Sunnybrook using VR to ease 'misconceptions' about electroconvulsive therapy

Researchers at Sunnybrook Hospital will begin a new study next month looking at whether virtual reality can help ease anxiety and fear in psychiatric patients before they receive electroconvulsive therapy (ECT) treatments.

Mental health videos are latest additions to a Sunnybrook VR catalogue

In a new study running at Sunnybrook Hospital, patients undergoing ECT will first experience the steps of the procedure through VR to see whether the virtual tour eases patient anxiety. (Dr. Fahad Alam)

Scheduled for a hysterectomy at Sunnybrook Hospital in 2016, Laura Victoria-Perez was full of nerves.

"I didn't know physically what to expect," she told CBC News as she sat in her Toronto apartment. "It was the first surgery I'd ever had."

That's why, when offered the chance in a pre-operative appointment, she agreed to experience her procedure virtually first.

Through goggles, the then 40-year-old watched as doctors rolled her gurney to a preparation room, explained the pre-operative procedure and started her I.V.

"It was really interesting, really engaging and I kind of got completely calmed down afterwards," she said.

"Instead of being nervous and worried about the surgery, now I was curious about whether or not it was going to be the same."

Laura Victoria-Perez says using the VR simulations did ease her pre-operative anxiety. (Taylor Simmons/CBC)

Victoria-Perez is one of 500 patients who participated in the first study done by the Collaborative Human Immersive Interactions Lab (CHISIL) — a partnership between Sunnybrook Hospital, the University of Toronto and the Hospital for Sick Children.

The study found experiencing a procedure through virtual reality (VR) first reduced anxiety during the actual treatment.

Now, the lab is trying to build on those results by launching a study at Sunnybrook Hospital in February looking at whether VR can educate, as well as decrease anxiety in psychiatric patients before they receive electroconvulsive therapy (ECT).

"We know that there may be some apprehension when it comes to receiving a procedure like ECT," said Dr. Peter Giacobbe, a psychiatrist and the clinical head of the Harquail Centre for Neuromodulation at Sunnybrook.

"I think there is some misconceptions about ECT and to allow patients to see it through VR from the first person perspective I think can ... hopefully alleviate barriers to patient acceptance."

Dr. Peter Giacobbe explains the procedure to patients using the VR simulation. (Martin Trainor/CBC)

The results are also important because of patient outcomes, according to Dr. Fahad Alam, an anesthesiologist who is the director of research at the Sunnybrook Canadian Simulation Centre and co-founder of CHISIL.

"When you look at any patient coming in for any procedure in the operating room, [anxiety] has been shown to increase wound infections, been shown to increase length of stay," he said.

"It's been associated with mortality or death in the cardiac surgery population, so anxiety is not a benign thing in itself. And when you have a vulnerable population like this, it can be compounded."

Dr. Fahad Alam directs the VR videos, so anyone can picture themselves as part of the experience. (Martin Trainor/CBC)

For the ECT study, about 200 patients will be immersed in 360-degree experiences before undergoing treatment.

The study will run for about one year and find out whether VR simulations will be more successful at reducing anxiety in ECT patients compared to two-dimensional videos as well as pamphlets.

"We are trying to see if we can help this type of population, reduce their anxiety levels, reduce the stigmatization of the procedure and actually hopefully enhance the education around it," Alam said.

Immersive experiences

Doctors at Sunnybrook are using VR to try to ease anxiety in patients receiving ECT treatments. In the final version, the patients arms will be covered completely, so anyone can visualize themselves being on the gurney. 0:44

In the ECT simulation, patients will see a gurney stretched out in front of them and have a 360-degree view of their surroundings.

First, a nurse will enter the room and explain what they'll be monitoring, then a psychiatrist will enter to speak about the treatment.

The patients then see themselves being wheeled into the procedure room, where they'll see electrodes being placed on their heads, and the anesthesiologist will explain how they'll be sedated.

After receiving the anesthetic, they'll wake up in a recovery room.

Patients will view the VR experience through goggles or through Google cardboard devices, which use your smartphone. (CBC )

Doctors will explain the equipment they're using and talk about the procedure, which involves using cylindrical paddles to deliver controlled, therapeutic seizures, barely visible to the naked eye, to part of the brain, but it will not be shown as part of the simulation. 

ECT procedure misunderstood, doctors say

ECT is a procedure used when medications and therapies for certain mental conditions, mainly depression, are unsuccessful. Close to one million Canadians suffer from treatment-resistant depression.

Part of the stigma against ECT can come from misconceptions stemming from movies and media showing painful and scary shocks, according to Sunnybrook's webpage, and that's what doctors are hoping to alleviate through VR.

Patients will see electrodes being placed on their heads while a doctor explains how the procedure will work. (Martin Trainor/CBC)

"This is a modern procedure, just like getting a colonoscopy done," Giacobbe said.

"We know that many of our patients are very interested in incorporating technology into their care and this is a very unique way of being able to have them experience what it's like to run through ECT."

The procedure is also used at the Centre for Addiction and Mental Health (CAMH) and Baycrest Health Sciences. It's considered 60 to 80 per cent effective in either completely relieving or improving symptoms of depression.

There are side effects though, most commonly muscle pain, headache and memory loss lasting between a few weeks and several months.

Some hospitals are also testing other methods to treat depression, such as focused ultrasound and magnetic seizure therapy (MST), which may reduce side effects like memory loss. 

The future of healthcare and VR

On top of the new ECT simulations, CHISIL has already created more than 60 VR experiences — everything from what it feels like to get a nerve block from anesthesia, an epidural when you're in labour or even just navigating the hospital — which they hope to release for use in-home and in-hospital when their studies are complete.

Alam is hoping to create a bank of VR experiences that patients can access in or outside the hospital. (Martin Trainor/CBC)

In the future, Alam is hoping to expand the VR work even more, using the technology for everything from calming burn patients during treatment to avoiding disorientation by transporting patients to their living rooms.

The additions are good news for Victoria-Perez, now two and a half years after her own surgery. Prone to anxiety herself, she believes the experience will definitely help others.

"I can't describe how calming it is to see what happens before it happens."


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