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Hi, welcome to Mental Health Matters. I'm Shannon Eliot.
Today we will be taking an in-depth look at the Coming Home Project, an innovative initiative
that uses a virtual world to provide camaraderie, support, and resources for returning troops.
Dr. Jackie Morie is the Project Lead for the Coming Home Project and a senior researcher
at the Institute for Creative Technologies at the University of Southern California.
She has worked in the field of immersive technology since 1990, focusing on effective and meaningful
applications of virtual environments. Dr. Morie has been published and speaks internationally
on games, immersive worlds, and avatars.
Welcome, Jacki. Thanks so much for joining me today.
>>Thank you, Shannon.
>>Can you kick us off by describing the Coming Home Project? What is its purpose and how
does it work?
>>The Coming Home Project was an idea we had to look at how virtual worlds that many people
were starting to use could be used by returning veterans who were coming home from conflicts
with a lot of mental health issues. And a lot of them don't live near veterans' centers,
so they couldn't really go in for this, and there's this stigma attached to getting mental
health help. So the anonymity and privacy of the virtual world coupled with its social
capabilities coupled with what we could put into it in terms of stress release activities,
we thought would be a really good way for these veterans to get some help without having
to put themselves out on the line.
>>So what are the project's components? If I were a veteran experiencing this, what would
I see and hear and feel?
>>When you would go into the virtual world of Second Life, you first of all have to have
an invitation to come into this area that we've made, which we call Chicoma Island,
even though it's a fairly large area. The area is made to be a very wooded space. It's
got a lot of waterfalls, water aspects. It's got a shoreline. We made something that looks
like a hunting or ski lodge, which would be the gathering place, the social center for
the island so that veterans could come and hang out there by the fireplaces, out by the
water. They could watch the birds fly and even do a little fishing in the virtual world
if they wanted. So we made it so that it was as far removed from the kinds of environments
that they were experiencing on their deployments because being in those same kinds of environments
-- either physically or virtually -- tended to stress them out. So we wanted something
that would calm them. So you would go into Chicoma Island and you would go into the veterans'
lodge and you would see this beautiful hunting lodge. But there are other areas on the island
as well. We have a welcome center that tells you what you can do there. We have some virtual
human agents, who are sort of autonomous programs who can give you a tour of the space and tell
you what you can find there and what you can do there. We have a labyrinth that you can
walk and a guide that tells you how to walk the labyrinth. We have some stables and some
other kinds of fun things for people to do. But there are some areas that are specifically
devoted to stress relief.
>>How many veterans are using it at the moment?
>>Right now it's still in the proof of concept stage. We've had some veterans from an in-world
veterans group that was self-formed. And this is a group that when we started the project,
there were about 300 veterans. Now there's over 1600. And they come from all conflicts,
all ages, and all services. So when we need testers, we get them to come work with us.
And what's interesting about that group is they use their space; they have their own
small island. They use that space like a BFW hall for the 21st Century. The people coming
back from the recent conflicts don't have a centralized geographic location. Most of
them come from rural areas. They don't have a place where they can meet with their buddies,
so this serves that purpose for them. So we don't have actual users yet because we are
still in the middle phase of a research project, but there are veterans who are very invested
in the virtual world.
>>So I'm curious about the use of these avatars. Can you tell me a little bit about what they
are and why they are so significant in this process?
>>An avatar is the representation of you in the virtual world. So in this one it's a 3D
representation. Most people start by getting a default avatar and trying to customize it
so it looks like them, so it resembles them in a physical aspect in some way. But often
that turns into customizing it so it reflects some aspect of your interior self. So some
of the veterans I know have wolves for avatars or have big biker guys for avatars. It's a
wide range. But this particular virtual world we're working in offers that. It offers you
to be anything you want to be. So people take advantage of that and use it to really get
in touch with aspects of themselves. So for example, say a veteran has been really injured
and can't walk. They might have an avatar that sort of mitigates that and is very powerful
in the virtual world.
>>So I recently had a chance to go into Second Life and experience the Coming Home Project
myself. Let's take a look.
Well Jacki, thanks so much for having me in-world with you.
>>It's my pleasure.
>>So where are we right now?
>>We're at what we call Chicoma Lodge, which is a lodge that we built for the veterans
so that they could have a place to gather that was very much different than the desert
scenes they were getting in the Middle East. So we made this into a hunting lodge, skiing
lodge type of facility with a lot of water and a lot of green.
>>It's beautiful. Do you mind if we take a quick look inside?
>>That'd be great.
>>Just like in the mountains.
>>So you can see here that we have a sign that says this is our Mindfulness Based Stress
Reduction workshop. And you can see who is running it. These are two experts from the
San Diego Mindfulness Center. And they have been working with us for about four years
now to develop techniques that allow them to do the same sort of program for mindfulness
that they do in the physical world in the virtual world.
>>That's impressive. Not an easy task.
>>It's taken some real thinking about it and we've had to refine as they've held classes.
So we came up with this area. Each of these cushions is like a meditation cushion, but
you can sit on it. And if you're sitting on a cushion, the person leading the mindfulness
has control of your avatar. So you can actually watch your avatar go through the poses that
are typical of a mindfulness session. Sometimes they're yoga poses. Sometimes you lay down
to do a body scan. And if there was a facilitator in here running a mindfulness class, he or
she would be able to tell our avatars to all lay down, so we would be listening to his
voice and then watching our avatars in the standard position that you'd have in a regular
mindfulness class.
>>And how many people at a time can this class accommodate?
>>Well we can put as many of these cushions out as we want. I think 16 would probably
be an upper limit. We are actually running classes right now for a longitudinal study
that we're doing with Dr. Valerie Rice at Fort Sam Houston. So she has about 8 people
per session and we are in our third or fourth session. We'll be doing these for about a
year so we get a good number of subjects for the study.
>>That's so exciting.
>>We're really excited to see if we can prove that delivering mindfulness in a virtual world
is as effective as delivering it in the real world.
So this is where we have the homework pods. It's not as beautiful as the lodge, but what
it affords is privacy. What it does is put a virtual reality sphere around us so that
we can have a beautiful scene while we're doing our homework. And if we click in front
of us, you see the homework menu.
>>Yes.
>>So you can choose which of the sessions you want to do for homework. So there's a
number of them that the people who are running the class have recorded so that you could
do a 45-minute body scan or just a 10-minute wisdom meditation while you're in here and
be in one of these environments. So you can choose which environment that you would want
to be in. It's amazing how much it affects our psychological being. You wouldn't think
that 3D graphics or being in this kind of world would do that, but it really does have
an effect. So if you're in a nature scene -- let me just change this here to the Grand
Canyon environment -- there is something about being in this scene that changes the way you
feel about things and if you are able to walk through it and hear the sounds. In our area
here around the lodge, you can be standing by a tree and hear a woodpecker or chipmunks
might be running around, so there's all that sort of subtle ambient sound that really helps
you feel like you're there.
>>That's great. Thank you for sharing this with me.
>>Oh, you're welcome. We love sharing this because we think it's a very exciting development.
>>So that was really interesting. I understand the virtual world has a stress reduction center
that includes mindfulness activities. Why did you guys choose to focus on mindfulness?
>>When we started working in the virtual world, nobody knew if it was going to be beneficial
in the ways that we envisioned it. So we wanted to start with something that had been proven
to work in the physical world. So mindfulness had 30 years of evidence-based research to
support it. And then we thought that was an excellent way to start.
>>What other stress release activities do veterans experience in-world?
>>We have a couple. One is a storytelling tower that they can look at stories from classic
warriors, like the Cheyenne Dog Warrior or the Samurai Warrior. And that's an interactive
exhibit, kind of like a museum exhibit, except when they get to the top of the storytelling
tower, having seen the scenes from the warrior's life, they can then talk to that warrior as
an AI (artificial intelligence) agent and that warrior can answer any questions they
have -- historical or personal. How did you feel when you killed somebody? They can ask
all kinds of really pointed questions in a conversational way with this agent who is
a storyteller. So that's one.
We have a running path that we put it. Now we had a military social worker say, "Couldn't
you put a running path into the virtual world?" Because when they come back, if they can't
run, they really miss it. And we thought, sure, but the way you navigate your avatar
in the virtual world is to navigate the up key. And we didn't think that would be very
satisfying. So we came up with this concept of using your ordinary microphone that you
would use to talk to other people in the virtual world. We wrote a function that recognizes
your breath. And so it recognizes the rhythm of your breath. We gave you a little biofeedback
device so you see this bar going up and down and as long as you can match your breath to
the rhythm of the up-and-down bar, then your avatar will run. And it will run around the
entire island, which takes about 10 minutes. So it's all about deep breathing, but it's
in the context of this fun activity of running. And we did a study on this and we found that
you were much more relaxed at the end of the 10-minute run. So that's some of the other
stress release that we have.
And then we have the mindfulness center. That looks like a gazebo at the rear of the ski
lodge, and that is filled with yoga cushions and different kinds of things that the instructors
need to be able to give that class within the virtual world because there are differences
from the physical world. But the gazebo is in a very nice location and there are paths
that you can walk for your mindfulness walking. There are yoga poses that we've built into
those cushions so the instructor can have everyone stand up and do a mountain pose or
do the relaxing pose for a body scan. So we put a lot of the functionality that would
be natural in the physical world into that gazebo so that the instructors have full control
of the class in ways they would be used to in the physical world. That was a big challenge.
>>Sounds like it. You mentioned that one of the draws of having avatars is that you can
be anyone you want to be. You can have your inner self come out. Are there ever any challenges
with that or any complications? Does that complicate the real world? For instance, the
person you said who might have struggled with walking in reality can suddenly walk in this
virtual world. But does that contrast leave him sad in the real world when he can't walk
in the real world as he did in Second Life?
>>I think it's more of an outlet and a way to manage those challenges in the physical
world, so they're not bound by those challenges anymore. I assume there's some small risk
to people getting addicted to being in the virtual world, but it's something that I think
provides more of social outlet. It provides camaraderie. Rather than being isolated, you
are actually with people. I think rather than people becoming addicted to the avatar, they
would instead be able to explore different parts of themselves. They can always turn
it off. It's not likely that they're going to become addicted to these characters because
they are in some sense part of them. So if we're addicted to ourselves, then maybe we
get addicted to our avatars. But I think in terms of psychological health, they fill a
very important need that we have, that we may not be able to get any other way. And
I think also in the future when we use these virtual worlds for what I call an advanced
form of tele-health care, the expressions of the avatar may be a very big psychological
tell for a therapist back at a clinic or an office so that they can get a sense of what's
going on with that person. Now that's not a proven thing yet, but I envision a day when
that will happen.
>>So what are some advantages and disadvantages of having veterans engage in virtual therapy
vs. in-person therapy?
>>The biggest advantage to having this therapy accessible in the virtual world is that you
can do it from anywhere. You only need a computer and an Internet connection. You are in there
with other people. Those other people can include your therapist or a group that you
are in. So that's one of the big advantages. You don't have to travel to a center to get
this help.
The disadvantage is if there is a crisis situation, then it's harder for the therapist or comrade
to do something about that. I would like to see a safety net of on-call crisis intervention
specialists who can be reached in such an event. So that's the biggest disadvantage,
I think.
There are so many benefits that are possible that we are going to continue to do research
in this area to see if we can show people like the VA hospitals and therapists that
this is a really viable way to get to a patient in a way you can't do by having them come
to the office once a month. So I see this as spreading as the advantages are noticed
and taken advantage of by the therapist.
>>What are some success stories that have come from this project?
>>Well because we're still in a research phase, we don't have it actively deployed to patients
yet. But we are in the middle of a longitudinal study that is looking at the effectiveness
of mindfulness therapy delivered via virtual world as opposed to mindfulness therapy delivered
via physical world. So we expect that that's going to give us the basis to show the military
that this can be deployed in this way. The stories we have from the people who are participating
right now include that it's easier to talk, they are more open, there's that sense of
anonymity that gives them a feeling of protection. So even in a physical setting in a group setting,
they might not say as much as they're saying in the virtual world.
>>Who would not benefit from this project?
>>Well we don't know if everybody's inclined to want an avatar and to be able to inhabit
an avatar in the virtual world. There may be some people who think it's kind of silly
or can't really wrap their heads around it, so those kinds of people might not be the
ones best served by getting therapy in the virtual world. But it is true that today there
are hundreds of virtual worlds and the biggest users of these virtual worlds are kids ages
5-15. They think nothing of having avatars for this, that, this world, another world,
and they're growing up this way. This is their social outlet. So they ma be priming themselves
to get more of the mental health or health care in virtual worlds in the future. Today
we're in a transition phase, so we've got people who have never used such things and
find them a little frivolous, but I think as we go along in time, this will become a
standard thing. We're all used to using social networks on the Internet right now. I think
virtual worlds are the 3D-embodied versions of social networks.
>>Is this project and experience designed to be an ongoing experience for veterans or
is it something that they do for three months and then transition out and they're back to
normal?
>>I think that's up to each veteran. So if they're finding a social existence in the
virtual world that is satisfying to them in some way, they may stay in the virtual world
for that social experience beyond any therapy that they do. It would be good if they had
access to different kinds of therapy when they need it, just like in the physical world,
and maybe easier to get to than some of the things that they have trouble accessing now.
I think it's a personal decision. I think people can use it as a tool to get help over
a discrete time period or they can find a lot of other reasons to be in the virtual
world and to stay there.
>>How do you see this project evolving in the future?
>>Well my vision is it that it becomes an integral part of advanced tele-health care.
So just like now we have video conferences with our physicians or with our therapists,
this would be a way to have an ongoing relationship but to meet your therapist or your doctor
in the virtual world. So you're both in there. Like I said, there's a lot an avatar can tell
about what you're doing and feeling at that moment in time. So I see this as something
that could be something that could be actually instantiated as part of health care in America.
It will help reduce costs. It will have all the benefits that traditional tele-health
care has. But it has these three advantages that that does not have. And those are the
environment. We can make it anything we want so we can look at 60 years of research into
what kinds of environments are psychologically beneficial to us and we can make those in
the virtual world. We have the social aspect so you're never alone. You've got these support
groups and there's always someone in there you can talk to. And thirdly, the avatar,
which is a strong draw for many people, maybe not everybody, but it is something that gives
you a way to show the real you to other people.
>>Are there any facilities interested in using virtual worlds with their patients?
>>We actually have a collaboration with the National Intrepid Center of Excellence for
Psychological Health and Traumatic Brain Injury in Bethesda, Maryland. So this is a place
where military people come when they want to remain active duty and they've been diagnosed
with some sort of mental health problem. And they want to get that fixed so they can get
back to active duty. They come and they stay there for four weeks with a family member,
typically. And they go through all kinds of possible therapies that might work for them.
Now we've been talking about using the virtual world therapy as a way to do continuity of
care for their patients. So when the patients leave, they don't really have a way to keep
in touch with them. We built the entire facility in the virtual world so that they can come
into the virtual world and actually go to the places where they were having their physical-based
therapy when they were at NICO. So it's called NICO for short. And we haven't implemented
that yet. We've been working with them for about a year to build the facility and to
put educational material in it as a first step so they can go in and review the kinds
of things that they learned when they were there.
The second phase is where we are for the next year, which is to get the therapists and the
medical professionals up to speed on using virtual worlds and to find out from them how
they could best be used in their context so that we can put those functions into the virtual
world. Then the final phase would be deploying it out to the patients and giving them the
opportunity to continue their care that way. So we're very excited about that collaboration
with the National Intrepid Center. We'll see where it goes and we hope that in three years
we can say it's a success story.
>>Virtual worlds are often thought of as lighthearted places, places for fantasy. Are there examples
of virtual worlds being used for more serious purposes?
>>There are actually quite a few. There are a number of educational institutions that
are using it as a test bed for distributed education. But there are also people looking
at it for purposes such as mental health. There is a group called Preferred Family Health
Care in Missouri, and several years ago they took their teen addiction program into the
virtual world. They found that because they served such a large area, it was hard for
the kids to get into the facility as often as they needed to be. So they gave them a
$500 computer and a webcam and sent them home. And they built a space in an open source virtual
world and the kids had to come into that for their sessions. And they could follow them
because of the camera. They found the retention rates just went through the roof, so from
maybe around 30 percent when they had to come into the physical facility to 90 percent of
the patients finishing the 3-4 month program. And they were just amazed at how much more
compliance from the teenagers just by putting the program in a virtual world. So that's
one success story.
Club One, which is a physical fitness place in the United States, has a number of nutrition
and exercise programs they provide at their physical locations. They built a center in
the virtual world and then they did a study where they did the same interventions for
people in the virtual world as in the physical world. And they found that the virtual world
cohort actually did better. They stayed on the program. They lost more weight. And they
think it might be because of the social support. So rather than having to go to a physical
place for every session, you could go into the virtual world any time you want and find
someone who is in your program so you can get that kind of moral support on an ongoing
basis.
So those are just two examples. There are a number of others. There's a PTSD island
where you can learn about PTSD. There is an online mental health group that is looking
at using virtual worlds for that type of thing. But more and more we are seeing studies that
show that the virtual world is a viable place to distribute this type of health care.
>>Well Jacki, thanks so much for joining me today. This has been absolutely fascinating
and I wish you and the project the best of luck in the future.
>>Thanks, Shannon.
>>To get in-depth information on the Coming Home Project, visit USC's Institute for Creative
Technologies Website at http://projects.itc.usc.edu.
To download and participate in Second Life, visit www.secondlife.com.
To read the New York Times coverage on the Coming Home project, visit:
http://bits.blogs.nytimes.com.
Thank you so much for watching. We'll see you next time.