Last updated
Using Virtual Reality to Enhance Ketamine Therapy Effectiveness for Treatment Resistant Depression (VRKet)
Share Print
Treatment-resistant depression (TRD) is a challenging condition that can significantly impact a person's quality of life. Ketamine has emerged as a promising treatment option for TRD, offering hope to those who have not responded to traditional antidepressant therapies. Your innovative approach of combining virtual reality (VR) meditation with ketamine therapy shows promising results in enhancing treatment outcomes.
Ketamine for TRD
Ketamine has demonstrated rapid and effective antidepressant properties in patients with TRD1. It can be administered through various routes, including intravenous (IV), intramuscular (IM), and intranasal methods. The medication's unique mechanism of action, which involves targeting the NMDA receptors, contributes to its efficacy in treating depression5.
One of the notable effects of ketamine is dissociation, which can provide patients with a different perspective on their life experiences and potential sources of depression. This altered state of consciousness may contribute to the therapeutic benefits of ketamine treatment.
VR Meditation as a Complementary Intervention
Your approach of incorporating VR-based meditation before ketamine therapy is an innovative strategy to enhance treatment outcomes. This pre-treatment intervention offers several potential benefits:
1. Environmental Control: VR meditation allows patients to immerse themselves in a controlled, calming environment, reducing negative stimuli and distractions.
2. Stress Reduction: The guided breathing techniques taught during VR meditation can help decrease stress and anxiety levels before ketamine administration.
3. Positive Affirmations: The inclusion of positive, affirming dialogue in the VR experience may help prepare patients mentally for the ketamine treatment.
4. Improved Mindset: By creating a more relaxed and receptive state of mind, VR meditation may enhance the patient's ability to benefit from the ketamine-induced dissociative experience.
Study Results
Your preliminary findings from 104 sessions with 14 patients are encouraging:
-12% improvement in the adopted mood scale (10-point Likert Scale)
-4% improvement in the PHQ-9 scale
These results suggest that the combination of VR meditation and ketamine therapy may lead to better outcomes for patients with TRD compared to ketamine treatment alone.
Potential Mechanisms
The synergistic effect of VR meditation and ketamine therapy may be attributed to several factors:
1. Enhanced Neuroplasticity: Ketamine has been shown to promote neuroplasticity1. The relaxed state induced by VR meditation may create an optimal environment for these neuroplastic changes to occur.
2. Reduced Anxiety: By decreasing pre-treatment anxiety, VR meditation may help patients approach the ketamine therapy with a more open and receptive mindset.
3. Improved Mindfulness: The meditation techniques learned through VR may enhance patients' ability to process and integrate the insights gained during ketamine-induced dissociation.
4. Positive Expectancy: The pre-treatment VR experience may create positive expectations, potentially
enhancing the placebo effect and overall treatment efficacy.
Future Directions
While your initial results are promising, further research is needed to fully understand the potential of combining VR meditation with ketamine therapy for TRD. Some areas for future investigation include:
1. Conducting larger, randomized controlled trials to compare outcomes between ketamine therapy with and without VR meditation.
2. Exploring the optimal timing and duration of VR meditation sessions in relation to ketamine administration.
3. Investigating the long-term effects of this combined approach on depression symptoms and relapse rates.
4. Examining potential differences in efficacy based on the route of ketamine administration (IV, IM, or intranasal) when combined with VR meditation.
In conclusion, your innovative approach of using VR-based meditation as a preparatory tool for ketamine therapy in TRD patients shows promise in enhancing treatment outcomes. By creating a more conducive mental state for ketamine therapy, this combined approach may offer new hope for individuals struggling with treatment-resistant depression.
Origin:
September 2021, Jennifer Moreno Department of Veterans Affairs Medical Center (San Diego, California)
Adoptions:
2 in-progress
Partners:
Mental Health and Suicide Prevention, XR Network
Recent Updates
Overview
Problem
To improve the effectiveness of Esketamine therapy, it's crucial to address patient anxiety and stre ... Esketamine treatment has indeed shown significant benefits for patients with Treatment-Resistant Depression (TRD). However, the realization that treatments were not meeting their full potential due to patient anxiety and stress is an important observation.
To improve the effectiveness of Esketamine therapy, it's crucial to address patient anxiety and stress before, during, and after treatments. This approach can help patients better accept and benefit from the treatment:
Reducing Pre-Treatment Anxiety
- Provide thorough education about the treatment process and potential effects.
- Encourage patients to focus on positive or neutral thoughts before the session.
- Implement relaxation techniques or mindfulness exercises prior to treatment.
Enhancing Treatment Experience
- Create a calm and supportive environment during the treatment session.
- Have trained medical personnel present to reassure patients and manage any adverse reactions.
- Offer guidance on how to navigate the experience, especially for first-time patients.
Post-Treatment Support
- Provide debriefing sessions after each treatment to process the experience.
- Offer ongoing psychological support to help integrate insights gained during treatment.
By addressing these aspects, patients can be more relaxed and receptive to the treatment, potentially enhancing its effectiveness. This approach aligns with the understanding that Esketamine works by promoting neuroplasticity and helping patients become "unstuck" from negative thought patterns. See more
Solution
Anxiety Reduction
VR-guided meditation has shown promisin ... Virtual Reality (VR) guided meditation has emerged as an effective non-pharmacological method for reducing anxiety and promoting mindfulness in various medical settings. This innovative approach offers several benefits for patients, particularly veterans, undergoing anxiety-inducing treatments.
Anxiety Reduction
VR-guided meditation has shown promising results in reducing anxiety levels:
- A pilot study demonstrated that a nature-based mindfulness VR experience significantly reduced subjective reports of anxiety and increased alpha brain wave activity, which is associated with relaxation.
- In a pediatric perioperative setting, VR-guided meditation effectively decreased caregiver anxiety compared to standard care.
- A study involving neurology residents found that a 15-minute VR meditation session led to a significant decrease in composite anxiety scores.
Promoting Mindfulness and Presence
The VR-guided meditation approach helps patients achieve a state of mindfulness and presence:
- By immersing patients in a virtual environment, negative stimuli and distractions are reduced, allowing for a more focused meditative experience.
- The meditation provides instruction on breathing techniques that decrease stress and anxiety, while also offering positive, affirming dialogue.
Implementation in Treatment
The VRKet method incorporates VR-guided meditation at various stages of treatment:
1. Pre-treatment: Veterans use VR equipment to engage in a calming meditation, reducing anxiety and fear before the procedure begins.
2. During treatment: Following any dissociation period, patients can continue using the VR equipment to maintain engagement and avoid distractions.
3. Post-treatment: The VR meditation can be used to help patients process their experience and maintain a calm state.
Benefits of VR-Guided Meditation
- Non-pharmacological: This approach avoids potential side effects associated with anxiety-reducing medications.
- Customizable: VR environments can be tailored to individual preferences and needs.
- Engaging: The immersive nature of VR helps maintain patient focus and compliance with the meditation practice.
- Accessible: With the decreasing cost of VR headsets and widely available meditative VR software, this intervention is becoming increasingly feasible.
By incorporating VR-guided meditation into treatment protocols, healthcare providers can offer patients a powerful tool for managing anxiety, promoting mindfulness, and enhancing overall treatment experiences. This approach is particularly valuable for veterans who may be dealing with complex mental health issues alongside their primary treatment needs. See more
Results
• 12% improvement in mood ratings
• 4% decrease in PHQ9 scores
• 19% improvement in pain ratings
The data includes 14 u ... This project is in its early stages, using a limited dataset to assess symptom improvement. A 0-10 Likert Scale measures pre- and post-treatment mood and pain scores, with lower scores indicating improvement. Preliminary findings show:
• 12% improvement in mood ratings
• 4% decrease in PHQ9 scores
• 19% improvement in pain ratings
The data includes 14 unique patients and 104 total treatments. Outliers were retained to maintain data integrity.
Methodology Improvements
To enhance the study's rigor and clarity:
1. Standardize scales: Use validated pain and mood scales like the Visual Analog Scale (VAS) or Brief Pain Inventory (BPI) for pain, and the Profile of Mood States (POMS) for mood assessment.
2. Expand sample size: Increase the number of participants to improve statistical power and generalizability of results.
3. Include control group: Implement a control or comparison group to better evaluate treatment effectiveness.
4. Longitudinal follow-up: Assess long-term effects by conducting follow-up evaluations at set intervals post-treatment.
5. Statistical analysis: Apply appropriate statistical tests to determine the significance of observed changes and account for potential confounding variables.
6. Standardize treatment protocol: Ensure consistency in treatment administration across all participants.
7. Qualitative data: Incorporate patient feedback and experiences to provide context for quantitative findings.
By implementing these improvements, the study can provide more robust and meaningful insights into the effectiveness of the treatment approach. See more
- Synthesis of treatment data identifying impact Project data
Files
Metrics
- Over 104 VR sessions completed
- 12% overall improvement in mood
- 4% overall decrease in PHQ9 scores
- 19% improvement in pain ratings
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1-2 Months
Identify perspective sample group. Population should have completed the induction phase (4 weeks with 2 treatments per week), currently experiencing an -
3-6 months
Implement VR equipment (Oculus 2 with the TRIPP app). Assess baseline for each treatment (PHQ 9, Mood and Pain). Provide equipment and application, and perform follow up assessment of the mood and pain. Following the treatment, assess mood and pain again. This isolates the response scores to the VR and medication interventions.
Departments
- Mental health care
- Psychiatry
- Biomed
- Logistics
- Infection control
- Purchasing and supplies
- Education and training
- Central supply
- Nursing services
- Psychology
- Information technology
- Information management
- Military sexual trauma
- Pain management
- PTSD treatment
- Suicide prevention
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
About
Origin story
Original team
Kevin Sojourner, MSN, RN NI-BC
Informatics Nurse Specialist
Andrew Bismark Ph. D
Psychologist
Comment
Comments and replies are disabled for retired innovations and non-VA users.