Risa Weisberg: At-Home VR Interventions
Jessica Hagen and Faaizah Arshad speak with Risa Weisberg, Chief Clinical Officer of BehaVR, on the potential for at-home scalability of care options with VR products, with the goal of improving overall immersive technology accessibility.
BIO
Risa Weisberg, Ph.D. is a licensed clinical psychologist and renowned expert in cognitive-behavioral therapy. She is a Professor of Psychiatry at Boston University School of Medicine and an Adjunct Professor of Family Medicine at Brown University. Dr. Weisberg is a Fellow and former member of the Board of Directors of the Association for Behavioral and Cognitive Therapy. She sits on the Scientific Council of the Anxiety and Depression Association of America, where she was the Treasurer and served two terms on the Board of Directors. She came to BehaVR from the Boston Veterans Administration Healthcare System, where she was the Assistant Chief of Psychology. Dr. Weisberg is an active and prolific researcher, having been continually funded through 18 grants from the National Institutes of Health (NIH), the Veteran's Administration, and other research foundations for the last two decades. She is a frequent grant reviewer for NIH and international scientific funding agencies. She has authored or co-authored approximately 90 journal articles, book chapters, and books. Her research focuses on developing and evaluating brief, more accessible, interventions for common mental and behavioral health problems, including anxiety, depression, chronic pain, substance use disorders, and living with other chronic medical problems.
The following is a transcript of the episode:
Jessica Hagen
Hello and welcome back to Psychiatry XR where we're exploring the use of immersive technology in psychiatric care. I'm your host for this episode Jessica Hagen. I'm a healthcare reporter covering the pharmaceutical and biotechnology industries and general happenings within healthcare globally. I'm happy to be joined by one of the podcast co-founders, Faaizah Arshad.
Faaizah Arshad
Hi Jessica. I'm thrilled to be here.
Jessica Hagen
In each episode, we invite a new guest to provide insight into the potential benefits, challenges and questions around immersive technologies and mental health care. Today, we're delighted to welcome Dr. Risa Weisberg, BehaVR’s Chief Clinical Officer. BehaVR creates digital therapeutics for mental and behavioral health using virtual reality. Dr. Weisberg is a licensed clinical psychologist and renowned expert in cognitive behavioral therapy. She is a professor of psychiatry at Boston University School of Medicine and an adjunct professor of family medicine at Brown University. Dr. Weisberg is a fellow and former member of the Board of Directors of the Association for Behavioral and Cognitive Therapy. She sits on the Scientific Council of the Anxiety and Depression Association of America, where she was the treasurer and served two terms on the board of directors. She came to behavior from the Boston Veterans Administration health care system, where she was the Assistant Chief of Psychology. She's an active and prolific researcher having been continually funded through 18 grants from the National Institutes of Health, the Veterans Administration and other research foundations for the last two decades. She is a frequent grant reviewer for the NIH and international scientific funding agencies. Her research focuses on developing and evaluating brief, more accessible interventions for common mental and behavioral health problems, including anxiety, depression, chronic pain, substance use disorders, and living with other chronic medical conditions. Thank you so much for joining us. Dr. Weisberg!
Risa Weisberg
Thank you so much for having me today. I'm thrilled to be here. And thank you for that very grand introduction. Very much appreciate that.
Jessica Hagen
It's well deserved. Can you tell me about BehaVR, its offerings and what the organization strives to accomplish and clinical psychiatric care?
Risa Weisberg
At BehaVR, we envision a world resilient from fear and pain. We include both physical and emotional pain in that definition. And our goal is to bring, into the homes and literally the heads of patients who need care, evidence based clinically validated treatment for common emotional and behavioral problems. We're creating fully immersive cognitive behavioral therapies in virtual reality environments.
Faaizah Arshad
That is so important Dr. Weisberg, especially about making sure that treatments are evidence based and clinically validated. And so what clinical trials or studies have taken place on BehaVR experiences? Where have they been done? And what are the results showing?
Risa Weisberg
Sure. So we have currently run a few small scale pilot studies of our work. Larger RCTs are coming very, very shortly. Currently, we just completed a study run by Dr. Garland of University of Utah, which was a pilot of our VR product for opioid use disorder. This treatment is called MORE VR. MORE is a treatment that Dr. Garland has created— Mindfulness, Oriented, Recovery, Enhancement— and we've produced a VR version of this treatment that has lots of empirical support IRL, so outside of VR, and now have piloted out in a small sample in VR, and just found that it was associated with reduced craving for opioids, as well as reduced negative effect and increased positive effect. So we're very excited to be soon launching a full RCT intervention which is really created to be used alongside medication for opioid use disorder. That study is funded through the National Institute of Drug Abuse through an SBIR grant, to us at BehaVR in collaboration with Dr. Garland at the University of Utah. So we're very excited about the pilot data and eager to get started on the full scale RCT. The other data that I actually just got to see this morning is from a small pilot RCT on our pain neuroscience education product, which is an intervention for chronic pain designed really to be used alongside physical therapy. And in that study done by a research team at Hanover College in Indiana, they found that as compared to patients who received physical therapy alone, those who got physical therapy together with pain neuroscience education in VR, has lower ratings of pain at the end of six weeks. And that is also an intervention that we are currently subjecting to a larger randomized clinical trial, which is being conducted by researchers at Belmont University and University of Utah. I think that study should close recruitment sometime this summer. And we're hoping to see results in the fall.
Jessica Hagen
So many times when patients are suffering from pain, they aren't consistently in the clinical setting. So it seems a long term objective of BehaVR is to create at home interventions with or without clinical oversight. Can you tell me why BehaVR believes it's vital for more at home care options to exist? And does this has anything to do with the aging baby boomer population?
Risa Weisberg
So the bottom line is, we do not have enough mental health specialists to meet the demand. There have never been enough psychiatrists, psychologists, social workers, licensed mental health counselors to meet the need. This has been a problem we've known for a very long time. And our main goal in developing interventions that can be used at home is really the increased access to treatments that work. Making treatments that only work when they're done in the clinic doesn't increase access to treatment, because you have to already have that access to get the treatment. And that's really our primary goal in bringing treatment to VR is to increase access. So we're designing interventions that can be used by individual patients in our homes who are looking at two levels of care. Some of our interventions are being designed to intentionally be marketed directly to consumer and to be wellness interventions, so that individuals with low levels of anxiety, depression, pain, may be able to access them directly, and it may keep them out of the need to engage in further care and therefore not utilizing spaces that could be used by patients who really do need to see that psychiatrist or mental health specialist. Other interventions we are working on, so for example, our intervention for opioid use disorder, we realize this has to be a beside-the-pill type of intervention. Medication for opioid use disorder is obviously a first line intervention, and we've felt strongly a necessary one. So this is an intervention that we're seeking prescription privileges for and going through FDA regulation processes for. We have an FDA pre submission under review currently and are waiting for our first conversation with them. So we're really seeing this sort of both home use, and then some interventions that can be done either in clinic or at least prescribed by an appropriate clinician to then be used at home. But the goal is to increase access to psychotherapy is so even if treatments might be prescribed by a medical professional, often, there isn't time for psychiatrists to also be doing cognitive behavioral therapies and frontline therapies. And it's really hard for even psychiatrists sometimes to find spaces in CBT practitioners practices for their own patients. And so we really feel strongly that these treatments need to be accessible without having to be done in the office.
Jessica Hagen
You've seen a lot of benefit then in combination therapy, and if you're going after the FDA approval, right, so what is that extra benefit that VR offers to combination therapy?
Risa Weisberg
Specifically for the opioid use disorder population, we know that medication for opioid use disorder is a frontline therapy and it's not something that outside of VR, is any different. So psychotherapy for opioid use disorder is helpful as an adjunct to medication. But buprenorphine, methadone, those medications are really the frontline treatment. And so we wouldn’t attempt to do anything in VR that was different than the standard of care outside the VR. For other interventions that we're developing, so for anxiety and depression, for example, we can see the possibility of combined treatments or standalone therapies as well, because that's how it really looks in terms of the data that comes from clinical trials done in real life outside of VR. So head to head trials have shown the four that cognitive behavioral therapy for anxiety and depression sometimes works just as well, sometimes works better than combination in therapy, sometimes combination therapy works better. And so mostly in real life, we see that as a patient choice type of issue. Some patients are going to prefer the ease of medication. Some patients, particularly with anxiety disorders, prefer not to take medications and to have psychotherapy. So we are developing those treatments to be used either adjunctive or standalone.
Faaizah Arshad
Yeah, and I strongly agree with the need to prioritize patient choice. And I think it seems relevant and important that BehaVR is trying to increase that at home accessibility. And so do you think then that there's a potential for at home scalability as well with psychiatric VR technology, because of the need for just more at home options?
Risa Weisberg
So certainly, over the last couple of years, we've seen a strong increase in the number of digital mental health companies and digital mental health offerings. The pandemic has obviously boosted what was going on before that as well, which was that patients were having a hard time getting into psychotherapy and technology attempted to answer that and fill that need. We sometimes get questions about the scalability of our products in particular given that they're in VR. A lot of other digital mental health companies are building interventions for use on your phone or building apps. There was a time, and I'm old enough to remember this, when we couldn't imagine a scenario where everybody would have a phone in their pocket. And we certainly can't imagine a scenario where everyone's phone in their pocket, could be really a full computer. And that you can do treatment over that phone, that you could engage in filling out questionnaires and see video and even see a therapist over your phone. That felt absolutely far-fetched. And then even once smartphones hit the market, there were still initially really only accessible to a few patients and to individuals who had a higher income level. Now we find that's really not the case and that smartphones have really made their way into the hands and pockets of almost everyone in our country. We envision a future where that would be the case for VR as well. VR headsets and headset technology has really taken off in the last couple of years, and is getting more and more portable, and cheaper and cheaper. So currently, the Meta Quest, which is the headset for which we're building a lot of our products now is $299. A session of CBT without insurance, depending on where you live in the country can easily cost you $300 and if you live in Manhattan, or in LA, it's going to be more expensive than that. If you're covered by insurance, perhaps you might be able to get CBT with a $30 copay. So we're still talking about less than a course of treatment to buy that whole headset, and the numbers and the prices are going to continue to come down. As more and more competitors hit the market. We're seeing news from Apple that they're getting into the VR game. And a number of other really big players, which is only going to drive the price of headsets down. So we do think that is this is going to be hugely scalable. Because we see a future where pretty much every household is going to have at least one headset.
Jessica Hagen
So to circle back to the clinical aspect of it, many clinical settings and larger hospital systems are really embracing and understanding the enormous value of digital health, especially within psychiatric care, and are considering how to integrate those digital technologies into the hospital and clinical settings. So is BehaVR thinking about integration into hospital or clinical settings, or has the company already established some type of integration into these settings?
Risa Weisberg
We're absolutely thinking about that every day. We are building our platform for optimum interoperability. So we're building a platform that is first of all, as safe as possible for data security. So all of our products and platforms are HIPAA certified as well as SOC2 certified as company, so, because we know that that's important for our patients on their own, whether or not we're working together with hospital settings, but that definitely will increase our ability to be used in those settings as well. And then we're building our platform for interoperability with hospital EMRs. And that we have a whole arm of our company that is devoted to looking at how we can best engage and integrate with hospitals EMRs and also hospital workflows. We know that no one has time in their practice to get data and interact with a fully separate system. It just doesn't work that way. And so for us to be usable in workflows, we need to build ourselves into that workflow. And that's a very serious aim at BehaVR.
Jessica Hagen
And one thing that I have to ask because I know that a lot of psychiatrists using VR would want to know this, can you share exact billing codes that psychiatrists can use for measurement-based care and VR treatment?
Risa Weisberg
So unfortunately, there really are no exact billing codes that I can share at this point. And payment for all digital therapeutics is really still one of our biggest challenges. And that's not specific to VR. There's a lot of work being done in Congress and work being put forward from Medicaid, Medicare, to try to get billing codes for digital therapeutics. We're hoping to see that happen in the future. But there's no specific codes that I can share at this time.
Faaizah Arshad
And Dr. Weisberg, BehaVR did sign one of the largest deals in medical XR history when it signed on with Sumitomo pharma to work towards commercializing its offerings, so are the company's commercial offerings for at home use different from its clinical offerings?
Risa Weisberg
So thank you, yes, huge shout out to our collaboration with Sumitomo pharma. They've been amazing partners are working very, very closely with them on all of our anxiety and depression products. Currently, those are in development. And we are developing, again, two levels of those interventions. So there'll be a level that is for prescription by a appropriate provider that may be empty, but also really opening up to non empty mental health providers. And then also a level of care that will be really a wellness application and that would be marketed direct to consumer through the level of care, that would be really more of a wellness intervention and would be marketed direct to consumer through whatever headset app store there in or App Lab that they're in. In terms of at-home versus in clinic use, we’re less specific on where you're using it. So those interventions are really designed as standalone interventions. And so you might be prescribed the intervention from your provider and they might find it easiest to have a headset or two available in their office. And you come into the office, you meet with your psychiatrist, you have your med check, and then they put you in the headset in another room for your session. Or it might be that you're prescribed the intervention and part of that prescription comes with a headset and you have a headset for at home use. So the products are really being designed standalone. So whether it's done in the clinic or done at home, it won't really change what that product looks like.
Jessica Hagen
And then do you take information from physicians or clinicians that have used BehaVR to improve your product? Or how does that work?
Risa Weisberg
Absolutely. So we have a Scientific Advisory Board of clinicians who are also scientists who are contributing to the build of our products. And we also engage what we like to call superfans. So all BehaVR products are built based on empirically validated treatments in real life, and with a very strong evidence base on what we like to call our mechanisms of action. And equally so, based on game thinking, and what we like to call our mechanisms of engagement. Because interventions only work if people are willing to do them, and if they're engaging, people are going to be more likely to do them. So we're designing immersive and highly engaging interventions through game thinking. Game thinking talks about gathering data that we might think of in mental health research as really qualitative data through the use of superfans who are people who are most apt to use your product. And so we currently are engaging teams of patient superfans — so individuals with the types of anxiety, depression and substance use problems that we're targeting, who play test our products and give us feedback— and we also engage a panel of providers superfans who are sort of early adopters of VR interventions, and are able to give us feedback on our products as we develop them. We have super fans that are coalition's for our chronic pain products already kind of set up. But we're always looking for more clinician super fans for some of our products. So if any of your listeners are interested, they should get in touch with us because we're always looking for early adopters of psychiatric XR who might want to be super fans for us.
Jessica Hagen
And how about people outside people who are not as familiar with BehaVR? Are you doing clinical research or any type of clinical implementation with people who are outside of BehaVR who haven't actually used the product a lot?
Risa Weisberg
Yes, of course. So, our clinical trials right now are being conducted, most of them really to standalone scientists and grips, but with some of our support, so that they can understand how to best use the product. As we're running more and more clinical trials, some of those that work well give us data, not only about feasibility, and usability from the patient's perspective, which is information that we're always very interested in gathering. But we're also looking for feasibility, usability data from the provider perspective. So for example, the intervention that we just pilot tested for opioid use disorder, in that intervention, of the patients who went through the treatment —and again, that was run at University of Utah in collaboration with us, because we have the SBIR grant, but the trial itself, ran fully at Utah —the patients at the end of their treatment gave us likely likelihood to recommend scores, and we got our sort of net promoter scores from those patients and they have extremely high net promoter score. Actually the highest we've seen for any of our products came from our opioid use disorder product, which was interesting to see those patients really seem to take to the VR experience very well. When we pilot that, when we roll into our next RCT for that project, we hope to be doing it at multiple sites, and to then be gathering data from multiple sites of the providers who are referring their patients to the intervention and getting feedback from those providers as well as to how usable they thought it was, how much they felt that the product helped their patients. How feedback about their perspective on the feasibility of having patients engage in this kind of VR treatment. That's all very important data test, in terms of making sure that the things that we're building are going to not only vie to the right patient outcomes, but also be answering the need that providers see.
Faaizah Arshad
Right, and I think definitely looking at both the needs of the patient and provider is so important. And you touched a little bit on this earlier when you talked about how the pandemic has really elevated the need for improving accessibility of care. But I think also the pandemic has shone light on physician burnout, and therapies that not only help patients, but also really improve physician well being. So I'm curious to know what BehaVR can offer physicians that'll translate to efficiencies of practice to improve the well-being of providers? Could you elaborate on that?
Risa Weisberg
I see this as a really important question. And I have two separate lines of answers for this question. So one is, how do we free up providers workloads, because we know that a lot of burnout is really just from the actual circumstances of your work, and how many hours you're working, the severity of patients that you're seeing, and this feeling of really responsibility that it being very difficult to say no to patients in need even when your practice is full. I think every mental health provider has seen that more and more over the last few years. And I know even as a pretty well-connected mental health provider myself, in the last couple of years, I've had friends, family members, acquaintances, reach out to me to ask me if I can find a therapists for them, for their family member, or for their friend. And this past year, it's gotten really tough even for me with connections to find therapists. And so the need is really strong— if you are seeing patients, it's hard to turn any away right now. So part of how I think, all digital mental health products and all digital therapeutics, but in particular ones like what we're building at BehaVR, which are really full scale CBT products can help with burnout is the ability to share some of the burden for patient care. So if you are a psychiatrist, prescribing medication for your patients, to know you're not really in it fully alone. I think very often psychiatrists are looking for CBT practitioners for their patients to get that combined care. And they also cannot find available practitioners at this point. And so knowing that there's something else that you can be prescribing for your patients where they can be getting some of that care, and they can be doing it at home on their own. Our prescription digital therapeutics are going to be built alongside with a clinician control panel so that you can check in and see how your patients doing see their scores over time, make sure they're doing their homework. So you'll have some check in with them. But it'll be very easy and quick, as opposed to having to, you know, schedule full sessions with your patients. And so I think there's really the ability to ease up some of the burden of the workload, knowing that your patients are getting full scale treatments and being able to check in on them without really having to fit them into your full schedule. So that's one way. The other way, and I've been talking about this a lot lately, is the general wellness product that we're building has really gained more and more interest from hospitals and other healthcare settings as a potential burnout solution for providers themselves. Because we're all humans, and we all have stress, anxiety and mood problems. And that's really what the general wellness mood and behavior, mood and anxiety product is about. We know that burnout is not just about stress, and it's not just about working too many hours, it's about feeling disconnected from your work about losing a sense of meaning and value in your work. And that it leads to not just feeling stressed, but it's highly correlated with anxiety and depression symptomatology as well. And so, we are starting to partner with different settings to use the general wellness mood and anxiety program that's coming out in the fall for directly addressing healthcare worker burnout, as well. And so, you know, we like to envision a future where perhaps, providers are getting in the headset, as well as their patients for similar types of products.
Faaizah Arshad
Yeah, that's so important about how we've seen in the past few years during the pandemic, an increase in the need for mental health care, and therefore a greater workload on psychiatrists and professionals who provide medications. So is there a way then that BehaVR plans to sort of measure either quantitatively or qualitatively, whether physician burnout is really being alleviated with their technologies? Or how do you determine whether the product is doing the best of both worlds, which is improving patient outcomes, but also decreasing physician burnout?
Risa Weisberg
So in some of our potential partnerships at hospital settings, we're trying to utilize our product directly for use by healthcare workers will be gathering data on outcome data on burnout scales and anxiety and depression scales of those health care workers directly. So that's one answer. And then, in terms of decreasing the burden and decreasing burnout because patients have someplace else to go, we haven't directly at this point thought about measuring burnout, specifically in providers in those settings, but this is a great conversation and making me think that maybe we should! But we'll be looking at metrics of value based care in those settings. And so really being able to look overall, together with those institutions at, you know, how are their patients doing over time and with their care utilization, like and cost of care in those settings once they're utilizing our products? And I think that will give us some indirect feedback in terms of the overall potential impact on burnout if it looks like other types of utilization come down.
Faaizah Arshad
Yeah, I see how it can be challenging to measure and report such metrics and psychiatric care. But it's good to hear that there are efforts being done to potentially collect indirect feedback, because I think having data to help evaluate the performance of these kinds of technologies can contribute to better patient and physician outcomes. And when do you plan to start working with clinicians in the wild? Is that something that your company has started doing?
Risa Weisberg
So in terms of working with physicians in the wild, we are currently engaged with Hogue in LA and also with a number of physical therapists through relationship with Confluent, who is a very large provider of physical therapy throughout the country, and rolling out our treatments for chronic pain, neuroscience education with the physical therapy teams through Confluent, and in rolling out some of our treatments for stress and also for maternal health. So we have a product that we developed in concert with Hogue, called NurtureVR, which is for perinatal stress and depression. And so those things are already being utilized in those settings. As we develop further products, we will be developing those partnerships with provider organizations and hospitals and physician settings. Our anxiety and depression portfolio products that we're developing through our partnership with SMP, our first product will be the general wellness product, and which is again, general wellness for stress, anxiety and depression. And we anticipate that being available in October of 2022. So that'll be our first product there. So as we build those products, then we'll be building those partnerships as well for further implementation.
Faaizah Arshad
And then why do you think that BehaVR has gotten so much venture capital investment compared to other XR companies. What factors set you apart and have helped you achieve that kind of success?
Risa Weisberg
We've had a number of factors that really stand out in what we're building. And one of those is our equal attention to mechanisms of action with mechanisms of engagement. There are a number of XR companies that are working quickly to put things on the market that are mostly about mindfulness. And mindfulness in VR is an extremely impactful type of mechanism of action. We know mindfulness has a lot of great indications and good data for its impact on anxiety and mood for certain pain. But it's really just one mechanism of action. And we're really trying to build full scale cognitive behavioral interventions that aren't just focused on one or two techniques, but that are the full scale of treatment that you might get in a psychotherapist office, which tend to be more than just learning one, one particular technique like mindfulness. And so I think that's one thing that really makes us stand out, we are not only doing exposure based treatments in VR, which is something that's been done for a long time now as well. VR was often used for exposure-based treatments, but really only in a clinician’s office. So typically, you would need a cognitive behavioral psychologist to have you come into their office, and they would sit down with you and pick exactly which exposure scenes you might see in your head side and maybe tinker with those a bit. And while those were quite effective, and there's great data coming from those interventions, for their impact on anxiety, they didn't solve the access problem, because you still needed to have therapists there with you doing those. So we're taking things like mindfulness that are already happening and other through other VR companies, things like exposure that was happening, but only can happen in the therapists office. And I think what's really unique about behavior is we're also really building full scale cognitive therapy in VR, which not many if any other VR companies are doing. So we're using the VR platform as a place to really do metacognition, and be able to speak your thoughts out loud, and then see them and reach out and touch them, and sit with them and be able to weigh out the evidence for and against those thoughts. To be able to see how those thoughts connect to your emotions and their behaviors in a very real lived part of a VR experience. And I think that full scale range of mechanisms of action really makes us stand out.
Jessica Hagen
So as somebody who is so embedded within medical XR, technology has developed in ways that are really going to make a difference in healthcare and at home self-care. So in your viewpoint, how would you like to see XR used in psychiatric care? And what is the greatest challenge we need to solve to get there?
Risa Weisberg
It is at this point, I think getting very easy to imagine a future where every household has access to XR. And we're, not just like every household has a headset, but every household has a person that has a set of eyeglasses. That ability to be getting full scale treatments in people's homes very easily through XR I think is really where we'll be in 100 years. I think the technology pieces of that are not one of the greatest challenges at all, I think that's coming along really quickly. And the technology is getting better and better and lighter, and easier, and less expensive. So I think sometimes people who are not as familiar with XR think that technology is what our challenge is, and think that app-based interventions are really more of the way of the future. I think app-based interventions are the way maybe of the present maybe a little bit of past, and that XR interventions are the way of the future. So I don't think that's our challenge. I think our challenge is that, together with all other types of digital therapeutics, we don't yet have great means to get proper reimbursement for prescribing digital therapeutics. So this goes to your other question earlier, about, you know, how do we get these into practices and whether payment models, we're still a very nascent place when it comes to this. And there's a lot of work that's being done, though, nationally, to help payment models be developed for digital therapeutics. So the digital therapeutic alliance, for example, is working very hard to encourage the introduction of legislation that will make the path forward a lot more smooth. We're seeing some legislation related to Medicare payment, for example, for digital therapeutics being proposed in Congress. And I think it's really just a matter of time that that will come but right now, I think that's one of the more immediate challenges is figuring out how these treatments, even the ones that have really great data supporting them are paid for.
Jessica Hagen
Dr. Weisberg, thank you again for your time today, we really really appreciate your insight into how BehaVR is using technology in psychiatric care. That's it for this episode of Psychiatry XR, we hope you gained a new perspective on extended reality use and healthcare and thanks for listening. This episode was brought to you by Psychiatry XR, the psychiatry podcast about immersive technology and mental health. You can join us monthly on Apple Podcast, Twitter, Spotify, or wherever you get your podcast. Psychiatry XR was produced by Dr. Kim Bullock, Faaizah Arshad, and myself Jessica Hagen. Please note this podcast is distinct from Dr. Bullock's clinical teaching and research roles at Stanford University. The information provided is not medical advice and should not be considered or taken as a replacement for medical advice. 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. We credit and are grateful to Austin Hagen for music and audio production. See you next time.