Therapists Use Virtual Worlds to Address Real Problems

An emerging technique to help troubled teens combines role-play in computer-generated environments with talk therapy















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GETTING WITH THE PROGRAM: Therapist Heather Foley uses a customized virtual world called Simulated Environment for Counseling, Training, Evaluation and Rehabilitation (SECTER) to work with patients in the Kids in Transition program. Here she uses the playback feature to review a patient's behavior. Image: © CFG HEALTH SYSTEMS

When a troubled 13-year-old named Joe first entered the Kids in Transition program in 2007 in Camden, N.J., he hardly spoke to his therapist. Like many teens at this residential mental health treatment facility, he was admitted because he had trouble controlling his anger, had run away from home several times, and had a history of run-ins with the law, according to Heather Foley, a social worker with the program. Therapists typically encourage patients like Joe to get at the core of their problems via face-to-face role-playing—pretending to be in a situation and having the patient practice how to handle it. But Foley says this approach was a nonstarter for Joe, whose confrontational behavior and attention deficit hyperactivity disorder (ADHD) impair his ability to engage and focus in this way.

When that approach failed, Foley enrolled her young patient in a program that treats teens using something familiar to most of them: the virtual world, in this case a customized one called Simulated Environment for Counseling, Training, Evaluation and Rehabilitation (SECTER).

Joe is one of 20 teens who have been treated using the program that allows them to role play in a 3-D virtual world environment in which they communicate with therapists through avatars.

Foley says that once a week for eight weeks she and the boy sat at computers in her office and donned headphones so that they could communicate with one another's avatars through the Internet, just as gamers do in the virtual environments of Second Life and World of Warcraft. She notes that SECTER avatars can assume different postures as do humans when interacting with one another. Users can also add special features to their avatars, including facial expressions, hair and skin color, and different mannerisms. For instance, Foley says, Joe made his avatar do high fives and sport a swagger when it moved.

In addition to treating troubled teens, virtual environments have been used to help treat Asperger's syndrome (a disorder resembling autism), anorexia and bulimia, anxiety disorders, post-traumatic stress syndrome and alcoholism as well as physical disabilities in stroke victims.



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  1. 1. NorthEasternFrog 11:09 PM 4/3/09

    Does anyone know if they are using VOIP to communicate?
    The article mentions headphones, but perhaps they text too.

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  2. 2. WestMarin 03:11 PM 4/4/09

    It never occurred to me before, but now that I read this article, it seems so obvious: use a virtual reality game to get through to troubled teens. This is THEIR world. It's their medium and operates on their plane. What better way to build empathy?

    The other huge benefit of the video game is that it's available anywhere, anytime. Helping someone in emotional distress doesn't just happen at the appointed hour. These kids need help the moment the get triggered  in the back seat of the car on the way to school or at 11:30 at night. If the therapist can offer assistance when the client needs it most, that's key.

    Of course, virtual reality is no substitute for the real thing. But as a way to connect with these kids, it has potential to serve a huge purpose.

    I'd like to know more about the SECTER program and am interested to see their ideas really latch on.

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  3. 3. ddubois 06:55 PM 4/4/09

    We are on the frontier of a new era in medicine. As a layman it appears to me that biofeedback techniques are on the cusp of taking a quantum leap forward in being able to modify behavior. Overcoming phobias of all sorts is just one application. Physical therapy is another. It will be fascinating to see all the different areas that Virtual Reality can be applied to in the coming years as the technology develops and clinical practices incorporate these new techniques. Don DuBois

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  4. 4. mmacedon in reply to NorthEasternFrog 09:40 AM 4/5/09

    Greenleaf's SECTER is a customized version of Forterra's OLIVE virtual world software. It uses VOIP and text chat.

    See
    http://www.forterrainc.com/index.php/industries/healthcare

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  5. 5. jtuf 10:11 PM 4/5/09

    Well, at least they're not pushing pills.

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  6. 6. eco-steve 12:47 PM 4/6/09

    Virtual reality will help third world people to escape from the cruel world they live in. They could adopt any avatars they like and communicate in the virtual world in a way that would be impossible otherwise. Just imagine a simulation which would teach them development skills. Already with Google Earth we can do virtual tourism on Mars...All the third world needs is for OLPC interfaces to be efficient. Imagination is the future...

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  7. 7. SharonMcL 06:24 PM 4/6/09

    'quick progress'? Can progress be defined in the same way as if by normal techniques?I think not. Clearer definition is needed so as not to mislead..

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  8. 8. SharonMcL 06:24 PM 4/6/09

    'quick progress'? Can progress be defined in the same way as if by normal techniques?I think not. Clearer definition is needed so as not to mislead..

    Reply | Report Abuse | Link to this
  9. 9. Baseboard 06:52 PM 4/15/09

    Kudos to CFG for their innovations and attempts to bringmental health into the 21st century.

    Reply | Report Abuse | Link to this
  10. 10. prmills 07:21 AM 6/17/09

    There was an interesting article in the Journal of Medical Internet Research recently looking at different healthcare related applications for virtual worlds (specifically Second Life) - http://tr.im/oMci
    As a physician I think 3D virtual worlds seem be the natural extension of existing "remote" communications methods and certainly have the potential to significantly augment these methods in helping consumers better manage their health. I have recently strated a project called HealthyWorlds to explore the use of VWs in delivering health related services. If anyone would like to know more or to get involved please do not hesitate to contact me or visit www.healthyworlds.com / twitter.com/healthyworlds

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