Battling Addiction, Pain, and PTSD With Virtual Reality

Last November, Erin Martucci became the first woman to deliver a child using nothing but virtual reality to ease her pain. It was a Saturday morning at Orange Regional Medical Center in Middletown, New York, and Martucci had been having contractions for more than two hours. Her gynecologist could sense her anxiety. "Once I break your water, things are going to pro­gress very quickly," he said. He offered her the common ob-gyn pain relief: "Do you want an epidural?"

She'd wanted to have a natural birth, but with waves of pain hitting every five minutes, her resolve was weakening. Soon it would be too late for an epidural. But then the doctor offered an alternative: a set of Samsung Gear VR goggles.

A toy? The goggles seemed silly to Martucci, but what the hell. They couldn't make things any worse.

When the doctor lowered the headset over her eyes, she found herself sitting on a low seaside cliff. She could hear waves crashing against the shore below. She looked around, and instead of a hospital room, she saw seagulls flying circles overhead and butterflies fluttering about in lazy circles. After a few moments, the sun began to sink on the horizon, and the Milky Way spread out above her. Fireflies twinkled; a campfire sparked to life. A woman's voice, soft and soothing, helped her focus her mind and steady her breathing.

The pain didn't disappear — Martucci was still aware of her contractions — but the virtual world gave her something compelling to focus on. Two hours of labor went by in what felt like 20 minutes. "When the doctor took the goggles off, I was like, 'What's going on?' " says the 40-year-old grade-school counselor.

"You're going to push now," he replied.

Two minutes later, she gave birth to an 8-pound, 4-ounce girl.

We are at the doorstep of a virtual reality revolution, and the upshot isn't just more vivid gaming — it's better health.

VR equipment is beginning to infiltrate hospitals and health clinics, helping patients to manage pain and anxiety and address phobias and depression. Early adopters are using VR software at home for therapy, guided meditation, and workouts that feel more like gaming than exercise. And as cheap headsets proliferate — a basic set can be yours for just $20 — enterprising researchers are discovering a range of wellness potentials: VR programs to battle PTSD, treat drug and alcohol addiction, and help you bounce back faster from injury. The scope of applications has helped the VR market reach nearly $14 billion this year, with a projection of $143 billion within the next four years.

For a revolutionary product, the technology is pretty simple: Put on a headset and a pair of tiny, high-definition computer monitors sits inches away from your eyeballs. The image on each screen provides a slightly different perspective, which creates a realistic sense of depth — like a 3-D movie that wraps all around you. As you turn your head, accelerometers built into the headset allow the screen to respond in real time. So if you hear someone yell "Heads up!" in your left headphone, you can look over and see a baseball flying toward you. All of this helps persuade your mind that virtual reality is reality.

"It turns out that it's very easy to trick the brain," says Robert Reiner, a New York–based psychologist. "As complicated and sophisticated as [the brain] is, it can really only pay attention to one thing at a time." VR creates an onslaught of sensory data for the mind to focus on — researchers call this “cognitive load” — and, unable to process two worlds at once, you're forced to focus on the most salient one. The real world fades away by necessity.

"VR presents a unique opportunity to expose someone to a different version of reality," Reiner says. It's like a teleportation device that relocates someone in the environment that's most conducive to healing. Maybe it's a serene mountaintop for a patient in trauma, or the Golden Gate Bridge for someone with a phobia of driving over water. In this new world, they can distract themselves from pain, face fears head on, or learn a new skill. And, according to Reiner, "there's really no other way to simulate this."

Reiner introduced VR to his patients in 1999, using a suite of programs to help people confront common phobias — fears of spiders, flying, and heights. These days, much of his therapy occurs in a chair that looks like a prop from Total Recall. The recliner has biosensor cables hanging from the headrest and a 1,100-watt subwoofer underneath. When, for example, fear-of-flying patients use VR to walk through an airport and board a plane, the speaker rumbles for more realistic takeoffs. This makes it possible to simulate intense experiences in an Upper East Side office, while still allowing people to feel safe. "You have to teach people at the deepest visceral level that something isn't going to hurt them," Reiner says.

The technique works. One of his patients, a 66-year-old New York City executive, was terrified of public speaking. But his daughter was getting married, and the man had to give a toast. "When I met him, he couldn't stand in front of me and read the New York Times," says Reiner. "He'd have a panic attack." But in the safe space of virtual reality, he could practice speaking in front of audiences. As he gained confidence, he moved on to virtual weddings. "When his moment came, he was ready," says Reiner. The man delivered a toast about how proud he was of his daughter to a roomful of family, friends, and people he'd never met.

When Facebook bought Oculus for $2 billion in 2014, it seemed like a watershed moment for VR. What few people realized then, however, is that researchers had been working with VR for decades, and many of their efforts focused on health and wellness.

One of the first big breakthroughs came in 2000, when scientists at the University of Washington in Seattle released a VR pain-relief program called SnowWorld designed for injured vets. Users could slink through an icy cave, blasting penguins and snowmen with snowballs; it was perfect for bedridden burn-ward patients, who played SnowWorld during excruciating bandage changes. In one study, SnowWorld reduced the patients' self-reported pain score from an average of 6.3 to 2.8, on a 10-point scale. What's more, the amount of time they spent thinking about pain fell from 76 percent to 22 percent. The explanation goes back to cognitive load: The more brainpower that goes toward something enjoyable, the less brainpower is available to register pain.

So why did it take decades to apply VR to more-common circumstances like childbirth? "Twenty years ago, a 'portable' VR unit was a $100,000 machine that required two people to lift it," explains Howard Rose, co-founder of  Firsthand Technology, which helped build the most recent SnowWorld update. By the early 2000s, VR headsets were still clunky, like having a half-gallon of milk strapped to your face, and the programs were designed primarily for military training. "Now VR devices are lighter, they fit better, and the graphics are better, too," says Rose. "As a result, developers are finally making programs that people will use."

That includes Dr. Brennan Spiegel, director of health and human services at Cedars-Sinai in Los Angeles. Spiegel has provided VR treatment to more than 300 patients, including those with depression and anxiety, and pain from diseases like cancer, pancreatitis, and irritable bowel syndrome. As Spiegel sees it, we'll soon have a new medical specialty called virtualism. "A virtualist" — a doctor specializing in VR treatments — "would talk to a patient, check his medical history, then pull the appropriate therapy program off the VR pharmacy shelf," he says.

Right now, Spiegel is using VR to help combat addictive medications like opioids — including hydrocodone, oxycodone, and fentanyl — which are responsible for two-thirds of drug-overdose deaths. "The dirty secret is that a lot of opioid dependency begins in the hospital," he says. "People are in pain, and doctors want to help, but they're not thinking about the long-term consequence." Give a patient a headset instead of a prescription, however, and you might be able to prevent the kind of drug dependence that led to the deaths of more than 25,000 people in 2016 alone.

Science certainly supports the idea: In 2014, researchers at the University of Barcelona wanted to find out how effective VR could be at pain reduction, so they had people plunge a hand into a tank of icy water and hold it there as long as they could. The control group lasted 20 seconds. Participants using a VR program didn't report pain until 70 seconds — a threshold more than three times as long.

This applies to chronic pain, too. In a University of  Tennessee study last summer, people with achy knees or hips saw pain scores fall 60 percent after just a five-minute VR session. Even more significant was that the effect stuck around: After the experience, they felt a third less pain than before.

At Cedars-Sinai, the virtualist concept is already taking hold. When Spiegel walks the halls holding VR goggles, his colleagues swarm. "It's like I'm the Pied Piper," he says. "Doctors say, 'I've got a guy downstairs with pancreatitis. Could you see him?' " Or maybe it's a heart transplant, or someone with mysterious aches. More often than not, VR helps ease the pain or even temporarily erases it.

Outside of pain treatment, VR's wellness applications seem endless. A Korean study found that alcoholics could prevent a relapse by simulating virtual drinking scenarios. People with hypertension and bad eating habits can put on a headset and use a nutrition program to change how they think about unhealthy foods subconsciously. The list goes on: VR is being used to treat drug addiction, stuttering, depression, and PTSD, and a whole cottage industry has emerged for fitness.

That's just the beginning. Soon, says Jared M. Porter, director of the motor behavior lab at Southern Illinois University, you may do physical therapy for an injury in the comfort of your own home. "You could put on a headset and work with a physical therapist 600 miles away, without ever leaving your bed," he says. "To the brain, you're still learning coordination and motor skills." In new, soon-to-be-published research, Porter proves it: He asked a group of novice golfers to practice either on a course and driving range or in VR, never actually holding a club or hitting a real golf ball. Then both groups went to a real-world golf course. "The group that practiced in VR was just as good as the group that practiced in real life," he says.

As for the future of VR? "It takes time for people to understand how the technology works, but we're going to hit a tipping point," says Rose, whose health care–focused software is in 15 clinics and hospitals nationwide. "Once we do, it'll be an explosion." Picture headsets as a normal part of going to a doctor's office, as common as a stethoscope or blood pressure cuff. At work, you might use VR to calm nerves before a presentation. Want to learn to play guitar? Put on a headset.

Skeptical? So was Martucci, the woman who made history with her VR-assisted childbirth. "I'm not technologically savvy, and I'd never used VR goggles before," she says. "But once they were on, I was totally engaged. I was focusing on the beach rather than the labor, and I couldn't believe I delivered my baby without an epidural."

Martucci has friends who are pregnant. "I tell them, 'Have your hospital look into this — you won't regret it.' "