Howard Gurr: Effectively implementing VR in private practice
Kim Bullock and Jessica Hagen speak with Howard Gurr, psychologist who practices in Long Island, New York, about using virtual reality in private practice, the development of companies that are focused on VR for mental/behavioral health, usability of VR, the VR market, the future of XR, and more.
BIO
Dr. Howard Gurr is psychologist who practices on Long Island, New York. In 2015, Dr. Gurr was introduced to Pious (now called Amelia Virtual Care). He started using VR in his practice in early 2016. He is currently an “ambassador” for Amelia Virtual Care in the US market. Dr. Gurr promotes the use of VR, has given webinars on the use of VR and beta tests systems for other VR companies. Dr. Gurr also developed a worldwide online directory of VR practitioners to help promote VR to the public, and provide a site for patients to find VR therapists (www.vrtherapistsinternational.com).
The following is a transcript of the episode:
Kim Bullock 00:14
Hello and welcome back to Psychiatry XR. I'm your host, Kim Bullock, and I'm joined by my co-host, Jessica Hagen. Hi, Jessica.
Jessica Hagen 00:22
Hello, everyone.
Kim Bullock 00:23
We are joined today by Dr. Howard Gurr, who is a psychologist who practices in Long Island, New York. In 2015, Dr. Gurr was introduced to a VR platform, Psious, now called Amelia Virtual Care, and he started using VR in his practice in early 2016. And he is currently now an ambassador for Amelia Virtual Care in the U.S. market. Dr. Gurr promotes the use of VR and has webinars on the use of VR and beta test systems for other VR companies. Dr. Gurr has also developed a really useful worldwide online directory of VR practitioners to help promote VR to the public and generously provides a site for patients to find VR therapist for free. And he is also one of the few clinicians really focused on VR, that I know, and has real virtual world experience integrating XR technology into practice. And he has been so helpful and kind to me as an informal consultant and colleague as I continue to learn and incorporate XR into practice. He also is a fellow podcaster. Although he's been at it a lot longer than us, being an early adopter of podcast starting in 2016. He hosts a show called The Shrink Is In. Welcome, Dr. Gurr.
Howard Gurr 01:42
Thank you, Kim. Glad to be here. Hello, Jessica.
Kim Bullock 01:45
Great to have you. Well, I thought we could just kind of dive in maybe with your history. What exactly got you using VR in your practice? Was it just a random event or was there a story behind it?
Howard Gurr 01:58
Yeah, there is a story behind. I have to start off by saying, basically, I'm a tech geek, and I accept that title gladly. And I've always tried to find ways to incorporate technology in my private practice for efficiency, either in terms of managing my practice, even the billing of the practice, and using the internet as a vehicle to market myself. So I was one of the first people I think who had a website. It was 1999, and I had a dial up account. Remember those things. And it was 1999 for dial up account. But $24.99 If you wanted a website. So I figured, alright, I'll make a website. And I found a way to make a website out of Microsoft Publisher '98. And they had a module where you could create a webpage, and I did. And I was one of the first people out there with a website, which got me a lot of business until everybody else joined in.
Kim Bullock 02:55
Yeah.
Howard Gurr 02:56
And then around 2000, I came across Skip Rizzo's work, where he had a virtual classroom. And I looked at that and I thought that's a great way to assess and treat kids with ADHD. Because at the time all we really had was rating forms, which I think they still use, and something called a TOVA or the Conners CPT, which were computerized tests that, as a clinician, were incredibly boring to administer because you had to sit there with a child and they had to look at a black screen and hit the mouse when every letter came up except the letter X. That was the diagnostic tool. So, I contacted Skip, and I went, "Hey, this is great." But, at the time, I reached him, he had already sold it off. I think Sitecore bought it from him. And he moved on to other things. So he obviously worked on, you know, PTSD and Bravemind and all those things. And then I basically tabled it. And then around 2005 or 2006, I wanted to do virtual reality therapy. There was one company that existed at the time out of Atlanta, and they had a platform, but I wanted to be remote because I wanted to do only public speaking anxiety for executives.
Jessica Hagen 04:14
Very specific. Yeah.
Howard Gurr 04:16
I thought that was a great market. But I didn't want them coming to me. I figured if I went to their offices, and I could just be mobile, that'd be great.
Kim Bullock 04:24
Wow, that's very forward-thinking.
Howard Gurr 04:26
Yeah, but it didn't work. [LAUGHTER] So what happened was, that company said, "No, it won't work. You need a much more heavy duty processing, and it won't work on a laptop of any sort." So, again, I tabled it. And then around 2015 I was at a workshop on technology and private practice, and the presenter just kind of threw out, "Oh, and there's this company in Barcelona thst is working on virtual reality with Samsung phones." And I went, "There it is. That's it." And so at that point, I introduced VR into my practice, but I spent probably three, four months bothering everyone I knew because I had to play with it. I had to get more accomplished in using the platform, and I didn't want to open it up into my patients until I felt comfortable with it. So, I bothered every relative and every friend I had, and I made him go through it. After about three, four months, I figured, alright, I'm ready. And that's when I started using it in my private practice.
Kim Bullock 05:25
So that was around 2016. Is that right?
Howard Gurr 05:27
Yeah, yeah. Early 2016.
Kim Bullock 05:29
Got it.
Howard Gurr 05:30
And I've been using it ever since. Now, I can't say that every patient I have is a VR patient and that it's appropriate for every particular problem. But when it's appropriate, and I see the need or the benefit for VR for that particular patient, I definitely introduce it. And since the pandemic, I've been doing everything remotely, which is, I guess, not the typical way that people use VR, but...
Kim Bullock 05:56
Well, it's becoming that way.
Howard Gurr 05:57
Yeah.
Kim Bullock 05:58
Yeah.
Howard Gurr 05:59
The Amelia platform just lends itself to that. So...
Kim Bullock 06:02
Right,
Howard Gurr 06:02
...it makes it easy.
Kim Bullock 06:04
Yeah. So, in the current, coming up to the present moment, what platforms or tools are you using an XR? Are you just using Amelia, or anything else that you're using? Or is it strictly Amelia?
Howard Gurr 06:17
It's mostly Amelia. When I was seeing patients face-to-face, you know, every platform, I think, has its limitations.
Kim Bullock 06:24
Yeah.
Howard Gurr 06:25
And they can only go so far. And it's important to kind of individualize the VR or the virtual environment experience for the people who have specific issues. And so when I was seeing people face-to-face, it was really great. I would use an Oculus, download specific 360 videos.
Kim Bullock 06:45
Right.
Howard Gurr 06:45
So, for example, I might have someone who had difficulty with insects, and I would have them go through the virtual environment with insects with me in the office. Because I was always concerned really about re-traumatizing people, if they did stuff on their own that was reminiscent or would respark their phobias or anxieties. So, that was the great thing about doing it face-to-face. I have subsequently used other 360 videos with people who had another headset and they would use it at home, or they would use it while I was with them in a video communication platform. But primarily, the platform I use is Amelia because it's inexpensive for the patient. You know, a lot of the other platforms use Oculus 2 or Oculus 3, or you know, the PICOS, but that would mean either, A) The individual would have to buy that. Or I would have to supply it, and I'm not sure I want to be in that business of supplying expensive headsets to people where I might or might not get it back, or, if I do get it back, I'm not sure. I'd have to reclean it and resanitize it. So, I don't want to be invested that much in that kind of technology. I imagine institutions would be but as a private practitioner, that's kind of cost prohibitive.
Kim Bullock 08:04
Yeah, and onboarding.
Howard Gurr 08:06
Yeah. If they tell me to buy a cheap, head-mounted display and use their cell phone as the engine, it solves that problem.
Kim Bullock 08:12
Yeah,. Yeah, I find that any other platform, the onboarding is so complicated. It usually doesn't work out, and there's a payment involved. And so I haven't been able to get any other platform except Amelia to do remote telehealth visits using XR as well. So that's kind of validating to hear you're kind of in the same boat. Because it seemed like before the pandemic, we had a lot more tools and things to use, and then, now that we're remote, things are getting a little bit more siloed. But maybe that hopefully, do you think that's gonna change or open up where we have other platforms? What do you see happening in the future? Yeah. I remember that.
Howard Gurr 08:49
Well, you know, the interesting thing is, when I first started, as I said, I think the major player in the field was Virtually Better. And I've been tracking the development of companies in the VR mental health realm, and I'm up to 114.
Kim Bullock 09:05
Wow.
Howard Gurr 09:07
And that's worldwide. Now, I think because of that, and I also think the pandemic probably escalated that development, because people realized, oh, you know, teletherapy works. And...because I remember, six or seven years ago, I got a board certification in telemental health. And my friends looked at me and went, "What'd you do that for? Why bother with that?" And I went, "Just wait and see. You'll see. It'll be beneficial." You know, and I jokingly tell people that I could be doing therapy anywhere and not necessarily wear pants, you know. [LAUGHTER} But I thought of the idea that, you know, I could be anywhere doing therapy, obviously, via the internet. And then when the pandemic hit, all of a sudden, everyone's turning around, going, "Oh, now I get it. Now. I understand."
Kim Bullock 09:53
Yeah.
Howard Gurr 09:54
And all of a sudden, teletherapy reached a level of acceptance that it didn't have before. Because before that everyone thought, "Oh, you know, there's a distance between you and the patient, and how valid is that? It's not as good as face-to-face. And now all of a sudden, there's enough research to suggest, well, maybe it is pretty good and it does work and it does answer questions about accessibility. Because, you know, patients can't find clinicians. And, you know, if you live 50 miles away from your clinician, if you, you know, live in, you know, Monkey Falls, Minnesota, if there was such a place, you would have difficulty and teletherapy takes that away. So, to answer your question in the short term, I think that we're in the process of an evolution here. And I think that virtual reality therapy is still in its infancy. And I think that the things that I am unhappy with in virtual reality therapy will be solved, supplement to companies stepping in and investing time and energy. And I think, you know, there's no place in the world for 114 companies, I think, to be in the same geography. So ultimately, what's going to happen is these companies are going to either disappear or merge, as we're seeing some mergers now with Amelia and XR [Health] and a few other companies that are, that are merging because that's the only way they're going to survive in this environment. And I think that they have to get more technologically sophisticated, but at the same time become simplistic...
Kim Bullock 09:59
Right. Yeah.
Howard Gurr 11:28
...for clinicians.
Kim Bullock 11:29
Yeah.
Jessica Hagen 11:29
Right.
Howard Gurr 11:29
Because it's got to be one button, you know, kind of a therapy tool.
Kim Bullock 11:36
Yeah. It just surprises me that there's 114 out there, but really only one that's usable right now by most clinicians.
Howard Gurr 11:45
Well, there's a couple of others that are usable, like a C2Care from France.
Kim Bullock 11:48
Yeah. I mean, but the onboarding is so hard for the patients and, and the cost, like you were saying. I mean, it's possible to use it, but it's, the ease of the use is a big barrier.
Howard Gurr 12:00
Yeah. And I think the other question I have is, and I was hoping Apple was gonna solve this one, but...
Kim Bullock 12:06
Yeah.
Howard Gurr 12:07
...I don't think that they did. Because I thought once Apple steps into the territory, you know, they kind of like, sit back and watch everybody else kind of make all the mistakes.
Kim Bullock 12:16
Yeah.
Howard Gurr 12:17
And then they walk in with a product that is so much more simplistic and sophisticated.
Kim Bullock 12:22
Yeah.
Howard Gurr 12:22
And I thought, once they enter, it is going to open up a lot of doors, but that hasn't happened yet.
Kim Bullock 12:28
It's only a few months, and maybe...
Howard Gurr 12:30
Right.
Kim Bullock 12:30
Yeah, yeah.
Howard Gurr 12:31
We need a couple generations for that to occur.
Jessica Hagen 12:33
Right. Yeah.
Howard Gurr 12:34
But I think the problem is, is that VR and augmented reality are not compelling enough for the average individual to buy it.
Kim Bullock 12:45
Yeah.
Howard Gurr 12:46
And I have kids who have VR headsets and they play with it for a while and then it winds up in a closet somewhere. Because it's just, there's no real reason. And it goes back to the idea that, you know, there was no real reason, I think, for people to have a cell phone 30 years ago or 25 years
Kim Bullock 13:05
Yeah. Even 15 years ago.
Howard Gurr 13:07
And now you can't live without one.
Kim Bullock 13:09
Yeah.
Howard Gurr 13:10
So, when VR or augmented reality or extended reality becomes as ubiquitous and as universal, I think the technology will speed up and we'll see a lot more advancements in things that we don't have now. So, for example, I know there are companies that are working on biometrics built into the headset.
Jessica Hagen 13:31
Right.
Howard Gurr 13:32
Well that's what I'm really missing when I do, you know, teletherapy with VR because I can't get the biometrics, I just get subjective units of distress and that's not always so accurate because people sometimes either underestimate or overestimate their anxiety levels. So, I really need the data, bio data, but I don't have that yet. So that's something down the road I think is going to develop, and I think it's gonna get more and more sophisticated and I'm hoping more simplistic in design.
Kim Bullock 14:04
Yeah.
Howard Gurr 14:05
So, the onboarding, as you said, is ridiculous. You know, some of them, you have to like side quest your device to get the app on.
Kim Bullock 14:12
Yeah.
Howard Gurr 14:12
And I could do that, but I don't think people generally can do that.
Kim Bullock 14:15
No. It's really hard.
Howard Gurr 14:16
And then, you know, there's one platform where the clinician pays a monthly fee and the patient pays a monthly fee.
Kim Bullock 14:22
Yeah. That doesn't fly.
Howard Gurr 14:23
That doesn't fly with me either.
Kim Bullock 14:24
Yeah.
Howard Gurr 14:25
Yeah.
Kim Bullock 14:25
So, one last question and I'll let Jessica, she's got some burning questions too to come in, but the other thing that I'm still in grief and mourning about is Google Cardboard left YouTube, that option, because I could use that for a lot of idiosyncratic stimuli that we needed for people. And, you know, there's a huge library on YouTube of VR 360s that you could use on Cardboard and then that disappeared. Do you know anything about that or why that happened? Or...
Howard Gurr 14:54
I don't know anything about that. But I do know, I still can download Google 360s.
Kim Bullock 15:00
Yeah, but it's not in the cardboard format that you could put it in a, in a headset as far as...
Howard Gurr 15:06
Oh, really?
Kim Bullock 15:07
From what I've tried. Yeah.
Howard Gurr 15:09
I really don't know about that.
Kim Bullock 15:10
Okay.
Howard Gurr 15:11
Because as far as I know, because I haven't downloaded any for patients recently. I have, maybe six months ago I did, but I haven't recently.
Kim Bullock 15:19
Yeah. Although maybe you can and maybe you know how and yeah, let me know.
Howard Gurr 15:23
I'll look into it.
Kim Bullock 15:25
Okay.
Howard Gurr 15:25
If I come up with an answer. I'll let you know.
Kim Bullock 15:27
All right. I'll turn it over to Jessica.
Jessica Hagen 15:30
Actually, you know, Dr. Gurr, I wanted to circle back a little bit. So you said that there's still a lot that's missing within a lot of VR experiences. What are some of those things that you feel are missing, or that maybe companies are not necessarily doing correctly?
Howard Gurr 15:44
I think when you have standard computer-generated virtual environments, you can't cover everything. And so you come up with a generic version of what you think that patient may need. So, if it's a driving phobia, you know, you come up with a generic driving virtual environment. But I've had people who say, "Well, you know, it's not, it's not so much the road. I don't like when the road's crowded," or "I don't like when there's a shoulder on a road," or "I'm on a higher road and I could look down." And so there's no way I think that a company can generate the variety and range of virtual environments I think that clinicians would use. So, I always think that it's important for them to have the ability to import into a platform, a virtual environment, that meets that need or is close to that need that is still controllable by the clinician. And there were companies that did that, which I thought were great. You could download a Google Earth video or an image, or let's say someone had difficulty on a particular corner, they had a car accident on a corner, you could download that corner and now you could kind of work through their anxiety. Or, you know, the YouTube 360s that work. That kind of thing where, because you can't have a library, so to speak, of all the virtual environments that people need. So that's one of the downsides.
Jessica Hagen 17:14
I wonder if AI is really going to help with that in the future. I wonder if you'll be able to create virtual environments kind of on the fly whenever you need utilizing AI.
Howard Gurr 17:24
That would be terrific.
Jessica Hagen 17:25
That'd be amazing.
Howard Gurr 17:26
Yeah.
Jessica Hagen 17:27
Yeah.
Kim Bullock 17:28
I have one other question. We're talking about Amelia and usability and tools, do you know what's hindering them to releasing the practice in between sessions because before the pandemic, they could take it home and practice their cue in their scenarios, but now that you can only do it with the practitioner in the room. So, what's holding up having homework reinstalled for Amelia? Is there some regulation?
Howard Gurr 17:57
The homework still exists.
Kim Bullock 17:58
Yeah, but it's only relaxation homework. It's not any exposure homework.
Howard Gurr 18:02
Right. So, I've asked them about that. Because the first iteration, you were allowed to have a session and you could use that for homework. I think their concern was something to do maybe with the FDA and concern about potential litigation if someone gets re traumatized because they're using it on their own.
Kim Bullock 18:24
Yeah, I was thinking something happened. Liability.
Howard Gurr 18:26
Right. And so I asked them about that, and I said, "That really was beneficial." And they said, "Well, we're working on that for next year."
Kim Bullock 18:34
Got it.
Howard Gurr 18:35
So, I think they're planning on it.
Kim Bullock 18:37
Okay, great. Yeah, we got to have them on the podcast pretty soon.
Howard Gurr 18:41
Yeah, I think they're one of the major players. Like even, you know, the idea of using Samsung Gear VR and headset, other companies followed them. They were the first. And I think that they opened up that door. And all of a sudden, all these companies realized, oh, this is a viable option. It's not that expensive to operate, and it created a whole different therapeutic model. The theory is that it takes 20 years for technology to eventually become enmeshed in mainstream clinical work. And you would think, well, VR has been around for a long time but my theory is that we're only at your seven.
Jessica Hagen 19:20
Why is that your theory? Year seven.
Howard Gurr 19:23
Because it's been around for so long, but no one knew about.
Jessica Hagen 19:28
Right.
Howard Gurr 19:28
And there wasn't enough research. Even if you look at the research, like 1985 I think there was one research article on VR in therapy. And in 2017, there were 1,000. But even though 1,000 seems like a lot, it's really not a tremendous amount of research articles. But I think that 2015 or so or 2016 is really when it happened. Like 2016 was supposed to be the year of VR. It was supposed to be the year VR was going to explode. It never happened.
Jessica Hagen 20:01
I think a lot of that, though, has to do with provider hesitation in actually implementing VR in the space. Right?
Howard Gurr 20:08
Yeah, but I also think VR as a medium didn't explode.
Jessica Hagen 20:12
Oh, yeah.
Howard Gurr 20:13
And so what happened was it didn't hit this huge marketplace that they projected it to do. And so because of that, I think people didn't become aware of it. And clinicians are a conservative bunch...
Jessica Hagen 20:26
Right.
Howard Gurr 20:27
...who will not pick up on something, I think, unless they've been trained in it and they're kind of technology averse in many levels. And so there's so many reasons why it didn't get picked up in practice, but it didn't even get picked up by the general population.
Jessica Hagen 20:45
Right.
Howard Gurr 20:46
I think. And so from my point of view, normally what happens, I think, is technology comes from, you know, the top and eventually starts leaking down to the general population. So, technology might be in medical practice of some sort. And eventually, it becomes part of our everyday usage. I think it's the other way with virtual reality. I think everybody has to have some knowledge about it, then experience with it, and play with it and accept it, and then it might start leaking up, so to speak, to the more clinical experience.
Jessica Hagen 21:21
Like the personal computer.
Howard Gurr 21:23
Yeah. Yeah.
Jessica Hagen 21:24
You know, the personal computer kind of evolved and became something that everybody had within their house after they tried it.
Kim Bullock 21:32
Yeah.
Howard Gurr 21:32
Right.
Kim Bullock 21:33
And you're unique because you're an early adopter and you're in private practice. And I'm sure there's a few more like you, although, I was wondering, in your experience in private practice, like, do you worry about HIPAA? Did your malpractice insurance give you any problems? Or is there anything as a private practitioner who may be listening to this wanting to dive in, any words of advice?
Howard Gurr 21:57
Well, I kind of limit my practice to the the areas that I'm comfortable in and that I've been trained in. I also think that if we look at VR as a tool to enhance clinical experience and clinical practice, as opposed to something new and different, it's not different than anything else. It's exposure therapy, the way I use it.
Kim Bullock 22:23
But does your malpractice think that way? That's what I mean.
Howard Gurr 22:26
Malpractice has nothing to do with it.
Kim Bullock 22:28
So, you didn't have to disclose anything, or there weren't any logistical things to adding this to private practice that were different than if you didn't use it.
Howard Gurr 22:37
Not at all. And there's not a difference, I think, between using it and not using it in terms of, you know, insurance reimbursement.
Kim Bullock 22:44
Right.
Howard Gurr 22:45
I had no, no trouble with that as well.
Kim Bullock 22:47
Got it.
Howard Gurr 22:48
But I say to people, "Listen, if I was working with a phobic patient who had difficulty with a dog. And I brought a dog into my office, would that be any different?" What I'm doing is I'm bringing in a virtual dog. The difference between me saying, "Okay, sit here and I want you to imagine that there's a dog in front of you." And using imaginative tools in traditional therapy. Yeah, I could do that. And people have done that for years and years and years. But it's not as efficient. And it's not as effective as doing it with virtual reality.
Kim Bullock 23:24
Okay, so they're not worried about cybersickness or collection of privacy or anything about...did you disclose it? Do you have to disclose it in malpractice?
Howard Gurr 23:34
I do disclose the possibility of cybersickness. But the way I work the practice, for the most part, there is no HIPAA compliance issues because even, you know, Amelia doesn't really know who I'm working with. Everybody's anonymous.
Kim Bullock 23:48
Yeah.
Howard Gurr 23:48
I know who I'm working with. And so my notes are all my notes, they don't have notes. And I asked them about HIPAA compliance issues and they swear that they're not keeping any data. So I understand the HIPAA compliance concern, but from clinical experience, I've had no problem with any of these issues. It's just a matter of adopting another tool. And that's another thing in terms of private practice, I think. I think clinicians make a mistake. And the mistake is born out of their training. So, for example, I think it's the American Psychological Associations' standards that for a program to be approved, accredited by them, they can't really have any business classes. They can't work that edge of, you know, psychology in terms of promoting private practice. It's all research oriented. So, people get out of school, and they have clinical skills and they have all their experience and training, but they know nothing about running a business and they don't even see themselves as a business. So, they figure alright, I'll rent an office, I'll get a telephone number, and I'll print up some business cards and I'm in. And that's a mistake because that doesn't work. And so they have to understand that I think it's important to separate yourself somehow from every other clinician. We're probably unique here. So, I'm in Suffolk County. Suffolk County and Nassau County, the major part of Long Island. Of course, Brooklyn and Queens are part of Long Island, but they don't see themselves that way. And so, in Nassau and Suffolk County, there are 1,000 licensed psychologists per county. And I'm not including social workers, mental health counselors, marriage/family therapist. I don't know their numbers. I just know that there are 1,000 licensed psychologist. And so this is a unique area. So, there's probably a therapist every block around here. But if you go to other parts of the country, that's not the case at all. And so here, you need to differentiate yourself, I think, to make yourself viable as a private practice.
Kim Bullock 24:08
Yeah. It's a business decision too. That's great to hear.
Howard Gurr 25:55
Right.
Kim Bullock 25:55
Yeah.
Howard Gurr 25:56
And I think the fact that, you know, if you have to buy an IQ test it might cost you $1,600/$1,700, for an IQ test. And so whatever the subscription is for a virtual environment package, it's a business expense, and I think people have to understand that, you know, that business expense can be made up very soon if you have enough patients using that particular tool.
Kim Bullock 26:18
Yeah.
Howard Gurr 26:19
So, I think it's important to see themselves as businesses and they don't.
Kim Bullock 26:22
Yeah. I get it.
Jessica Hagen 26:25
But then also for a lot of providers that are hesitant just to utilize the technology and whether the technology is going to be as effective in clinical practice, what would you say to them?
Howard Gurr 26:36
I can only tell them that I find it efficient. And I will see patients under 10 sessions, and resolve whatever their issue is, and I could not do that for traditional therapy. And about a third of my practice are actually referrals from other clinicians. And so in the process of the therapeutic relationship, all of a sudden the patient would say, "Oh, by the way, I have to go to my brother-in-law's wedding, and I haven't been on a plane in 20 years and it's six weeks from now. And the clinician might say, "Well, I'm not going to get to it in six weeks." But Dr. Gurr can, and so I would then get that patient for, you know, whatever time period I needed to get them on the plane, and I'm not really stepping on the other therapists toes because I'm not touching the other things. I'm very focused on what I have to resolve and work through with that patient, and then I send them back. And so it works so efficiently that I don't understand why people don't incorporate it. I just think, at this point, it's like the gold standard in exposure therapy because the next step is bringing people to places. So when I have to bring a person to an airport, get on a plane with them, do all the things that really you needed to do but it's too time consuming and costly and inefficient. And VR is close to that and able to hit the same anxiety levels that I need to get through to train people to get over their anxiety on their own.
Kim Bullock 28:11
Alright, well, I have one final question for you. So, since this is Psychiatry XR, and you psychologists are always ahead of the curve, and you've been doing this for three decades, and psychiatrists are just coming into this, do you see any special role that psychiatrists could play or anything that's unique for psychiatrists versus psychologist in this XR realm?
Howard Gurr 28:36
Yeah, I think there are areas that we as psychologists aren't really going to touch. And so obviously, you know, VR and medication combinations or psychedelics and VR, cognitive impairments, neurodevelopmental disorders, those are areas that psychiatry would touch probably more than we would because they're more physically and medically related. And I think that probably down the road, you know, augmented reality and psychedelics are probably going to be a lot bigger than they are now. And I because it's going to combine two a little offbeat approaches that would work together, I think, synergistically. So, I think that anything having to do with psychotropics and VR and medication and VR, yeah, that's, that's your realm, not mine.
Kim Bullock 29:31
Okay. Got it. All right. Well, any other thoughts or anything else you want to say or thoughts about what the future of XR is going to look like?
Howard Gurr 29:44
Well, here's my dream. My dream is born out of, and I'm gonna date myself on this one, Star Trek the second iteration, where they have the holodeck and in the holodeck, what would happen is it's a big large room, and they would use it for rest and relaxation, because they're on a ship not going anywhere. But what you could do is you can walk into this room and program the room to be whatever you wanted it to be. So if you wanted, I remember there was one episode where they all got dressed up in western cowboy gear, and they walked into this 1800s saloon that they created. And so they pushed the buttons and they created this saloon, and there were real life avatars in the saloon, who they interacted with. And that's my dream. That if we could just individually program a virtual environment where someone has difficulty. Let's say someone has social anxiety, you know, you could create that particular environment. And...
Kim Bullock 30:48
Yeah.
Howard Gurr 30:48
It's interesting, I just had this thought, in the 80s, my friend and I decided we were going to open up a therapeutic bar, and it was going to be a place where people who had social anxieties could now mingle and it would be, you know, there would be clinicians in the bar with them, kind of coaching and helping them, which we never did. But that was the idea that we would have a therapeutic, non-alcoholic bar scene and people would would practice.
Jessica Hagen 31:18
Oh, you never implemented it?
Howard Gurr 31:21
Never did it. No.
Kim Bullock 31:23
Well, it's not over. Yeah, I think there's potential here.
Howard Gurr 31:28
Yeah. Well, that's where the virtual reality would come in. It wouldn't be a brick-and-mortar place. It wouldn't cost anything. And I think people are going in that direction. Like, for example, there's this company from Norway. I think they've been on SPIT-C's schedule. I've played with their platform, and it's pretty engaging. They have AI avatars that interact with a non-script format, and they basically respond to what you're saying.
Kim Bullock 31:31
Yeah.
Jessica Hagen 31:31
Right. That's fascinating.
Howard Gurr 32:02
I thought it was it was very fluid.
Kim Bullock 32:04
Yeah. There's a lot coming. All right. Well, I think we could make your dream come true. I see it happening.
Howard Gurr 32:11
I'm hoping. Yeah.
Kim Bullock 32:13
Well, thank you so much.
Howard Gurr 32:15
Well, thank you for having me.
Jessica Hagen 32:16
Thank you so much for joining us.
Howard Gurr 32:18
It was great. Thank you.
Kim Bullock 32:20
And so that's it for this episode of Psychiatry XR. We hope you gained a new perspective on using extended reality in healthcare and thanks for listening. This episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology in 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. And you can join us monthly on Apple podcast, Twitter, Spotify, or wherever you get your podcasts. Psychiatry XR was produced by myself 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 replacement for medical advice. This episode was edited by David Bell and music and audio was produced by Austin Hagen. See you next time.