A team of researchers from the Black Dog Institute and UNSW has received an innovation grant to further investigate an immersive virtual-reality experience which improves people’s mood and potentially reduces suicidal feelings.
The grant from the Suicide Prevention Research Fund, administerd by Suicide Prevention Australia (SPA) will allow the experience to be exhibited in Brisbane and tested as a suicide prevention tool in partnership with Metro South Health.
The installation project, called The Edge of the Present, was developed for The Big Anxiety festival at UNSW in 2019. The project was led by Scientia Professor Jill Bennett from UNSW Art & Design and Professor Katherine Boydell from the Black Dog Institute, and developed in partnership with people with lived experience of depression and suicidality.
The ten-minute mixed-reality experience, designed by artist Dr Alex Davies from UNSW Art & Design, explores virtual landscapes within a purpose-built room. It gives the user the experience of being in a tropical rainforest one moment and a snow-covered mountain or desert landscape the next.
“This research is the first to assess the effectiveness of such an immersive mixed-reality experience as an intervention for depression and hopelessness. It does so by rapidly increasing positive mood and stimulating positive ‘future thinking’,” says Prof. Bennett.
The experience aims to cultivate the capacity for future thinking by encouraging positive actions that are rewarded in an instant feedback loop.
“The experience is not just a passive one but involves the user making choices to open doors and windows … each choice is rewarded by positive sensation. So, for example, you open a door and feel the breeze on your face, or step out into the warmth of a sun-baked meadow,” says Prof. Bennett.
“On the one hand it’s relentlessly positive … There are all these beautiful scenes, it’s impossible not to like. But on the other hand, it’s important that the user has agency and that this very positive sensation, and this amazingly beautiful resplendent scene, is coming as a result of your direct action.”
Prioritising subjective experience and empathy
The Edge of the Present is part of Prof. Bennett’s Felt Experience & Empathy Lab [fEEL] that investigates subjective experience of mental health, trauma, life course events and ageing.
Funded through her ARC Australian Laureate Fellowship, the Lab brings together psychologists, clinical trauma specialists and immersive arts designers to examine what people are “thinking, feeling, doing” with a focus on “the nature of relationships and how we change those”, she says.
The Lab uses emerging immersive visualisation technology to study subjective experiences like suicidality and ageing. It has a larger social goal of improving our understanding of stigmatised and devalued populations, and remediating the effects of stigma and prejudice.
“We use the technology to not only convey the experience, but to create different possibilities for acting that are quite enriching, whether for the people with that lived experience or the people around them,” she says.
“It's 90% about the process and how beneficial it is for people, and then there may be a high-end art output which takes the work to another level and to different audiences, but it's never just about the art.”
Currently around 65% of people with mental health concerns do not seek help, she says.
If you only work with people who present in a health environment, “you only have a small proportion of the people that you want to treat in your program,” she says. “I think there's increasing interest from a health perspective in operating outside of those confines.”
Exploring connections between future thinking, imagination and memory
The Edge of the Present originated in a project, funded by ARC and the NSW Ministry of Mental Health, that Prof. Bennett ran with Dr Davies and some UK-based cognitive neuropsychologists over several years. It looked at memory, memory loss, amnesia, and future thinking which is very similar to the process of memory from the neuro-psychological point of view, Prof. Bennett says.
“We were looking at when, and under what conditions, people have difficulty producing, creating new memories or the future-oriented version of that: imagining themselves in future scenarios.
“There’s evidence to suggest that people who are severely depressed have trouble not just remembering but [also] attaching emotion [and positive sensation] to memories. It's very hard to think of yourself having a pleasurable experience in the past or in the present.”
The project explored ways to cultivate future thinking beyond simple abstract planning through a series of workshops with young men who had survived suicide attempts.
Working with people with lived experience is “fascinating … [and] so valuable and revealing”, Dr Davies says. Drawing on insights from the workshops, the media artist created the mixed-reality platform that invites the user to “invent the next ten minutes”.
Dr Davies develops “spatial narrative environments where people experience a story world, in physical space,” that delivers an immediate sense of “being there”, he says. The challenge of experimenting with form and content to create a compelling experience for this particular audience was important to him, he says.
Promoting major changes at a micro level
The Edge of the Present starts with a sparsely furnished room that opens onto a series of beautiful vistas experienced on a sensory level.The name came from a participant in one of the workshops who described this “feeling of being stuck at the edge of the present where you can't move forward. You just can't see ahead,” Prof. Bennett says.
The focus turned to a kind of micro intervention, supporting users to make positive decisions on a manageable scale.
“You're creating a future if you can make choices about the next few minutes – even if you have minimal energy, you do a tiny thing for massive reward, you do another tiny thing for massive reward. You effectively transform this very bare environment,” she says.
“It's so important just to envisage that things can change, that you can make this shift, and not in an overly ambitious way, but just literally in five minutes to do something, see the shift.
Putting anxiety on the big stage
The installation drew large queues at The Big Anxiety festival in 2019. “Even if you knew nothing about the suicide narrative, it's the kind of environment that people wanted to be in and really enjoyed being in,” Prof. Bennett says.
The festival, a UNSW initiative in association with the Black Dog Institute, works alongside the Lab to create an open discussion about the state of mental health today. It supports diverse groups, with a particular focus on community-driven projects.
Professor Boydell of the Black Dog Institute ran the pilot study on the project during the festival in 2019. The research was funded by the Black Dog Institute’s NHMRC Centre of Research Excellence in Suicide Prevention and included 79 people, many with lived experience of depression and suicidality.
It involved some baseline testing of mood as well as a series of psychometric tests to measure impact on mood and some other indicators around future thinking and hopelessness.
The data from the pilot study showed the platform has capacity to induce immediate mood change, says Prof. Boydell.
“We demonstrated that positive mood and well-being increased significantly post-intervention. Hopelessness scores decreased, as well as negative mood. So now we hope to replicate the study on a larger scale in Brisbane at a location which doesn’t have the stigma of a health agency,” she says.
“Nothing has made me feel instantly better [more] than this virtual-reality work,” one participant in the pilot study reported. “This is the seventh time that I’ve been back and I just can’t get enough of it. Maybe it’s because I have an addictive personality, but I just feel like my mood is instantly better!”
The SPA grant will see the installation exhibited later this year as part of The Big Anxiety festival in Brisbane, in partnership with Metro South Health. The team sees longer-term potential for the platform to be adapted for suicide prevention in care settings such as clinics and psychiatric emergency, providing a positive and hopefully beneficial experience for those in crisis.
“This would be a world-first for psychiatric emergency, as these settings currently offer very little for patients to do. Acute patients are often accommodated in a room with nothing in it. So to offer patients such an environment would be a big shift, especially if the experience proves it can cultivate neural pathways for positive thinking,” Professor Bennett says.
“This is really about giving something that is pleasurable and self-driven to people, rather than something that's like medicine or a bitter pill that you have to swallow.
“It's not like a medical intervention at all, it's like a game or engaging with an artwork. It’s what you want to be doing in your leisure time. So if that is something that can [through our further testing be proven to] have quite a dramatic effect on mood, that will be quite extraordinary.”