Maheen Mausoof Adamson: VR For Traumatic Brain Injury in Veterans & Lessons on Healthcare Leadership

Maheen Mausoof Adamson discusses her varied career, how she first got involved in using virtual reality to diagnose and treat traumatic brain injury in Veteran patients, and key leadership skills to push the field of behavioral health forward.

BIO

Dr. Maheen Mausoof Adamson is a clinical associate professor of Neurosurgery at Stanford School of Medicine, Director of Research for Women's Operational Military Exposure Network (WOMEN) at War Related Illness & Injury Study Center (WRIISC), and Senior Scientist for Rehabilitation Services at VA Palo Alto. A neuroscientist by profession, Dr. Adamson completed the Stanford Byer’s Biodesign Faculty Innovation Fellowship and a Master’s of Science in Healthcare Leadership at Brown University. Dr. Adamson utilizes innovative tools such as neuroimaging, neuromodulation, genetics, proteomics, and virtual reality for improving the lives of adults with traumatic brain injuries, Alzheimer’s disease, pain, and depression.

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-hosts, Faaizah Arshad and Jessica Hagen.

Faaizah Arshad

Hi Kim! So glad to be here and excited for this conversation. 

Jessica Hagen

Hi Kim.

Kim Bullock

Yes! We have today Dr. Maheen Mausoof Adamson, who is a clinical associate professor of Neurosurgery at Stanford School of Medicine, Director of Research for Women's Operational Military Exposure Network (WOMEN) at War Related Illness & Injury Study Center (WRIISC), and Senior Scientist for the Rehabilitation Services at the VA Palo Alto. She is a neuroscientist by profession, and Dr. Adamson completed the Stanford Byer’s Biodesign Faculty Innovation Fellowship and a Master’s of Science in Healthcare Leadership at Brown University. Dr. Adamson utilizes innovative tools such as neuroimaging, neuromodulation, genetics, proteomics, and virtual reality for improving the lives of adults with traumatic brain injuries, Alzheimer’s disease, pain, and depression. Welcome Dr. Adamson. You have had such an amazing and varied career in so many areas. We could do a whole show on any number of your interests. And, yeah, I'm really particularly interested in your healthcare leadership and educational experiences that really have impacted going forward with virtual reality. And maybe we can begin with a focus on how and when you began your interest in the use of virtual reality.

Maheen Mausoof Adamson

Thank you very much for inviting me for this. I'm really appreciative of this, and I’m extra, extra happy that this is a podcast about XR because it has come such a long way. So I am going to actually go way back and talk about how immersive experience was exposed to me. This is really interesting. When I came here as a postdoc at Stanford, I worked in the flight simulation lab at the VA and Stanford flight simulation center, and it was a research study that was with Jerry Yesavage and Joy Taylor.

Kim Bullock

Wow.

Maheen Mausoof Adamson

And they had a real Frasca —that's what it's called, the engine— and you could sit in there, and the idea was simulation of flight. So, pilots could sit in there and get that experience so that it made them do all these incredibly complex cognitive tasks. So, they could imagine that they were in the plane flying. And during that time, we tried to measure their eye tracking with Tobii eye cameras. This is 15 years ago. And we also went to visit all these different driving simulators at Stanford. We went to USC. I saw the original virtual Iraq that Dr. Skip Rizzo had created. We also went to NASA and saw their flight simulations. And it was so intense and such an intense experience. But at the same time, it was all big screens, right? So, you had to sit in the middle, and you were immersed in this technology because you had these big screens surrounding you. And that was immersive enough for me, right? As we move forward into this era with… I have a 19 year old, he's the first one who introduced the headset to me before anybody else did. And I was like, “Oh, my God, this is crazy!” I have all these things happening at the same time. And the first thing that outright came up to me was that “How do I handle vertigo?” because I have vertigo. And that was way back about six, seven years ago. And I feel like technology has changed so much. So right before the pandemic… because I'm at the VA and most of my research is with Veterans who, after they serve the country, have had some incredible experiences that have caused many health problems. Some of them are physical, some of them are mental, and some of them are altogether. And a lot of them are in areas that are very difficult to get to. So, VA Palo Alto is a flagship VA hospital, but it's in a very expensive area. And it's far away from Central Valley. It's far, and lots of Veterans don't have the resources to come. So, about a few years ago— this is before the pandemic again, I keep saying that because the pandemic changed the world a lot in terms of virtual reality as well— and we were doing certain things like assessing them and giving them certain at-home tasks to do and we were approached by certain companies and they were trying out these things. They just gave a headset to a patient and said, “Hey, what did you think?” They gave it to a couple of patients. And if you look at a presentation that I do, it's about 12 patients, I think, and they all said, “Wow, I'd love to have this at home.” Now in our department, which is Polytrauma Rehab Department, and I work with an incredible team— it's Esmeralda Madrigal and Molly Timmerman, Joyce Chung— and we were all like, “Huh, can we send these home?” I mean, it was like epiphany, right. And of course, in those days before the pandemic, nobody dared say anything like that, right? Because everyone was at work. There was no such thing as virtual work. I mean, there was, but you know, and especially when you're working with the federal government, our rules are different. They're very strict. So, we were kind of like, “Okay, we'll try to do it.” And then when the pandemic hit, things changed, and the VA has really been very supportive. So that's really kind of my journey of getting into virtual reality as a physical, you know, thing that you could do with patients. 

Kim Bullock

Wow, that's fascinating. And what were you using when you originally were giving the headsets to the Veterans? What were you using it for?

Maheen Mausoof Adamson

Sure.

Kim Bullock

Was it just distraction? Or was there a purpose? Or was there certain content? Or were you just kind of playing with it and observing?

Maheen Mausoof Adamson

So, lots of things. So, I'm going to tell you a little bit about my own research so you can see why I'm doing this. So, I've been looking at cognitive decline, dementia, Alzheimer's disease, and also the mechanisms behind it. But about six, seven years ago, I started working with Dr. Odette Harris, who's a neurosurgeon and a Chief of Staff at VA, and also at Stanford a Professor of brain injury. So she brought me in because she wanted me to really look at the research behind traumatic brain injury. And traumatic brain injury is a big umbrella term because under it comes all these different psychiatric and physical problems. And so when I came in, I was really focused on looking at brain injury and the problems that lead to executive function problems, cognitive decline that can lead to dementia. And pain is another huge issue, and so is PTSD, anxieties and other issues. So, when I was looking —I do brain imaging, and you said in my introduction, I do all these other things— but when I became Research Director under her, one of the things that she told me to do is like, “Hey, look at the whole spectrum, I want you to look at epidemiology, diagnosis, treatment, rehab.” And this was told to me like, five years ago, and I was like, “Okay, well, if you do one thing, and we take it all the way to treatment, how do we align the diagnosis with the treatment and in rehab?” So treatment is one thing, and then you can take it home or use it in rehab. So we looked at companies that were giving us VR headsets for meditation. That was our goal, so that meditation could help people with PTSD. It could help them with anxiety. If they're sitting at a doctor's appointment, maybe we can offer it to them when they're in-patient, and they can relax with it. Now, remember, VA is all adults, right? So this is kind of like in pediatrics… you have when they're going through surgery, they see VR, and they're kind of calming down. We don't have children at the VA. So this is kind of like, you know, helping them calm down. So that was one aspect of it. The other aspect was I worked with a couple of companies. One was, we tried to work with them— actually, it was a good experience, but we wrote some grants, which didn't get funded at that time. This is pre pandemic. The name of the company was Karuna.

Kim Bullock

Oh, yeah, Karuna. Oh, yeah, I worked with them.

Maheen Mausoof Adamson

Yeah.

Kim Bullock

They were one of the first to get on-board.

Maheen Mausoof Adamson

And they were, they were very good. And they always joked about it. They're like, “Oh, our name is like, you know, the virus.” But, they actually had really good metrics that could be obtained from their physical therapy. And so, I think since then, we are working with another company to do meditation. But I don't remember the name of the company that we're working with now. But the idea was that we ran about 15 patients on their task, and we got the data. And the idea was that we were trying to take care of upper shoulder pain. So, we could test the entire procedure to help with using VR. And so that was pain. That was PTSD. And then, during the pandemic, I got approached by my friend at the Naval Postgraduate School. Naval Postgraduate School has a very large simulation department. They are very well funded by DOD (U.S. Department of Defense). They're an amazing place to visit. They have the warfighter program, and there's like all this AR and stuff going on. It's pretty cool. So, my friend approached me, and her name is Dr. Quinn Kennedy— very well known in the aging world; does a lot of wonderful papers and podcasts and now consults for another company called neuroFit; very much interested in cognitive aging and how we can live a better healthy brain life. So, she approached me and she said, “Hey, you know, why don't we do a project with the Air Force Gaming lab and do a VR project because we're so much into VR. Can you think of something that would help VA Palo Alto?” We had, at that time, a building that was ready to move in, but we just moved in it, just like a month ago. So, at that time, it was almost ready to move in. But we had these big rooms in it called Smart Rooms. And what those rooms were is after you've had TBI and you're kind of recovering. You stay in those rooms for three months, or six weeks. And those rooms are very nice. And they have all these USB ports. There’s a big living room and kitchen, and there's a side bedroom and bathroom, and the caregiver can live with you. And it's a place where you can construct experiments maybe and get rehab data. So, we had this idea that we would take the blueprint of the room and give it to the Air Force Gaming lab, and they would make a simulation out of it. And what we would do is we would go to our occupational therapist and our physical therapist at the VA and say, “Hey, what are the tasks that you do with these patients? Tell us what the tasks are.” And take those tasks and simulate them in that room. And so we did that. We did that in the pandemic. We actually created this beautiful simulation. And it was a task like pick up the medicine bottle, how many pencils are there, put them — and it’s all done by you know, virtual reality with these gears, and handheld and virtual. And we did it and we ran it in about 21 providers. Our whole thing was — this was one of the things I learned from my leadership at Brown is — that you can't give a task to a patient until the provider agrees that this is good for them. So, the provider buy-in is really important. So, the patients like… occupational therapists, physical therapists, neurologists, PMNR specialists, they need to see it and they need to say, “Okay, this is something my patients will use.” It's a beautiful project because from the start we had everyone's input. And then we had them do the actual and we published it in Frontiers. So the idea was that in this VR, I have already told you we used it for meditation, we used it for chronic upper shoulder pain, and in this, we used it for executive function, organization, daily tasks. So what's called ADLs and LADLs. Yeah, so long story short, that's the answer. 

Kim Bullock

Yeah, that is so fascinating. I've got 100 more questions for you. But I'll open it up to my co-hosts, Faaizah and Jessica, to weigh in here and ask you what's on their mind.

Jessica Hagen

I'm actually quite curious, what was the response from patients to having the VR simulation? 

Maheen Mausoof Adamson

We have some quotes that we always give in our talks, and most of them were like, “Wow, this is awesome. Like, why don't we have this? Why didn’t you show this to me before? Why can't I have it at home?” So, everybody really, really liked it. There were a few complaints of like, “Oh, this is jerky or this is vertigo.” But the more you used it, the better the comments were. One thing I do want to point out, though: vertigo is more common in women and Veterans are mostly male.

Jessica Hagen

I experienced that when I went to Oculus 5, long ago. And I experienced that. I did some VR experience there, and I just got the worst vertigo, and I had to stop doing it right in the middle. I feel like the technology has definitely progressed though to get a little bit better in that regard.

Maheen Mausoof Adamson

It has. It's become really good. In fact, I just went to another conference. I think it was in September or October. And Kim knows this more than anybody else. You use VR for getting rid of phobias. And one of the phobias is of heights. And in my opinion and what I experienced is, when I'm standing on a really high height, I am scared out of my mind. Then I get that vertigo feeling where the ground is rising up to me and going down. And so it's like that Alfred Hitchcock movie, but I feel like it may be that VR is the best medicine to get rid of vertigo. That's what I've been told.

Jessica Hagen

Oh, you think so?

Maheen Mausoof Adamson

In fact, Dr. Walter Greenleaf, who's a mentor of mine, has actually said that to me. He goes, “Hey, you know, you could try to get rid of some of your vertigo by actually doing this.” But I'm too chicken.

Faaizah Arshad

Dr. Adamson, I wanted to ask you so you've talked about how VR can be used for different things like vertigo and phobias. And, you know, you've done a lot of research on patients with traumatic brain injury. Do you see VR as mainly a tool to treat traumatic brain injury or can it also be valuable in diagnosing TBI too. And I'm not very familiar with like what technologies are currently used to diagnose TBI. But like, do you think virtual reality can be beneficial in that aspect?

Maheen Mausoof Adamson

This is such an important question! And it's such a deep question because it actually tells us about the potential of VR in the future in clinical populations that are subtle, right. So I used to think that it's really difficult to work with severe TBI patients. I think it's really difficult to work with mild and moderate because their symptoms are so subtle, right? They may improve, but then they are more at risk for, you know, developing cognitive decline. So, after they have gotten treatment, their concussion symptoms can go away, but they still have risk for developing other things. So one of the things that's happening in the TBI world, and it's been happening for a long time… so there's different ways of diagnosing TBI, right. So we have the self-report, or clinically administered questionnaires, in which the clinician asks “When did you have it? How long ago? This and that.” This is with mild and moderate TBI. You know we deal with Veterans, so they've had their TBI a long time ago. So, when you ask those questions, you can ask about how long your loss of consciousness was, how long did you have your post traumatic amnesia, all of those questions. Those are good questions, clinical questions. You still need objective measures. And some of the objective measures could be brain imaging, which I still love, but I think it's expensive. But if you can look at, you know, fiber tracks that are shearing or certain resting state showing areas in executive function in their network that's down, that's a great way to diagnose, I think, in a research way. But one of the other ways that people are looking at is eye tracking. So, you have this ocular motor activity— simple idea would be that you have a dot and you can follow it. You can measure it according to the average and how it looks in healthy people compared to how it looks in traumatic brain injury patients, mild and moderate. So, we did a study like that in my lab with neuroFit’s Dorion Liston. And eye tracking is really good at that. A lot of headsets come with eye tracking. So, suppose: this is just a scenario. You have a Marine who has had traumatic brain injury, young guy— this is completely hypothetical— loves to play games, you know, uses headsets. Could it be possible that he's playing video games, or he's doing a task that we provide him in his home with the headset, and ocular motor activities being measured? He's had TBI, he's recovered. But he's doing this again and again, and any kind of switch, any kind of change in his eye tracking can help us see that something's going on. Now, that could also be associated with certain tasks that he's doing, he or she, you could have cognitive tasks and get scores off of them, executive function tasks, emotional or PTSD. And we can measure those to see whether they're falling in the mean, or whether they're two or three standard deviations away. So, there are ways to make this very predictable, very diagnostic and very helpful, other than just something that you use for what's called therapy and also assessment.

Kim Bullock

Great.

Jessica Hagen

And what type of barriers do you see to applying that type of research and clinical care?

Maheen Mausoof Adamson

So, I wear this research hat, and then I wear this ethical hat. So, I'll switch the hats now. One is, of course, patients’ consent is one thing, but then also making sure that there's no coercion, making sure that we are not causing more problems than necessary. So, one thing that is important in the aging population is fatigue. So, eye fatigue, and making sure that the head, the neck, all these physical ailments that can happen with a headset, the weight of the headset, all of those physical things— you have to be very careful about that because you don't want to cause literally physical burden on the patient. The other obstacle that I see is, you know, Kim is a clinician, but she's very much into research. She understands. We are researchers. We love data. And we want data now. We wanted it yesterday, right? But it's difficult to get data from patients— that's one claim— and second, allowable by the VA. So, if you work for the federal government, and you're working with a population that is the one that I just mentioned, we have to go through the hurdles of creating a smooth pathway because if you're tracking and if you're predicting, you want data to be simultaneous. You don't want it to come two days late. So, those are some of the biggest obstacles that I feel that we need to overcome. Now, one of the best things that has happened in the past few years is we have what's called the VHA Innovation Excellence Center. And it's at the VA central office. And there are very capable leaders there that are really helping virtual reality reach to a ton of other VA hospitals. They are literally working very hard to make this very smooth for Veterans. There is Caitlin Rawlins. There is Anne Bailey. They're working very hard on this. At VA Palo Alto, we also have Dr. Thomas Osborne. I think Kim, you might know him. He's the Chief Medical Officer at the VA Palo Alto. And he's doing some really incredible VR and AR innovation work. And he's also doing it in the surgical unit, which is really cool.

Kim Bullock

Wow. Well, yeah, speaking of leadership, what do you think are the key leadership skills, especially since you've had some specialty training in that through Brown and through your Byer’s fellowship? Are there leadership skills or behaviors you think that are needed, or are in place that are moving XR and behavioral health forward? Could you give us the Cliff Notes of what you know?

Maheen Mausoof Adamson

Sure, I think I'm kind of, in a way, I feel like I'm preaching to the choir because you guys are already doing this by all kinds of stuff, including this podcast. But I think it was really interesting doing this Master’s of Healthcare Leadership during the pandemic because it changed so much about leadership. If you read any of the articles that come out by McKinsey or Harvard Business Review, leadership has really turned literally over its head, right? So, before you remember that it was like this pyramid of workers and then you have the employees and then the leaders at the top. Now leadership has switched and the leader is holding everybody up. We're responsible of holding everyone up. We are responsible of being engaging and making sure that our biggest resource, which is the human capital— which are employees, and people who are actually doing the work— they are happy with what they're doing, and in that, creating relationships, and making sure that you're giving credit to everybody.

Kim Bullock

Sounds like more of a feminine style over the masculine.

Maheen Mausoof Adamson

Absolutely Kim! And absolutely. And, and we have to be very careful. And I'm not saying I'm clean. I've made mistakes. Everybody does, right? And I make mistakes almost every day. But the key thing here is to realize that even though it's feminine, we are trained in the male patriarchal system, so we may follow the rule. But the inside says, “Okay, no, you know, you have to bring people in and give credit to people.” And also the other thing that's incredibly important, and as researchers especially, we don't think about this as much as clinicians do: patients are number one. They have to be the center. The Veteran patient is number one. He or she has to be the center. And everything has to be applicable to them. Whatever project I work on, no matter how exciting it is, if it's not translatable to the bedside… and not even the bedside… in-home, if it's not given in the hands of the patient, it's useless to me. So, I have to think that way. And another thing that is really important about VR, which I love, is that it puts care into the hands of people who can't afford it. And those very rare things like that. Like medicines cost a lot, all the techniques we do— MRI— costs a lot, TMS costs a lot, everything costs so much. So if you can actually do this in populations that live far away, that are challenged by income, that are marginalized by race, ethnicity, by gender, then you can actually provide this. And I think, constantly kind of questioning yourself, looking at your population (who you're serving), is an art of leadership that we are learning and we continuously have to do all the time.

Kim Bullock

That's a great way to frame it. And yeah, thank you.

Faaizah Arshad

Yeah, on that note of accessibility, I was thinking: So, in the past, when I've been at the VA and I volunteered, I've noticed that sometimes Veterans can be afraid to ask for help if maybe they feel stigma, and this is something we've talked about on a past episode too. So, I'd love to hear your input. You know, sometimes there can be that like fear of judgment. So how do you think that providers can improve therapeutic alliance with Veteran and military populations to continue making VR treatment accessible because it's so important to do that? What's a good way to establish that trust and rapport?

Maheen Mausoof Adamson

So, recruitment’s always really hard, right? And it's been tough to recruit on clinical trials and things like that. What I noticed about Veterans is that they are a group of people, and I may be correct in saying that people who work in the military — the Veterans across the world — have this phenomenon: they're very tight together. And if they see one person who has served in one, they communicate with each other, and they have what's called a buddy system, or a sister system, however you call it. And they like to help each other a lot. I have yet to find a Veteran who I say, “Hey, I'm doing this research. And I would like you to be part of it because it helps other Veterans”… I've yet to find somebody who says, “No.” They're always ready. And we don't give out a lot of money or anything like that. It's like completely up to them. So, they're very, very open about it. They're very helpful. We know that it's difficult for them to open up. And people always talk about trauma and sexual trauma. And they talk about women. But there's also sexual trauma in men in military. And there's PTSD that they don't want to talk about. There's a stigma with it. So, one of the things that we have tried to do, and one of the things that VA does, is to work with the Veteran service organizations and have volunteers that go out in the Veteran community that look like them, that have had similar experiences like them, so we can communicate with them and get them to be part of our studies or part of our clinic. Give them access to our health care. And the other thing is, a lot of the people go to private healthcare instead of the VA because they don't think the VA can help them. So, putting a better word out for the VA and telling them that the kind of exposure that you've had in the battlefield, is what our doctors know about. 

Kim Bullock

Yeah, so bringing peers in, it sounds like, pair it with either the group as a whole or bringing peers in. But sounds like that's crucial, and especially to research.

Maheen Mausoof Adamson

Right. I mean, we know about military trauma. We know about combat PTSD. We know about, you know, Gulf War illness. We know about Agent Orange. Like this is what we are trained to understand. So, trying to open up on that level. And then also, again, coming to the leadership thing, and I think doctors are really good at this is that when a patient comes in, don't tell them about yourself. Ask them questions about them. Right? So that's like, “Oh, yes. I have a degree in neuroscience. And I went to Brown,” and they're like, “I'm here to help you tell me about you.” And why don't we make them feel comfortable, you know.

Kim Bullock

Yeah.

Maheen Mausoof Adamson

I want my doctor to make me feel comfortable. It's a scary thing. I always say to my… I have three brothers who are engineers, and I say, “You guys are like in a very easy profession.” Because in medicine, everyone comes to you at their lowest point. They're sick. So, you have to be nice to them. You have to get them to tell you what's going on. Because self-report is a very difficult variable.

Jessica Hagen

It's difficult for a lot of people to open up and be honest. And you know, to have a healthcare provider that's open to that honesty and is receptive is incredibly important.

Maheen Mausoof Adamson

And maybe that's another angle VR can help with right.

Kim Bullock

Yeah, one of my last questions is, what is your vision for how XR could be most helpful in the field of mental health? Or how would you like to see XR being used in 100 years? Like what's your dream for XR? Or do you have one? You don't have to have one?

Maheen Mausoof Adamson

I do. I actually do. I mean we didn't talk about… I know XR includes both VR and AR and we didn't really talk about AR in the sense that AR is used a lot for simulations, education purposes, and things like that, skill learning. But I really see VR reducing depression in older adults— people who can't leave their nursing homes, people who can’t walk too much, who have a difficult time speaking. They're older. Their kids are far away. My mom lives, you know, my mom is in Pakistan. She's currently in Dubai, partying with the rest of her, you know, people, but she's far away. She's 80 years old. And FaceTime is good. But to me, the personal thing would be that you can bring people— and I know that there are companies that are doing this— you can bring the actual presence of their daughter into the headset.

Kim Bullock

Yeah.

Maheen Mausoof Adamson

Creating that emotional connection is, I think, it's going to be amazing if you can do that.

Kim Bullock

Yeah.

Maheen Mausoof Adamson

Yeah. And the challenge for that is teaching older adults how to use it.

Kim Bullock

Yes.

Maheen Mausoof Adamson

But by the time we get to this point, I will be the older adult and I’m over it.

Kim Bullock

There might be more acceptability by then.

Maheen Mausoof Adamson

Exactly. So, I think I see that. I also see a lot of precision medicine being given. And all these different storytelling scenarios you have in VR can be precisely adapted for different things. Different racial— Example: I'm going to say the word racism. You could have scenarios created in which people could understand what is considered racist in an environment. And that's a very murky subject. But I think you could do it with simulations.

Kim Bullock

I think you can change implicit biases. That's what I think is so fascinating.

Maheen Mausoof Adamson

Exactly. You said it.

Kim Bullock

You can actually… Yeah.

Maheen Mausoof Adamson

You could do it without even telling them. It's happening. Yeah.

Kim Bullock

Yeah. Indirectly getting to those deep brain structures and biases.

Maheen Mausoof Adamson

Exactly. And that's what happens to us, right? We think we're doing great, but then something implicit happens, and our reaction is exactly the way it was reported in the newspaper. And you're like, “No way.” 

Kim Bullock

Yeah.

Maheen Mausoof Adamson

Right. So.

Kim Bullock

So, anything else that you'd like to share with the listeners or a topic we didn't cover, that's really important?

Maheen Mausoof Adamson

I think you introduced me as the Director of Research for the Women's Center, which just started in October. It's a national VA funded center that helps women who have been exposed, who've had several different toxic exposures during their time in the military. And I really am excited about this center, particularly because I have been working in polytrauma, looking at symptom, treatment, rehab, brain differences that are based on sex, right. I think no matter what, the trauma women face is different from the trauma men face. So, I think, every treatment — and I'm doing the same with TMS… I'm trying to find out like with transcranial magnetic stimulation, what are the differences with women versus men— I think that with VR, we have to do the same. We have to figure out how women respond to it and how men respond to it, just like we see children respond to it, especially if it has to do with treatment. And I don't know about you Kim, but I don't think there are enough clinical trials that tell us that VR is at least, VR is better than standard of care, or VR is not, is the same. I don't think there's enough clinical trial. I don't think that there's enough. There's a lot of conferences. There's a lot of talk. There's a lot of projects going on. But I feel like there's not enough money that's being pushed towards it by any of these agencies. And I think that one of the reasons why we have so much data coming out is because we have a lot of support from industry.

Kim Bullock

Yeah.

Maheen Mausoof Adamson

And industry support is very different from a regulated, organized, federally funded trial.

Kim Bullock

You're absolutely right. All right.

Maheen Mausoof Adamson

Those are my last words.

Kim Bullock

Oh, my gosh, this was amazing. This was a very rich, important conversation, but definitely could be continued. There's so much more to say as well. Thank you so much for your time, Dr. Adamson. We very much appreciate it and all you do for patients and providers and research in the world. Thank you. And we'd love to have you again because I have a feeling we have much more to talk about.

Maheen Mausoof Adamson

Thank you very much. I really appreciate it. And thank you for letting me talk about the background of VR and how I was exposed to it and what I'm doing with it now.

Faaizah Arshad

Thank you Dr. Adamson.

Maheen Mausoof Adamson

Thank you.

Kim Bullock

So that's it for this episode of Psychiatry XR. We hope you gained a new perspective on using extended reality in health care, and thank you so much for listening. And this episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology in mental health. And 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 another guest talk about XR and its use in psychiatric care. You can join us monthly on Apple Podcasts, Twitter, Spotify or wherever you get your podcasts. Psychiatry XR was produced by myself, Kim Bullock, Faaizah Arshad, and Jessica Hagen. And please note the podcast is distinct from my own clinical teaching and research roles at Stanford. The information provided is not medical advice and should not be considered or taken as a replacement for medical advice. And this episode was edited by David Bell and music and audio was produced by Austin Hagen. See you next time.