they don't want to adopt it, but then maybe they could help us, you know, see why and understand how we could actually support their practice better with what we're building.
Kim Bullock
Okay. I love that vision. Yeah, especially with diagnosis because we do spend a lot of time in evaluations.
Emmanuella Michel
Exactly and there is a labor shortage—
Kim Bullock
Yes!
Emmanuella Michel
More and more like a professional to support the demand. So, we have no choice but to find other alternatives to wellness.
Kim Bullock
Yep. Anything else that you're burning to share? Any ideas or any topics?
Emmanuella Michel
Well, no, I think that it was really, really nice. But maybe one thing I can say is that Cogni needs you— psychiatrists and psychologists and mental health professionals that are listening. We are looking for 10 mental health providers or organizations that will be willing to do some trials with us so that we could do some product market fit and make sure that we respond to your needs and to your clients needs.
Kim Bullock
Got it, so yeah! It looks like running the clinical trials is too a place for psychiatrists and psychologists.
Emmanuella Michel
Definitely.
Kim Bullock
Yeah, like the validation of, of your prototypes.
Emmanuella Michel
Yeah. And its credibility also, like showing that we created something that is going to be used by real people. It's not just in our heads as entrepreneurs.
Kim Bullock
Yeah.
Jessica Hagen
Right, right. Credibility is so important!
Emmanuella Michel
Definitely.
Kim Bullock
Yeah.
Emmanuella Michel
And without it, it's so interesting, without credibility from psychiatrists, mental health providers, and it's so interesting, even like family doctors— There was a cardiologist also that asked me, you know, “Do you have an experience that I could use with patients that just find out that they're going to have like, open heart surgery, and they're going through a lot of anxiety, how to talk to their family. Before that surgery, do you have something that we can use, so that they go through it for a couple of days before the surgery?” So, it's many people within the healthcare system.
Jessica Hagen
Yes.
Kim Bullock.
All right. Well, thank you so much, Emmanuella. We're so lucky that you joined us!
Emmanuella Michel
Thank you so much for inviting me. It was fun. It was really, really interesting. And continue doing your great work.
Jessica Hagen
Thank you so much for being here.
Emmanuella Michel
Thank you.
Kim Bullock
Thank you. This episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology and mental health. And 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’s 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 myself Kim Bullock, Faaizah Arshad, and Jessica Hagen. Please note that 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 replacement for medical advice. The episode was edited by David Bell and music and audio produced by Austin Hagen. See you next time.