The Crisis in Healthcare and a New VR Solution – VRsano

Ideally the healthcare system, as indicated by its name, should be unified in its goal to provide efficient care, not only treatment, for the full spectrum of people’s health as well as to ensure a fulfilling professional realization for those working in it. Instead, for quite some time the healthcare system has felt more like a battlefield of opposing forces and conflicts of interests when the focus should be the health of the general public and fostering scientific advances to ensure it. The distrust between the 4 participants (patients, providers, payers and vendors) is exponentially growing due to numerous pitfalls within and among the 4 receiving ends of the healthcare experience.

Despite the multibillion dollar spending on and investment in healthcare, the current staggering statistics on the prevalence of and death due to cancer, heart disease, autoimmune diseases, the opioid crisis, antibiotic resistance, medical mistakes, post-surgery complications, prolonged stay and re-hospitalization, unjustified procedures, polypharmacy and debilitating side-effects of drugs (the list goes on) only indicates that the system is failing us all – consumers, providers and payers.  Many researchers and startups are developing technologies in an attempt to reverse this downward spiral and offer a solution. However, too many new innovations fail due to the fact that it is difficult to satisfy all 4 players with the same solution. Even when the solution is beneficial to one or even two of the players, it can go against the specific needs or fail to consider the circumstances surrounding the others and therefore end up being underutilized or entirely rejected by the entire system.

To combat this problem, new solutions need to consider the needs and expectations of all the four gears in the healthcare system. A successful solution needs to provide an engaging, de-stressing, safe, and efficient experience to all patients and provide them with a sense of participation and control in their own treatment. To satisfy healthcare providers, it needs to be easy to understand and implement and should be able to smoothly integrate into the healthcare providers’ already complex workflow. And to be approved and accepted by the payers and vendors, the innovation needs to be not only scientifically justified, highly efficient and safe but also affordable, while simultaneously lowering costs across the board during the healthcare experience.  Such a solution can seem like an impossible feat but it exists and is currently in development.  Its name is VRsano and it is a patented virtual reality-based method designed to address the entire list of problems mentioned, and as such to greatly benefit all the receiving ends in healthcare.

The Flawed Biomedical Model

Research has consistently shown that the psychological aspect of the patient has a great influence over their prognosis, recovery speed, and overall healthcare outcomes, however in hospital settings the psychological aspect is usually overlooked and treatment only focuses on the physical body.  This prioritization of the body and the disregard for the mind in medical settings has been going on for centuries, as the two have been considered separate entities that do not interact in a meaningful way ever since Descartes introduced his theory of dualism in the 17th century. His theory at that time was understandable considering the fact that it was based on knowledge of anatomy and disease derived from the study of dead bodies.  Cartesian dualism claimed that the mind and body were separate entities that exist in parallel but do not interact, which is why medicine shifted to a focus exclusively on the physical body for healing via the biomedical model, employing reductionism to address the body as a composition of distinct parts which could be fixed independently of the others. However, although the body and mind do not interact in dead matter, this is not the case in a live system.

A significant and growing body of research has shown that the body is not only a physical machine made of parts working separately but everything is connected in one cohesive system, made up of matter, mind, and energy, with each part reacting to and receiving influence from the others in complex feedback loops, with the mind at the controls.  This is especially important to remember when the body is in crisis.  A number of studies have found that high preoperative anxiety or stress is predictive of poorer outcomes, including greater pain, increased level of postoperative infections and complications, longer hospital stays, and poorer treatment compliance (1,2). Research has confirmed the existence of the complex feedback loop between the immune system and the central nervous system (CNS), in which the main role is played by the limbic-hypothalamic-pituitary-adrenal (LHPA) axis (3,4) which initiates the release of stress hormones (such as ACTH, cortisol, catecholamines, and prostaglandins) that are associated with immunosuppression, or in other words, the body’s ability to handle threats and heal.

Psychoneuroimmunology and the Power of the Mind

The number of studies researching the key role and involvement of the mind and brain in the healing (or worsening) of the body is conclusive and has laid the foundation of the relatively new field of Psychoneuroimmunology (PNI).  One example from this field is a series of recent studies Ben-Eliyahu and colleagues (5, 6, 7, 8) demonstrated that there is a very sensitive and critical window before and immediately after cancer surgery that can determine future outbreaks of preexisting micrometastases and the initiation of new metastases depending on levels of stress during that critical period.  PNI provides science-based explanation as to why some people “miraculously” heal when they have certain mindsets and/or use alternative practices such as meditation or hypnosis, and what were previously considered unexplained or anecdotal cases of recovery have been receiving much more attention recently as the importance of the mind continues to reveal itself, contributing to the development of reliable ways to achieve and replicate those “miracles.”

With that pursuit in mind, it has been found again and again (9, 10, 11, 12, 13, 14, 15) that some kind of preoperative intervention (even a short one) intended to alter the psychological state of the patient leads to decreased anxiety and stress, less postoperative complications, fewer hospital days, overall better treatment compliance, reduced perception of pain and decreased use of analgesics, and alterations in physiological indexes (16). A patient’s preoperative mental state can significantly influence physiological state and responses during surgery (17, 18, 19, 20) and the rate of postsurgical recovery (21).

You might be asking what kind of interventions can be used to lower patient stress rapidly and reliably in medical settings? Although there are several methods that have shown varying degrees of effectiveness, two psychosomatic methods have so far shown consistent and powerful effects in this regard: virtual reality and clinical hypnosis.

Virtual Reality

Patients exposed to VR treatment in medical settings consistently report feeling less pain, less time thinking about their pain, and even experiencing fun during painful treatments (22, 23, 24, 25, 26). The experience of pain arises from the neural processing of signals from pain receptors, which means that attentional resources play an important role in creating the subjective feeling of pain (27). VR engages a significant amount of these attentional resources and therefore leaves less of them available to focus on pain.  The effectiveness of the VR approach has been proven significant and generalizable, with the scope of existing research showing that patients in VR treatments report an average of 35-50% less pain than patients being treated as usual (22). Although proven as effective as analgesic drugs in some instances, shortcomings of the VR approach used alone limit its widespread use in medical settings. Some of its limitations are the following:

1. Since its power is primarily in distraction, the alleviating effects are generally confined to the duration of the VR exposure. There is no accumulative, learning-based effect achieved via changed expectations, enhanced health-related abilities, or lasting psycho-physiological shift due to neuroplasticity as is observed in bio/neurofeedback and clinical hypnosis.
2. VR is applicable primarily for distraction from pain/discomfort and therefore is of limited use in pre-, during, and post- surgery and in other treatments requiring a more holistic change of the patient’s psychosomatic state.
3. The patient is simply a recipient of VR and does not develop a sense of mastery or self-efficacy over their bodies, thus the method will not have a continuous and significant effect over the distressed psychosomatic state.

Clinical Hypnosis

Clinical hypnosis has also consistently proven to be a powerful method not only for easing pain and anxiety, but for altering somatic functions and leading to improved outcomes after surgery, radiology and chemotherapy treatments, and other invasive medical procedures and treatments (28, 29, 30, 31, 32). Medical hypnosis has been shown to reduce intra-operative blood loss, hospital stay duration and pain and to accelerate bone and wound healing (33, 34, 35, 36). It has been used as a successful adjunct to treatment in coronary bypass surgery, severe burn treatment, and emergency medicine (37, 38, 39, 40).  Research has shown that patients in the hypnosis group have hospital stays that are 1.6 to 2 days shorter than patients in the non-hypnosis group (41, 42). There has also been evidence that participants in hypnosis groups exhibit structural differences in healing after surgical procedures. A meta-analysis on hypnosis utility with surgical patients found that patients taking part in hypnosis treatment had better outcomes than 89% of patients in control groups, with beneficial effects observed in measures of negative affect, pain, pain medication, physiological indicators, recovery, and treatment time (43).

Although proven to be a powerful tool for healing, clinical hypnosis has also been difficult to employ in medical settings due to various shortcomings in the way it is currently practiced.  Limitations include therapists’ variables such as a lack of ability, training, and consistency, environmental variables such as the setting, costs, availability of trained staff, limited time for treatment and difficulties to integrate it with ongoing medical treatment. In addition, the lack of an observable/objective feedback about physiological markers and information about whether and when the patient is ready for the next step in the hypnosis induction make the process difficult to implement in many medical settings.  Patient’s variables interfering with the intervention include lower hypnotizability, lack in cognitive abilities of visualization and concentration, heightened distressed state/distractibility, and general distrust of hypnosis.

What is required to make clinical hypnosis applicable on a larger scale and effective for various patients and practitioners is a standardized method for deploying the hypnosis which monitors patient psychophysiological indicators so that the appropriate hypnosis induction module can be launched when the patient is ready for it, and a way to take the burden of visualization off the patient so that they can focus on relaxation and immersion. In addition, detecting and customizing the treatment to the patient’s degree of hypnotizability is a must as it makes the method beneficial for virtually any patient, even those who are not very susceptible to hypnosis.

VRsano

Such a method that combines the benefits of virtual reality, clinical hypnosis and neurofeedback while simultaneously minimizing their limitations is not simply hypothetical anymore; it is a recently patented method called VRsano.  VRsano uses immersive virtual reality to pull patients out of their distressing experience and capture their attention in a photorealistic alternative reality. The VR component captures the interest of patients with photorealistic imagery designed specifically to trigger a particular neurological response and to foster neuroplasiticity in the desired direction while making the experience fun and relaxing with no invasive elements.  VRsano also uses biofeedback to measure brainwaves and relevant physiological markers in order to output the appropriate step of the method when the patient is ready to receive it. In addition, the biofeedback component makes the method interactive (engaging even more attentional resources) and “rewards” the patients with a sense of mastery over their own psycho-physiological state.  Finally, the use of clinical hypnosis guides patients into a deep state of relaxation, preparing them mentally and physically for their treatment and helping them “reprogram” their brains to regain control over their bodies and healing process.

The VRsano method consists of a headset incorporating VR goggles, built-in EEG components and biofeedback sensors (if applicable) and a computer for processing the input information and physiological data and generating the output modules. It will be easily and quickly set up and employed, not burdening healthcare providers with the need for extensive training or technological know-how.  The method doesn’t include any invasive elements to interfere with other aspects of the patient’s treatment/medication or to introduce additional risks.  The physiological markers measured by the sensors during sessions will be displayed in real time, recorded and stored for the customization of future sessions and to serve as an auditable record of the patient’s treatment history.

The VRsano method will also be available as a mobile application.  It will be easy to use since the patient will only need to enter their demographic information, their desired immersive environment, target symptoms (if applicable) and type of medical treatment (if applicable). The recorded physiological data will be auditable later if needed and/or directly streamed to the practitioner (or a customer help center).  The design of the method makes personal use safe due to the biofeedback sensor’s ability to detect distress symptoms in real time.  Such distress signals will lead the algorithm to switch to distress-dampening modules (or end the session if necessary) and alert the practitioner.

The affordable, measurable, auditable, and easy-to-implement VRsano will be favored by payers and managed healthcare due to the fact that it will significantly lower the cost of medical services by decreasing the duration of hospitalization and re-hospitalizations, required procedures and complications, and drug and opioid use.

VRsano will be invaluable in hospital settings to ease patient stress and prepare them for their upcoming treatment, make them optimally receptive to said treatment and speed up recovery. Even a single session will have a significant impact on the outcome of the treatment and if used continuously the method will induce a lasting shift in brain and body functioning in the desired direction through clinical hypnosis and guided learning principles.  Its non-invasive, simple-to-use, and entertaining characteristics will be favored by patients and practitioners alike as VRsano will alleviate the patient’s symptoms and the stress caused by the hospital experience as well as speed up recovery and optimize the treatment in terms of outcome and cost.

Future of Healthcare

A successful future of healthcare depends on making the treatment experience easier and more manageable in terms of effort and costs across the board.  To find such solutions, we must approach the healthcare recipient and the healthcare field in similar ways – as systems composed of multiple parts that work together, not separately, with each affecting the other and needing to be considered and cared for in order for the entire system to work effectively.  VRsano provides a new, paradigm-shifting solution to both the problems in individual patient care and the healthcare system as a whole, and will pave the way for a future of healthcare where care will be much better ensured and health will be much more effectively achieved for all.

References

1. Johnston, M. (1988). Impending surgery. In S. Fisher & J. Reason (Eds.) Handbook of life stress, cognition, and health (pp. 79-100). New York: Wiley
2. Mathews, A., & Ridgeway, V. (1981). Personality and surgical recovery: A review. British Journal of Clinical Psychology, 20, 243-260.
3. Meyerhoff, J. L., Oleshansky, M. A., Kalogeras, K. T., Mougey, E. H., Chrousus, G. P., Graner, L. G. (1990). Neuroendocrine responses to emotional stress: possible interactions between circulating factors and anterior pituitary hormone release. Circulating Regulatory Factors and Neuroendocrine Function, Advantages in Experimental Medicine and Biology. 274, 91-111.
4. Sternberg, E. M., Crousos, G. P., Wilder, R. L., Gold, P. W. (1992). The stress response and the regulation of inflammatory disease. Annals of Internal Medicine. 117(10), 854-866.
5. Ben Eliyahu, S. Page, G. G., Yirmiya, R., Shakhar, G. (1999). Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. International Journal of Cancer, 80(6), 880-888.
6. Ben Eliyahu, S. (2003). The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain, Behavior and Immunity, February; 17 Suppl 1:S27-36.
7. Neeman, E., Zmora, O., Ben-Eliyahu, S. (2012). A new approach to reducing postsurgical cancer recurrence: perioperative targeting of catecholamines and prostaglandins. Clinical Cancer Research, 18(18), 4895-902.
8. Neeman, E., Ben-Eliyahu, S. (2013). Surgery and stress promote cancer metastasis: new outlooks on perioperative mediating mechanisms and immune involvement. Brain, Behavior and Immunity. Suppl:S, 32-40.
9. Contrada, R. J., Leventhal, E. A., & Anderson, J. R. (1994). Psychological preparation for surgery: Marshaling individual and social resources to optimize self-regulation. In S. Maes, H. Leventhal, & M. Johnson (Eds.), International Review of Health Psychology, Vol. 3, 219-266. New York: Wiley.
10. Devine, E. (1992). Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies. Patient Education and Counseling, 19, 129-142.
11. Gil, K. M. (1984). Coping effectively with invasive medical procedures: A descriptive model. Clinical Psychology Review, 4, 339-362.
12. Johnston, M., Vogele, C. (1993). Benefits of psychological preparation for surgery: A meta-analysis. Annals of Behavioral Medicine, 15, 245-256.
13. Johnston, M., Wallace, L. (Eds.). (1990). Stress and medical procedures. Oxford, England: Oxford University Press, p 184.
14. Mumford, E., Schlesinger, H. J., Glass, G. V. (1982). The effect of psychological intervention on recovery from surgery and heart attacks: An analysis of the literature. American Journal of Public Health, 72, 141-151.
15. Suls, J., Wan, C. K. (1989). Effects of sensory and procedural information on coping with stressful medical procedures and pain: A meta-analysis. Journal of Consulting and Clinical Psychology, 57, 372-379.
16. Kiecolt-Glaser, J. K., Page, G., Marucha, P. T., MacCallum, R. C., Glaser , R. (1998); Psychological Influences on Surgical Recovery. Perspectives From Psychoneuroimmunology. November; American Psychologist.
17. Abbott, J., Abbott, P. (1995). Psychological and cardiovascular predictors of anaesthesia induction, operative and postoperative complications in minor gynecological surgery. British Journal of Clinical Psychology, 34, 613-625.
18. Greene, P. G., Zeichner, A., Roberts, N. L., Caltahan, E. J., & Granados, J. L. (1989). Preparation for cesarean delivery: A mutticompouent analysis of treatment outcome. Journal of Consulting and Clinical Psychology, 57, 484-487.
19. Markland, D., & Hardy, L. (1993). Anxiety, relaxation, and anesthesia for day-case surgery. British Journal of Clinical Psychology, 32, 493-504.
20. Scheier, M. E., Matthews, K. A., Owens, J. E, Magovern, G. J., Sr., Lefebvre, R. C., Abbott, R. A., & Carver, C. S. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. Journal of Personality and Social Psychology, 57, 1024-1040.
21. Liu, R., Barry, J. E. S., & Weinman, J. (1994). Effect of background stress on postoperative recovery. Anaesthesia, 49, 382-386.
22. Hoffman, H. G., Chambers, G. T., Meyer III, W. J., Arceneaux, L. L., Russel, W. J., Seibel, E. J., Richards, T. L., Sharar, S. R., Patterson, D. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine, 41(2), 183-191.
23. Hoffman H. G., Meyer III W. J., Ramirez M., Roberts L., Seibel E. J., Atzori B., Sharar S. R., and Patterson D. R. (2014). Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behavior, and Social Networking, 17(6), 397-401.
24. Maani, C., Hoffman, H. G., DeSocio, P. A., (2008). Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles. Journal of CyberTherapy and Rehabilitation, 1:193-198.
25. Flores A., Hoffman H. G., Russell W., (2008). Longer, multiple virtual reality pain distraction treatments of Hispanic and Caucasian children with large severe burns. CyberTherapy Conference. San Diego, Calif.
26. Sharar, S. R., Carrougher, G. J., Nakamura, D., Hoffman, H. G., Blough, D. K., Patterson, D. R. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of Physical Medicine & Rehabilitation, 88(12), s43-s49.
27. Eccleston, C., Crombez, G. (1999). Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125:356-366.
28. Lang E. V., Berbaum K. S., Faintuch S., Hatsiopoulou O., Halsey N., Li X., Berbaum M. L., Laser E., Baum J. (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 126(1-3):155-164
29. Lang E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. 355(9214):1486-1490
30. Montgomery G. H., Bovbjerg D. H., Schnur J. B., David D., Goldfarb A., Weltz C. R., Schechter C., Graff-Zivin J., Tatrow K., Price D. D., Silverstein J. H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 99(17):1304-1312
31. Lee J. S., Spiegel D., Kim S. B., Lee J. H., Kim S. I., Yang B. H., Choi J. H., Kho Y. C., Nam J. H. (2007). Fractal analysis of EEG in hypnosis and its relationship with hypnotizability. Int J Clin Exp Hypn. 55(1):14-31
32. Colgan S. M., Faragher E. B., Whorwell P. J. (1988). Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet. 1(8598):1299-1300
33. Lynn, S. J., Kirsch I., Barabasz A., Cardeña E., Patterson D. (2000). Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis, 48(2), 239-59.
34. Lang, E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355(9214), 1486-1490.
35. Ginandes, C., Brooks P., Sando W., Jones C., Aker J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. American Journal of Clinical Hypnosis, 45(4), 333-351.
36. Ginandes, C. S. & Rosenthal, D. I. (1999). Using hypnosis to accelerate the healing of bone fractures: A randomized controlled pilot study. Alternative Therapies in Health and Medicine, 5(2), 67-75.
37. Mehmet, C. O. (2000). About self-hypnosis and coronary artery bypass surgery. Journal of Cardiothoracic Surgery (Torino), 41(2), 335-336.
38. Peebles-Kleiger, M. J. (2000). The use of hypnosis in emergency medicine. Emergency Medicine Clinics of North America, 18(2), 327-338.
39. Gallagher, G., Rae, C. P., & Kinsella, J. (2000). Treatment of pain in severe burns. American Journal of Clinical Dermatology, 1(6), 329-335.
40. Spiegel, R. B. (2011). The Integration of Heart-Centered Hypnotherapy and Targeted Medical Hypnosis in the Surgical/Emergency Medicine Milieu. Journal of Heart-Centered Therapies, 14(2), 87-106.
41. Lobe, T. E. (2006). Perioperative hypnosis reduces hospitalization in patients undergoing the Nuss procedure for pectus excavatum. Journal of Laparoendoscopic & Advanced Surgical Techniques, 16(6), 639-642.
42. Cowan, G. S., Jr., et al. (2001). Assessment of the effects of a taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia). Obesity Surgery, 11(5), 589-593
43. Montgomery, G. H., David, D., Winkel, G., Silverstein, J. H., Bovbjerg, D. H. (2002). The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis. Anesthesia & Analgesia. 94(6), 1639-1645.