My World Survey 2, the largest study into Irish youth mental health, compared results from 2012 with 2019. The study found that reported anxiety in adolescents (aged 12 to 19) had doubled from 11% to 22%, while severe anxiety in young adults (aged 18-25) increased from 15% to 26% (Dooley, 2019). This data is pre-COVID and estimates the psychological fall-out from the pandemic considering young people (aged 15-25, who are already the highest risk age for developing a mental disorder), as a particularly vulnerable group. (O’Connor, Wrigley et al. 2020)
In their paper; Virtual Reality in the assessment, understanding, and treatment of mental health disorders, the authors concluded that ‘ ‘Revolutionary’ is an overused word; for VR and mental health care, it may actually be justified over the coming years.’ (Freeman et al. 2017) Freeman, a leading expert and founder of Oxford VR, believes that well-designed VR treatments could remove the need for input for some disorders, while significantly reducing therapy required for others. He believes VR has the potential to transform mental health treatment so eventually it could be ‘out with the couch, on with the headset’, and in time VR could ‘merit the level of attention to neuroimaging’. (Freeman, Reeve, et al. 2017).
Despite the evidence for the efficacy of VR in the treatment of anxiety, and its particular appeal for young people, prior to this project, VR had not been utilised in Child and Adolescent Mental Health Services (CAMHS). When we consider Irish youths have the fourth-highest suicide rate in Europe (UNICEF, 2017) it is imperative that we prioritise the development of innovative accessible ways to support young people’s mental health.
During 2021 Adaptas Training, Psychologist Dr. Celine Mullins and VR Producer Camille Donegan, produced a series of Virtual Reality films for CAMHS (Galway Roscommon Child and Adolescent Mental Health Services) to help teenagers manage their anxiety. The project was spear-headed by Senior Occupational Therapists at CAMHS, Niamh Morrin and Fiona Mulvey.
With The Dala Project, teenagers embody Dala, a gender neutral character who is anxious about going to school. Dala uses a Pathfinder app on their phone which coaches them through breathing exercises and other techniques to overcome their anxious thoughts and feelings.
The scripting, design and development of the piece was co-created with the teenagers at CAMHS Galway and Roscommon.
The Dala Project appears to be unique in VR development, as it puts the user experience (anxious teenagers attending CAMHS) at the heart of identifying both the problem and the solutions. The team created an avatar they named Dala and through Design Thinking, with the teenagers, answered the question ” How does anxious Dala get to school?” During this process, the team realised Dala’s anxiety was triggered by the external environment of school but the primary triggers were internal; thoughts about fitting in, being popular, making friends, embarrassing themselves, getting into trouble. These worries triggered Dala’s stress response which caused them to feel overwhelmed in school.
We needed to address these internal triggers if anxious Dala was to get to, and stay in, school. This led to a powerful metaphor; that anxiety is like a phone App that when open and running drains the battery eventually causing shut down. As many of the team had experienced physical and emotional shut-down in school this really resonated for them. Dala can choose to close Anxious App recharging the battery and open Pathfinder App with Moxie who coaches Dala through their anxious thinking. With practice, Dala learns what they need from Moxie and can manage by themself. There are two scenarios: Getting Up (for teenagers who cannot get into school due to experiencing anxiety) and Going to Class (for teenagers who struggle to stay in school due to the experience of anxiety). There are three videos in each scenario: Anxious App, Pathfinder and Good to Go. Good to Go was considered important by the team as many anxious teens may not have previously considered it possible to be in school without experiencing anxiety. This means users, embodying Dala, hear their thoughts and feelings, see what they are seeing, hear what they hear, and should they experience anxiety escalating, can experience settling their anxiety with coaching (Moxie), and can also experience settling their anxiety without coaching.
The prototype was tested with 20 teenagers, 12 attending CAMHS and 8 not attending CAMHS. There was a 45% reduction in reported anxiety from watching the first video (Anxious App) to the last video (Good to Go) which is what we had hoped for. The purpose of testing was to assess: (i) how important VR immersion is for the scenarios’ efficacy, (ii) how much the teenagers could relate to Dala, and (iiI) how believable they found the scenarios. The results were:
This means the VR is believable, relatable, immersive and therefore feasible for use with all teenagers experiencing school anxiety. All the participants were positive about using VR and no one had any side effects like dizziness or motion sickness. They reported that it was helpful not only for teenagers experiencing anxiety but for all teenagers as it gives them an insight into how those teenagers experiencing anxiety feel, and also could better prepare them should they experience anxiety in the future. This has been re-iterated by parents in the clinic who have used the Dala Project scenarios along with their teenagers, stating that it has given them a whole new understanding of what their teenager is going through and provided new ideas and ways to support them. CAMHS therapists have found the VR scenarios very useful for teenagers who are so anxious that they may shut down in sessions and are unable to engage with talk therapy. In the past, these teenagers may have missed appointments because the appointments triggered anxiety. Other teenagers have found it helpful to have new ideas and language to discuss anxiety as this reduces their feelings of overwhelm.
CAMHS have developed a detailed workbook, to accompany the videos, which provides information on the research, rationale for and how the prototype was designed and tested. There are specific guidelines for teachers/therapists to structure the sessions and worksheets to evaluate progress and enhance learning during and between sessions. This is an ebook so it can be easily shared, downloaded and the relevant worksheets printed. To view the workbook please follow this link: https://my.visme.co/view/kk91z347-z4p5zz811ggo57n1
The Dala Project, has been awarded the Healthcare Collaboration award in the Health Technology Innovation Awards 2021 (November).
The Dala Project scenarios are now actively used at the CAMHS clinics in Galway and Roscommon where teenagers ‘become Dala’ using VR headsets.
Follow this link to view the YouTube Video Trailer for The Dala Project https://www.youtube.com/watch?v=Abxf5LeaJ84