Skip Rizzo: VR-Based Exposure Therapy for PTSD in Veteran Populations
Skip Rizzo, clinical psychologist and Director of Medical Virtual Reality at the University of Southern California Institute for Creative Technologies, speaks with Kim Bullock, Faaizah Arshad, and Jessica Hagen on using digital technologies and imaginal exposure for PTSD internationally, such as in veteran populations.
BIO
Albert “Skip” Rizzo is a clinical psychologist and director of medical virtual reality at the University of Southern California Institute for Creative Technologies. He is also a research professor with the USC Dept. of Psychiatry and at the USC Davis School of Gerontology. Over the last 25 years, Skip has conducted research on the design, development and evaluation of virtual reality systems targeting the areas of clinical assessment and intervention across the domains of psychological, cognitive and motor functioning in both healthy and clinical populations. This work has focused on PTSD, TBI, Autism, ADHD, Alzheimer’s disease, stroke and other clinical conditions. Despite the diversity of these clinical R&D areas, the common thread that drives all his work with digital technologies involves the study of how interactive and immersive Virtual Reality simulations can be usefully applied to address human healthcare needs beyond what is possible with traditional 20th Century tools and methods. To view some videos of this work, please visit this YouTube channel.
The following is a transcript of the episode:
Jessica Hagen
Welcome back to Psychiatry XR where we aim to inspire worldwide conversations around the use of extended reality in psychiatric care. I'm your host for this episode, Jessica Hagen. And I'm joined by my co hosts, Dr. Kim Bullock and Faaizah Arshad.
Kim Bullock
Hi there.
Faaizah Arshad
Hello.
Jessica Hagen
We're happy to have Dr. Skip Rizzo as our guest on the podcast today. Dr. Rizzo is a clinical psychologist and Director of Medical Virtual Reality at the University of Southern California Institute for Creative Technologies. He's also a research professor with the USC Department of Psychiatry and at the USC Davis School of Gerontology. Over the last 25 years, Dr. Rizzo has conducted research on the design, development and evaluation of virtual reality systems targeting the areas of clinical assessment and intervention across the domains of psychological, cognitive and motor functioning in both healthy and clinical populations. His work is focused on PTSD, traumatic brain injury, autism, ADHD, Alzheimer's disease, stroke and other clinical conditions. Despite the diversity of these clinical research and development areas, the common thread that drives all of his work with digital technologies involves the study of how interactive and immersive virtual reality simulations can be usefully applied to address human healthcare needs beyond what is possible with traditional 20th century tools and methods. Dr. Rizzo, thank you for joining us today.
Skip Rizzo
Yeah, thanks for having me.
Jessica Hagen
Can you tell me about the projects that you're currently working on and those that you're most excited about in medical XR?
Skip Rizzo
Well, right now, I'm, I'm kind of in a quasi transition phase, where I'm really trying to put more focus on getting things out of the lab, and into the hands of users that can benefit. I think that we're at a point where the technology now has caught up with the vision. You know, we did a lot of things over the last 20 years that, you know, we had to cobble it together. We had very primitive systems. We didn't have an evolved design method. And that's all changed. In addition to the technology getting much better and lower cost, we also have a pretty serious scientific literature that documents where we can add value by applying these immersive and interactive methods. So I'm really sort of reducing my time at USC to do more work in private industry. And a lot of that work is quite exciting, because I get to see things that were originally developed in the lab start to get out. One case in point, going way back, working with ADHD assessment, actually attention process assessment with a virtual classroom that, you know, we built a prototype in 1998 and tried to commercialize it in 2003, but it was, you know, bridge too far, it was still quite early. The data was sound, the application was pretty cool, but the cost for dissemination was through the roof. So, we did a lot of research with it. But now more recently, I've been working with a company— I think for conflict-of-interest purposes, I won't mention the names of any of these companies— I’m working with a company that now has built everything on the latest, greatest standalone VR headset technology. And they have the resources such that we're able to have an 800-child normative database from age six to 13. So that we have, you know, standards that we can compare performance. And that's really exciting because finally, we're at a point where, with a $500 headset, you've got a virtual classroom that a child has to perform attention tasks, you know, in a realistic context, but also with distractions flying around like in the real world. And, you know, I'm pretty happy about seeing that on the verge now of being available in a wide scale. I'm still doing you know, of course, the lab research with Bravemind with the PTSD exposure therapy work. We've just published a randomized controlled trial, looking at this compared to standard prolonged exposure and got some pretty positive results, interesting results from that. But that also is escaping the lab. The VA is adopting it on a wider scale. I think probably the project that I'm most excited about right now though, is working with a team of psychologists in Ukraine, and trying to sort out a suite of applications that will hopefully help address the impending mental health crisis due to the trauma of the war going on over there. So taking this kind of a virtual Iraq or Afghanistan scenario, and putting the code in the hands of Ukrainian developers, I think it's really important to have them as part of the team. They know the lay of the land, the situations and so on, and to build out Ukrainian relevant content for this type of direct trauma focused exposure therapy. So, that's a good one. We're also working with Metaverse type apps where we take spherical imagery of Ukrainian places that people would know places in Kyiv and so on, and build out social gathering points for people to be able, anywhere in the world, to be able to join in an avatar representation in VR or on a flat screen monitor, to be able to get some social support and be able to discuss these kinds of things that they've gone through and provide that as an initial toe in the water application.
Jessica Hagen
Can you tell me a little bit more about Bravemind, so that our listeners really understand what kind of work you're doing?
Skip Rizzo
Well, Bravemind is a virtual reality exposure therapy application. And basically, what we do is deliver this evidence-based approach of prolonged exposure that has traditionally been done exclusively in imagination, where a person is asked to mentally revisit the trauma scenario that they went through, and to narrate the experiences if they were having that experience now, and you do it in a graduated way. And overtime from a behavioral perspective, we refer to this as extinction learning— they get more comfortable by confronting the trauma scenario in a safe place. But the threat really isn't there when they're doing this. And by revisiting and confronting this trauma rather than avoiding it, eventually, you see less activation in the brain, particularly around the amygdala versus maybe a little beefed-up activation of frontal areas, certain key areas that help modulate emotion. But by doing that, repeatedly, you do see good clinical outcomes if people go the whole course of the therapy. And it's admittedly, it's hard medicine for a hard problem. So what we've done is we built out these contexts that people have commonly experienced trauma in Iraq and Afghanistan, and give the clinician a control panel, so that they can modulate the stimulus presentation in the virtual world in real time, as the patient is narrating their experience. So, maybe their trauma involves getting blown up in a Humvee on a desert roadway. While we would put them on that desert roadway, either as a driver, if they were the passenger up in a turret, we would adjust the time of day, lighting conditions, at night, you know, afternoon, morning, dawn, clouds in the sky, introduce ambient sounds, and then have the person go through it in VR. And, you know, maybe you start off not blowing up the Humvee. At the start, you know, you get the person just to be comfortable even being in the vehicle in that context. And then over, you know, the standard exposure therapy approaches about 10 sessions, it's highly manualized. And so we're doing the same thing that the evidence based approach of prolonged exposure aims to do, but we're doing it in VR. And, you know, you might say, well, you know, if it's already evidence based that imagination, you know, why do it in VR? Well, I'll make the case from our recent randomized controlled trial. First off, when we're entering people into the study of informed consent, we described, the two treatment approaches: prolonged exposure and VR exposure, with the caveat that, you know, it's a research study, you're going to be randomly assigned to one or the other. And they agreed and signed off and then our first question was: Now, if you had your choice from what you know, which would you pick? And 77% would have picked VR. So you have may be breaking down barriers to care — there's more of an attraction, perhaps a misinformed attraction. Maybe people think, you know, they're going to play a video game and fix their PTSD. Certainly isn't that, but there's an attraction to it that may draw more people, particularly digital generation folks into treatment, which is, you know, essential because you're going to have the best treatment in the world, but if people don't seek it out or participate in it, you're not going to see any benefit. So that's one finding. But the second finding, which I find really provocative, was that in our pre-planned predictions, we predicted the people that also had that, had comorbid depression. So they had PTSD, and they had major depression, that they would get a better outcome in VR than in prolonged exposure and imagination. And that was, in fact, what we found. You know, overall, we found that everybody, on average benefited from both treatments. So, we didn't see a difference across everyone between VR and prolonged exposure. But we saw clinically meaningful, statistically significant reductions in PTSD. But we did have this pre planned prediction that we could activate people to engage in their trauma memory, even if they were depressed, which is, you know, it's a hard, hard challenge, when somebody's really depressed, and getting them to try to revisit, and, you know, with effortful memory, pulling up these hard memories that they've maybe practiced for months or years trying to avoid thinking about. We're able to activate those emotions in a therapeutic way. So, you know, this is I think, where VR is going towards — not just, you know, the overall, “Does it work, you know, for everyone.” I think now we've got to start predicting better: Who might benefit from this type of treatment? And what are the ingredients in the treatment that that contribute to those types of outcomes? Is it multi-sensory stimulation? Is it the graphic fidelity? Is it how the user interacts in the world? It needs a lot of research. I think we're at the phase one, where, you know, we've shown a lot of good, decent global effects. Of course, we always need more. I think now we're at a point where we can we can start to fine tune how we make decisions for clinical implementation.
Kim Bullock
I've always wanted to ask you Skip about— and by the way, that, yeah, that it's a fascinating study with the folks with depression looking like, there's some superiority, possibly with the VR, just wonderful results there and very promising. I always wanted to ask you but never have about using VR for the in vivo exposure. So when I read the studies, it seems like the VR is being used, at least in military populations for imaginal exposure. Is there some reason that it's not being used as well, for the in vivo exposures? Because usually, when I do it in my clinics, although I'm with civilians, I'm doing two parts. I'm doing imaginal exposure, and I'm doing the in vivo exposure. They work together. Is it that it's just not written about? Are people using it for in vivo? Was there an active decision about not to use it for the in vivo or to use it for imaginal versus in vivo?
Skip Rizzo
In hindsight, I think there was sort of a gap in how a lot of folks thought about this. I think for civilian trauma, you know, it's like with our sexual trauma application, which I can talk about briefly, but they were everyday civilian contexts. In fact, we had built out, we got funded to build this into a safety and feasibility trial. Basically, we thought we'd have it easy. We'd build some barracks and these Afghan and Iraqi scenarios and places where you might expect people would be subjected to that type of trauma. And then when we interviewed patients, we found out that most sexual trauma in the military isn't happening in the trenches of Afghanistan. It's happening stateside. It's happening at US bases in cars, you know, offices. So we had to build out civilian content. So that is closer to in vivo, but in vivo really is taking a person to the place in real life.
Kim Bullock
Yeah, but they're avoiding now in there as a result of the memories. Yeah.
Skip Rizzo
As part of the standard prolonged exposure approach, typically, after session four or five, you try to get the patient to do in vivo exposure between sessions as homework. So you get a list of the types of places or avoiding going to crowded marketplaces or stores and an area where there might be a Middle Eastern neighborhood or something, or driving down a roadway that has a lot of trash, you know— that's reminiscent of where an ID had been hidden. Things like that. And, you know, I think that is an important thing. And typically in the old days for, I remember Barbara Rothbaum telling me for fear of flying, she used to accompany people to the airport and some airlines that actually let them, you know, go on a plane before it took off and just get used to sitting on a plane, and then eventually, the graduation flight together, is very costly. And, you know, you don't control all the stimuli. What if you have a really turbulent flight? And so there are challenges where, aside from cost, accompanying a patient to one of these locations. So that's why we kind of rely on homework and the trust of the patient coming back the next week and saying, ‘Yeah, I went to that marketplace or sat in that restaurant with my back to the door’. You know, and did they really? Or, you know, it's hard to know. So one solution that we're working on right now is a spherical video, in vivo homework scenario, where you can send a patient home with a standalone headset, like, you know, whatever. I'm not going to name the names, but the low cost, no computer needed all the processing done on a headset, with a library of commonly reported contexts. And so this is what we're building out now with, with a private company in partnership with the VA. And we really want to build out this library of content, so that we can use it for, for PTSD with veterans or for sexual trauma, but also build out such a vast library of everyday contexts that have some resemblance to common places, people have experienced trauma, whether it's in a car, or it's in a, you know, a bad neighborhood, or whatever, and make that available. And one of the cool things about that is that, you know, for homework, you can actually document that the patient is spending 15 minutes in that context, because you know, everything's being kind of monitored in the headset, and you can adjust, you know, if it's being in a crowded restaurant. You can build out when you create the spherical content. You can build out the restaurant empty. You can start adding more people into it. And you can systematically increase the provocativeness of the content. And it doesn't require a ton of 3D graphic development for all these varied contexts. So I'm hoping that the spherical video approach will be useful for this component.
Kim Bullock
Wow. Great. Another thing I wanted to ask you— you're so inspirational, because you kind of bring all the stakeholders together and different disciplines of entertainment and the art world and the military and the medical. And how do you see psychiatrists differentiating themselves or contributing? Because this podcast is Psychiatry XR. We're kind of a bit late to the game. I feel like all the psychologists have really developed it. And yeah, do you see any value for us psychiatrists, or how do you think we can contribute most or, what, how do you see us?
Skip Rizzo
This is one of the cool things about this work is that it's necessarily interdisciplinary. You know, you got to be, you got to make friends with programmers, 3D graphic artists. And I'm proud to say some of my best friends are psychiatrists. But I think seriously, psychiatry brings the medical end of things, particularly with understanding medication, possible combination therapies. I don't really think it's so much of a horse race as it is trying to find the optimal selection of therapeutic approaches. In fact, this randomized control trial that we just published, was using a combination approach using D-cycloserine as one of the conditions — a drug that was thought to amplify extinction learning in the amygdala is a cognitive enhancer. Unfortunately, that didn't pan out in this study. It has in others. I think there's a dose and timing thing. But this is an area, whether it's for PTSD and looking at other medications or looking at medical factors that modulate or moderate clinical outcomes or whether it's depression: Can you get a better benefit when you're doing some kind of a VR application to address self-compassion or depression while someone's on or off medications or, you know, so psychologists would be foolish to just think they own therapy? I mean, psychiatry has been practicing therapy in different ways. It's a different model. But it also brings in the medical side of things that I think is important, you know. So, you know, I just see their partnerships all over the place for this. You know, looking at this with the ADHD work, we're partnering with the psychiatrists to look at dose levels for various medications for ADHD and trying to see, you know, if the rate of stimulus presentation interacts with that, or a whole variety of untapped research questions. So, yeah, I think it's kind of foolish to just hide out in your own silo and not work with other interesting people that have knowledge that complements what you know.
Faaizah Arshad
Dr. Rizzo, something that I'm curious to know about is how your work has been received by the industry and by academia. And, you know, are there differences in how it's been received? And how do you manage conflicts of interest between the two?
Skip Rizzo
Oh, boy, that that's one I'm still wading through right now. Because it's only been the last two, three years that I've really, in earnest been working in private industry. You know, certainly, as a USC Professor, I have to, you know, disclose everything: contracts, how much you make, this and other. And there's also certain limits as to how much time you can spend outside. And consequently, that partially led to me reducing my time to about 60% at USC, so that I would have that open space to do these things. And I'm pretty careful about managing these things. But it is a challenge. And it's a whole different world working in private industry. You know, sometimes you feel like you have massive resources with some of these, you know, some of these companies are, are well funded. But then, you know, it's not like, your goal is to publish a paper. And in fact, sometimes some of these companies don't want you to publish. They want to keep their trade secrets. And so there's different goals and aims, and getting it right, and also having to push back if somebody wants you to make a claim and scientifically, you don't feel comfortable making that claim. We've got to figure out a way to represent their interests, but also being true to the science. So, there were a lot of different challenges and they’re challenges that you don't learn in graduate school or medical school. There is no course in this. Maybe there are now— it's been so long since I've been actually on the other side. But you know, it is a, it is a learning curve. And, and sometimes the, sometimes the corporate world can be kind of crueler than, than the academic world. Academia has its own struggles and battles. And for me, it's been really very hard in academia over the years because I've always been on soft money. I've always had to generate through grants my own money. And that means there's a positive side to that, that by having to write proposals all the time, you really, I think you hone your thinking and become sharp. But man it becomes tiresome, you know. And having to wait, the glacial pace of, you know, submitting an NIH grant, getting the reviews back, get invited to resubmit. You know, you're two years down the road before you see any money. And meanwhile, a company that got some reasonable investment has already built out what you were thinking about and started to test it. This group I worked with on a classroom— they're, they're pretty good because they get the science and, well, they know that if you're going to build an assessment tool, you've got to have norms. There's no way around it. You can't just wave your hand and say, ‘Oh, yeah, this is going to predict the kid that has ADHD.’ You know, so, you know, some companies get it. Some companies want to take shortcuts, so you kiss a few frogs before you find your prince or princess along the way.
Faaizah Arshad
That's funny. Yeah. And then, what do you think are the biggest barriers or gaps to getting veterans and the military population access to VR treatment? And are there any solutions that you think need to be created to improve that access?
Skip Rizzo
I think particularly with veterans, we're seeing a real change at the VA, where they're recognizing the value of trying innovative approaches that involve technology, not just VR, but other approaches. And so that's becoming, there's, there's an awareness level that is improving. You know, the challenge, one of the biggest challenges with veterans is that oftentimes, you know, they're, they're kind of, you know, there's, there's a fear of being judged or stigma, or that nobody's going to be able to help them. You know, you've got, you know, somebody who just got out of graduate school, doing a clinical internship, a young psychologist and never been to war. Clinician, you know, that, you know, it’s not like clinicians have to have the condition or treating or have that experience. Certainly that's not the case. Otherwise, there wouldn't be enough, enough care available in terms of availability of trained providers. But you have that challenge with the population where they kind of feel like you don't know what they're going through, or that no one's going to be able to help them. And so building the therapeutic alliance in the trust is as important as the implementation of whatever clinical strategy or process you're trying to do. I think, there’s been research showing that therapeutic alliance accounts for probably 50% of the variance in clinical outcomes? So, you know, I think, now that for better or worse, Meta being on the Super Bowl advertisement roster, and, and seeing ads all the time for VR, it's no longer being looked at as some harebrained sci-fi, sci-fi kind of toy or just for entertainment. It's being seen as, you know, as a feasible tool. And there's an attraction to that, you know, certainly, with kids with ADHD, you know, you tell them, “I want to sit down and do a neuropsychological valve with you,” you've got to work in keeping them attended. But you say, “I'm going to do a test at a VR headset. Do you want to try it?” You know, and that's kids. Now with veterans, like I said, there was this preference finding that we found. Even though people that didn't get what they preferred still showed good outcomes, but it was the initial preference for VR that was striking. And again, we're just allured to this technology, because it's in our everyday life. And maybe there's a credibility that people have implicitly about if there's technology involved, you know, it's got to be serious.
Kim Bullock
Destigmatizing. Yeah.
Jessica Hagen
Do you find that preference for virtual reality to kind of span all age groups?
Skip Rizzo
I would have wondered about older populations. But from what I've seen with a number of companies that now we're producing things for long term care facilities, and nursing homes and so forth, that once you have an older person try a VR experience, they kind of, most of the time, they're like, ‘Wow!’, you know. There's a, I have a video of my mom, visiting Rome, in VR, circle video of Rome, but I filmed her while she was doing it. And she hadn't been in Rome 40 years. But it brought back a flood of memories and stories that she told about her experiences when she went there. And it was, you know, I think it was emotionally positive, and it was cognitively stimulating. So I don't think we should rule out populations. And I think we're finding, you know, particularly now the aging population, or people like me, have grown up kind of around technology over the last 30 years. So it's not a, it's not a hard sell. I haven't seen, in any of the research I've seen across any clinical group or age group, I usually see kind of a preference or an interest when documented. I know that Cristina Botella’s group in Spain has published a number of studies showing that with exposure therapy for regular anxiety disorders, people prefer VR, like VR more, you know. You see more and more of these kinds of, kinds of findings. I think, you know, now that we can do some of this stuff at home, that might be a real value. Particularly with, with the headset that I use with my mom, there's a feature called the Connect feature on it, where I can be anywhere in the world on my laptop, and I can pop into her virtual world by like a little zoom window, and I can have a conversation once she's touring around Rome or London or wherever it is. And I can see what she sees on my screen as she moves her head and looks around. So now, that's a nice thing for communication and connectedness. But a clinician now can pop in. It's not a solitary experience. So I think, with features like that, where the clinician can pipe in at strategic points, or along the way for support, you know, I think we'll start to see these things become sort of common practice. And as the awareness continues to build, of course, supported by the science, you know, I think we're going to see more people just think of VR— not as some nice to have science fiction thing, but as just as the standard tool, another tool for enhancing therapy process.
Kim Bullock
Yeah, I feel like patients are accepting it and even preferring it. But it's the providers now I'm finding that are more reluctant, you know. We have to work on the barriers for providers to feel comfortable in delivering it. But I don't know if that's your experience.
Skip Rizzo
Exactly. I think that the patients are an easier room to work. Clinicians a lot of times, you know, let's face it, some clinicians still do the same thing they learned 10, 15 years from graduate school. They don't always grow, or to do new things is a learning curve that, you know, there, there's some resistance. I think it's becoming less. Earlier, it wasn't just the unfamiliarity with the technology, but there was a suspicion. There was suspicion that it was, you know, if I bring technology into the therapeutic context, it's a barrier between me and my client, or whatever. I've heard that. But I think we're getting past that point. Now. It's just ‘Alright, how do I turn the damn thing on? How do I change up the features? Or what do I have to do? Do I have to Bluetooth it to my phone?Or can I,’ you know, all these kinds of things. But I think it's, it's getting easier. And onboarding is just as important as whatever you deliver, you know, whether it's a patient or onboarding experience with a guide that's in it, that walks you through how to operate the controls and/or how to select options or how to move and travel. But, you know, getting clinicians along the way— they need training. And for like, for example, with the Bravemind with the PTSD stuff: it's a day and a half training for clinicians before they’re certified to use, and they have to already have prolonged exposure training. So there's a bit of a training curve there. Which brings me to another area of clinical training. You know, we've done some work and more recently at the VA with clinical training with virtual patients, as it found some good outcomes without, you know, we did a study that came out in JAMA Network, Open Network, I guess it's called, with Greg Reger, at the VA for motivational interview training. And, you know, it was 45 minutes of back and forth with a virtual patient. And we saw that compared to the standard method with equivalized time of training, we found much better real world implementation of motivational interviewing. So, you know, I think that is a great opportunity, moving in the future for clinical training, and then maybe, that that same kind of virtual patient training can also start to bring in, okay, well, now it's virtual training. So, you know, how would you introduce a head mounted display? And how would you show them how to operate it or adjust it? And, you know, we can use technology to train how to use technology, maybe?
Jessica Hagen
So you've kind of touched on this a little bit already about how it's going to kind of evolve into the future. What do you think needs to be done to reach optimal success in 20 years for medical extended reality use?
Skip Rizzo
Assuming all the sciences there documenting this, then it is just a set of pragmatic challenges. I think improving access to care by being able to trust that you can do some therapy remotely with VR and that's where that connect feature may come in. Remember we know that teletherapy has some real assets. You know, and the VA has been doing a good bit of that as well. And you know, at one time though and late 1900s, the idea of doing prolonged exposure without being in the same room as your, your client was just considered almost unethical. But, you know, people did the safety and feasibility trials under controlled conditions and found that you can get the equivalent outcomes for remotely. And some of the work that I think Dan Freeman has done with Oxford, VR, where they've sent people home with headsets for fear of heights, exposure therapy, and found good outcomes, you know, whether we have to be in the room with a person or not, I think might be a clinical judgment as to how safe they would be doing anything provocative on their own. But I think there is a large mass of people that would never, never get around driving every week to see a therapist, but would be more willing to do it at home with a therapist supervising or jumping in. I think we have to tread carefully on this. So I see more remote delivery, like when at a time when in the future, hopefully, in 20 years, VR headsets or whatever the display technology is in distant future. Eventually, hopefully, they’ll be like toasters, you know. Every home will have one, you might not use it every day, but every home will have some kind of an immersive room or, you know, little contact lenses that people are actually developing to deliver VR. Or whatever the device is, as we start to reach out, I think we're going to be able to expand the reach of care, which is very important, if you know, World Health Organization whch estimates 450 million people with mental health conditions right now on the planet, of which almost two thirds, you know, from their research, will never see the inside of a therapy office. Can we kind of whittle away, chop that number in half maybe, and provide care to those folks using technology and, and maybe, maybe this becomes more than treatment. Maybe we develop methodologies that are better for building resilience, for helping children that have had adverse childhood experiences have game activities that are fun, but also teach them skills for dealing with challenges that they might have a problem with, and thereby prevent a whole long lifetime of mental health challenges or problems. So I'd like to see, you know, the health and wellness stuff, you know, evolve to make it more interesting. You know, there's so many mobile apps that you know, have really good content. People put a lot of work into, you know, developing the content for mobile apps. But for some reason, a lot of them just don't stick. You know. There's some scary data about, somebody was telling me at a conference, ‘So yeah, the median number of uses of a mental health mobile app after the first try, is one.’ So if you're going to make it stick, make it engaging, maybe virtual human friends, that AI that gets to kind of know, that can kind of guide you along and and say, ‘Hey, there's this new application. Maybe you want to try this. It'll help you manage that anger that I've noticed has been coming out lately in certain circumstances.’ I mean, this is getting really out there. But this is a future that could happen. And it's up to folks like us to be thoughtful in how it's evolved so that we're not doing things that put people at more risk. But once we can get that down, then I think technology is going to offer tremendous opportunities for improving human well-being.
Jessica Hagen
Dr. Rizzo, thank you so much for sharing your valuable insight into what's happening in medical XR in psychiatry. Is there anything else that you'd like to share with our listeners today?
Skip Rizzo
I'm glad that COVID is hopefully starting to wind down so that we can all hang out in person now. And then I've been to a couple of conferences lately in person and I forgot how much fun it was to actually hang out with colleagues and talk about our work aside from watching them present on a zoom call.
Jessica Hagen
Absolutely. Thanks again for your time, Dr. Rizzo. We very much appreciate it.
Skip Rizzo
Thanks for having me. I've enjoyed chatting with you guys.
Jessica Hagen
And that's it for this episode of Psychiatry XR. We hope you gained a new perspective on the use of 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. You can join us monthly on Apple Podcast, Twitter, Spotify or wherever you get your podcasts. 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. A big thanks to Austin Hagen for music and audio production. See you next time.