Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T01:58:29.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric Interventions in Virtual Reality: Why We Need an Ethical Framework

Published online by Cambridge University Press:  07 September 2020

MARIA MARLOTH ,
JENNIFER CHANDLER  and
KAI VOGELEY
Get access Rights & Permissions [Opens in a new window]

Abstract

Recent improvements in virtual reality (VR) allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders (e.g., exposure therapy), the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: (1) reality and its representation, (2) autonomy, (3) privacy, (4) self-diagnosis and self-treatment, and (5) expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR.

Keywords

virtual realityhuman–computer interactionvirtual reality in clinical contextautonomy
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Special Issue 4: Clinical Neuroethics , October 2020 , pp. 574 - 584
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Funding acknowledgement: This study was funded as part of the project consortium THERENIA within the funding framework “Network of European Funding for Neuroscience Research” (NEURON) under the ERA-NET scheme of the European Commission, with funds from BMBF, Germany (01GP1822), and from the Canadian Institutes of Health Research (CIHR).

References

Notes

1. Lem, S. Summa Technologiae. Minneapolis: University of Minnesota Press; 2014.Google Scholar

2. Bailenson, J. Experience on Demand. What Virtual Reality Is, How it Works, and What it Can Do. New York, London: W & W Norton Company; 2018.Google Scholar

3. Lanier, J. Dawn of the New Everything. A Journey Through Virtual Reality. London, UK: The Bodley Head; 2017.Google Scholar

4. Matamala-Gomez, M, Donegan, T, Bottiroli, S, Sandrini, G, Sanchez-Vives, MV, Tassorelli, C. Immersive virtual reality and virtual embodiment for pain relief. Frontiers in Human Neuroscience 2019;13:279; available at https://www.frontiersin.org/article/10.3389/fnhum.2019.00279 (last accessed 06 Mar 2020).CrossRefGoogle Scholar

5. Kellmeyer, P. Neurophilosophical and ethical aspects of virtual reality therapy in neurology and psychiatry. Cambridge Quarterly of Healthcare Ethics 2018; 27(4):610–27.CrossRefGoogle ScholarPubMed

6. Bourdin, P, Barberia, I, Oliva, R, Slater, M. A virtual out-of-body experience reduces fear of death. PLOS ONE 2017;12(1):e0169343; available at https://doi.org/10.1371/journal.pone.0169343 (last accessed 06 Mar 2020).CrossRefGoogle ScholarPubMed

7. Vogeley, K, Bente, G. “Artificial humans”: Psychology and neuroscience perspectives on embodiment and nonverbal communication. Neural Networks 2010;23(8):1077–90.CrossRefGoogle Scholar

8. Roth, D, Bente, G, Kullmann, P, Mal, D, Purps, CF, Vogeley, K, et al. Technologies for social augmentations in user-embodied virtual reality. In: 25th ACM Symposium on Virtual Reality Software and Technology (VRST ’19), November 12–15, 2019, Parramatta, NSW, Australia. New York, NY: ACM; available at https://doi.org/10.1145/3359996.3364269 (last accessed 06 Mar 2020).Google Scholar

9. Roth, D, Latoschik, ME, Vogeley, K, Bente, G. Hybrid Avatar-Agent technology—A conceptual step towards mediated “social” virtual reality and its respective challenges. I-com 2015;14(2):107–14.CrossRefGoogle Scholar

10. Didehbani, N, Allen, T, Kandalaft, M, Krawczyk, D, Chapman, S. Virtual reality social cognition training for children with high functioning autism. Computers in Human Behavior 2016;62:703–11.CrossRefGoogle Scholar

11. Maples-Keller, JL, Yasinski, C, Manjin, N, Rothbaum, BO. Virtual reality-enhanced extinction of phobias and post-traumatic stress. Neurotherapeutics 2017;14(3):554–63.CrossRefGoogle ScholarPubMed

12. Rizzo, A, Shilling, R. Clinical virtual reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology 2017;8(5 Suppl):1414560.CrossRefGoogle Scholar

13. Park, MJ, Kim, DJ, Lee, U, Na, EJ, Jeon, HJ. A literature overview of virtual reality (VR) in treatment of psychiatric disorders: Recent advances and limitations. Frontiers in Psychiatry 2019;10(505):1–19; available at https://www.frontiersin.org/article/10.3389/fpsyt.2019.00505 (last accessed 06 Mar 2020).CrossRefGoogle ScholarPubMed

14. Freeman, D, Reeve, S, Robinson, A, Ehlers, A, Clark, D, Spanlang, B, et al. Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine 2017;47(14):2393–400.CrossRefGoogle ScholarPubMed

15. Maples-Keller, JL, Bunnell, BE, Kim, SJ, Rothbaum, BO. The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harvard Review of Psychiatry 2017;25(3):102–13.CrossRefGoogle ScholarPubMed

16. Valmaggia, LR, Latif, L, Kempton, MJ, Rus-Calafell, M. Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence. Psychiatry Research 2016;236:189–95.CrossRefGoogle ScholarPubMed

17. Freeman, D, Lister, R, Waite, F, Yu, LM, Slater, M, Dunn, G, et al. Automated psychological therapy using virtual reality (VR) for patients with persecutory delusions: Study protocol for a single-blind parallel-group randomised controlled trial (THRIVE). Trials 2019;20(87):1–8.Google Scholar

18. The Editors. Being and believing: Ethics of virtual reality. Lancet 1991;338(8762):283–4.CrossRefGoogle Scholar

19. See note 5, Kellmeyer 2018.

20. Rizzo, A, Koenig, ST. Is clinical virtual reality ready for primetime? Neuropsychology 2017;31(8):877–99.CrossRefGoogle ScholarPubMed

21. Madary, M, Metzinger, TK. Real virtuality: A code of ethical conduct. Recommendations for good scientific practice and the consumers of VR-technology. Frontiers in Robotics and AI 2016;3(3):1–23; available at https://doi.org/10.3389/frobt.2016.00003 (last accessed 06 Mar 2020).CrossRefGoogle Scholar

22. See note 21, Madary, Metzinger 2016.

23. Kellmeyer, P, Biller-Andorno, N, Meynen, G. Ethical tensions of virtual reality treatment in vulnerable patients. Nature Medicine 2019;25(8):1185–8.CrossRefGoogle ScholarPubMed

24. See note 5, Kellmeyer 2018.

25. See note 21, Madary, Metzinger 2016.

26. See note 5, Kellmeyer 2018.

27. Rizzo, A, Schultheis, MT, Rothbaum, BO. Ethical issues for the use of virtual reality in the psychological sciences. In: Bush, SS, Drexler, ML, eds. Ethical Issues in Clinical Neuropsychology. Studies on Neuropsychology, Development, and Cognition. Lisse, The Netherlands: Swets & Zeitlinger; 2003, at 245–77.Google Scholar

28. Slater, M. Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philosophical Transactions of the Royal Society 2009;364:3549–57.CrossRefGoogle ScholarPubMed

29. See note 28, Slater 2009.

30. See note 28, Slater 2009.

31. See note 14, Freeman et al. 2017.

32. See note 21, Madary, Metzinger 2016.

33. See note 21, Madary, Metzinger 2016.

34. See note 18, The Editors 1991.

35. Kuntze, MF, Stoermer, R, Mueller-Spahn, F, Bullinger, AH. Ethical codes and values in a virtual world. Cyber Psychology & Behavior 2002;5(3):203–6.CrossRefGoogle Scholar

36. See note 27, Rizzo et al. 2003.

37. See note 5, Kellmeyer 2018.

38. See note 27, Rizzo et al. 2003.

39. Schultheis, MT, Rizzo, A. Emerging technologies in practice and research. In: Morgan, JE, Ricker, JH, eds. Textbook of Clinical Neuropsychology. Studies on Neuropsychology, Neurology and Cognition. New York, NY: Psychology Press; 2008, at 848–65.Google Scholar

40. Ramirez, EJ, LaBarge, S. Real moral problems in the use of virtual reality. Ethics and Information Technology 2018;20(2):249–63.CrossRefGoogle Scholar

41. Pan, X, Hamilton AFC, . Why and how to use virtual reality to study human social interaction: The challenges of exploring a new research landscape. British Journal of Psychology 2018;109(3):395–417.CrossRefGoogle ScholarPubMed

42. See note 40, Ramirez, LaBarge 2018.

43. Slater, M, Antley, A, Davison, A, Swapp, D, Guger, C, Barker, C, et al. A virtual reprise of the Stanley Milgram obedience experiments. PLoS One 2006;1(1):e39; available at https://doi.org/10.1371/journal.pone.0000039 (last accessed 06 Mar 2020).CrossRefGoogle ScholarPubMed

44. Skulmowski, A, Bunge, A, Kaspar, K, Pipa, G. Forced-choice decision-making in modified trolley dilemma situations: A virtual reality and eye tracking study. Frontiers in Behavioral Neuroscience 2014;8:426; available at https://doi.org/10.3389/fnbeh.2014.00426 (last accessed 06 Mar 2020).CrossRefGoogle ScholarPubMed

45. Lemley, MA and Volokh, E. Law, virtual reality and augmented reality. Pennsylvania Law Review 2018;166:1051–138.Google Scholar

46. Dibbell, J. A rape in cyberspace. Republished in Dibbell J. (1999) In: My Tiny Life: Crime and Passion in a Virtual World . New York, NY: Henry Holt & Co; 1993.Google Scholar

47. Buck, S. The ‘rape in cyber space’ from 25 years ago posed problems we still haven’t solved today: Free speech vs. virtual ‘action’ on the early web”. Timeline 2017; (last accessed 23 Apr 2020) available at https://timeline.com/rape-in-cyberspace-lambdamoo-da9cf0c74e9e (last accessed 23 Apr 2020)Google Scholar

48. See note 41, Pan, Hamilton 2018.

49. See note 21, Madary, Metzinger 2016.

50. See note 21, Madary, Metzinger 2016.

51. Yee, N, Bailenson, J. The proteus effect: The effect of transformed self-representation on behavior. Human Communication Research 2007;33(3):271–90.CrossRefGoogle Scholar

52. Spiegel, JS. The ethics of virtual reality technology: Social hazards and public policy recommendations. Science and Engineering Ethics 2018;24(59):1537–50.CrossRefGoogle ScholarPubMed

53. Hershfield, HE, Goldstein, DG, Sharpe, WF, Fox, J, Yeykelis, L, Carstensen, LL, et al. Increasing saving behavior through age-progressed renderings of the future self. JMR, Journal of marketing research, 2011;48:23–37.CrossRefGoogle ScholarPubMed

54. Banakou, D, Hanumanthu, PD, Slater, M. Virtual embodiment of white people in a black virtual body leads to a sustained reduction in their implicit racial bias. Frontiers in Human Neuroscience 2016;10:601; available at https://doi.org/10.3389/fnhum.2016.00601 (last accessed 06 Mar 2020).CrossRefGoogle Scholar

55. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. New York, NY; Oxford: Oxford University Press; 2009.Google Scholar

56. Nozick, R. Anarchy, State and Utopia. New York, NY: Basic Books; 1974.Google Scholar

57. See note 18, The Editors 1991.

58. See note 18, The Editors 1991.

59. See note 21, Madary, Metzinger 2016.

60. See note 27, Rizzo et al. 2003.

61. See note 18, The Editors 1991.

62. See note 23, Kellmeyer et al. 2019.

63. See note 27, Rizzo et al. 2003.

64. Whalley, LJ. Ethical issues in the application of virtual reality to medicine. Computers in Biology and Medicine 1995;25(2):107–14.CrossRefGoogle ScholarPubMed

65. See note 64, Whalley 1995.

66. Tabbaa, L, Ang, CS, Rose, V, Siriaraya, P, Stewart, I, Jenkins, KG, et al. Bring the outside in: Providing accessible experiences through VR for people with dementia in locked psychiatric hospitals. In: Proceedings of CHI Conference on Human Factors in Computing Systems Proceedings (CHI 2019). New York, NY: ACM; available at https://doi.org/10.1145/3290605.3300466 (last accessed 06 Mar 2020).Google Scholar

67. See note 5, Kellmeyer 2018.

68. See note 5, Kellmeyer 2018.

69. See note 8, Roth et al. 2019.

70. See note 9, Roth et al. 2015.

71. See note 8, Roth et al. 2019.

72. See note 5, Kellmeyer 2018.

73. Foucault, M. Maladie Mentale et Psychologie. Paris, France: Presses Universitaires de France; 1954.Google Scholar

74. See note 8, Roth et al. 2019.

75. See note 21, Madary, Metzinger 2016.

76. See note 52, Spiegel 2018.

77. See note 21, Madary, Metzinger 2016.

78. See note 8, Roth et al. 2019.

79. See note 41, Pan, Hamilton 2018.

80. See note 20, Rizzo, Koenig 2017.

81. See note 5, Kellmeyer 2018.

82. See note 64, Whalley 1995.

83. See note 39, Schultheis, Rizzo 2008.

84. See note 39, Schultheis, Rizzo 2008.

85. See note 21, Madary, Metzinger 2016.

86. Hardy, GE, Bishop-Edwards, L, Chambers, E, Connell, J, Dent-Brown, K, Kothari, G, et al. Risk factors for negative experiences during psychotherapy. Psychotherapy Research 2019;29(3):403–14.CrossRefGoogle ScholarPubMed

87. See note 40, Ramirez, LaBarge 2018.

88. See note 23, Kellmeyer et al. 2019.