Last updated 2024-06-13T18:27:27Z

Using Virtual Reality to Enhance Ketamine Therapy Effectiveness for Treatment Resistant Depression (VRKet)

Treatment Resistant Depression (TRD) can be a life threatening condition, at times leaving victims with little to no hope. Ketamine is delivered with one of three routes, intravenous (IV), intramuscular (IM), or intranasal. The medication has many potential side effects, including physiologic changes (heart rate and blood pressure), but most notably, dissociation. Dissociation give the patient an “out of body” experience, which is thought to provide the patient with a different perception of their life, trauma, or causes of depression. The goal is to enhance the response to Ketamine therapy for TRD with the use of pre-treatment Virtual Reality (VR) meditation. This intervention has provided patients the opportunity to modify their environment and mental state to prepare for the treatment.

After 104 sessions completed by 14 patients, we have found an average of 12% improvement in the adopted mood scale (10 point Likert Scale ranging from 0, no depression, to 10, the worst depression ever experienced), and a 4% improvement in the PHQ9 scale. VR- based meditation immerses the patient in a virtual environment which decreases negative stimulation and distractions. The meditation provides instruction on breathing techniques that decrease stress and anxiety, and provides positive, affirming dialogue.

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

Overview

Problem

It was initially identified that the Esketamine treatment provided benefit for patients suffering from Treatment resistant Depression (TRD). What took time to realize, however, is that the treatments were not meeting their full potential. Patients expressed anxiety and stress before, during, and after the treatments related to the unknown; whether it be t ... It was initially identified that the Esketamine treatment provided benefit for patients suffering from Treatment resistant Depression (TRD). What took time to realize, however, is that the treatments were not meeting their full potential. Patients expressed anxiety and stress before, during, and after the treatments related to the unknown; whether it be the unknown for the initial experience (first treatment), the unknown from the current experience “bad trip”, or previous traumatic experiences (combat, MST, etc.). Reducing stress and anxiety before the treatment helps center the patient, and puts them in the present. This allows the patient to be relaxed and more and excepting of the treatment. See more

Solution

Reducing anxiety and guiding the patient to be “present” and grounded before receiving the treatment is essential. VRKet has identified a method to achieve these goals without the use of pharmacology. Providing the patients with a VR-guided meditation not only helps reduce anxiety, but also provides the patient with a sense of mindfulness and presence befo ... Reducing anxiety and guiding the patient to be “present” and grounded before receiving the treatment is essential. VRKet has identified a method to achieve these goals without the use of pharmacology. Providing the patients with a VR-guided meditation not only helps reduce anxiety, but also provides the patient with a sense of mindfulness and presence before, during, and after the treatment.
First, the veteran will use the VR equipment and VR programming to engage in a calming meditation to reduce anxiety and fear. Coming into the treatment calmly allows the veteran to be open and receptive to the treatment. Following the dissociation period, the veteran may request the VR equipment to continue the meditation and remain engaged in the treatment, avoiding distractions like cellular phones. See more

Results

This project remains in the infant stages with a limited data set. To identify improvement in symptoms, a Likert Scale ranging from 0-10 is used. The patient identifies their pre-mood and pain scores and is reassessed following the treatment. The lower the score indicates a (-) or decreasing score on the Likert Scale.

Preliminarily data identifies a 12% ... This project remains in the infant stages with a limited data set. To identify improvement in symptoms, a Likert Scale ranging from 0-10 is used. The patient identifies their pre-mood and pain scores and is reassessed following the treatment. The lower the score indicates a (-) or decreasing score on the Likert Scale.

Preliminarily data identifies a 12% improvement in mood ratings, 4% decrease in PHQ9, and 19% improvement in pain ratings. The outliers were not removed for this synthesis with the intention of maintaining the integrity of the data. The data set consists of 14 unique patients and a total of 104 treatments. See more

Files

Synthesis of treatment data identifying impact Project data

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)

There are no successful adoptions for this innovation.

AR: John L. McClellan Memorial Veterans' Hospital (Little Rock, Arkansas)

Started adoption on 01/2024.

CA: Jennifer Moreno Department of Veterans Affairs Medical Center (San Diego, California)

Started adoption on 09/2021.

There are no unsuccessful adoptions for this innovation.

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	Mental Health IT Supply Chain

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email Kevin.Sojourner@VA.Gov with questions about this innovation.

About

Origin story

The Neuromodulation Clinic at the San Diego VA has been administering derivatives of Ketamine to treat Treatment Resistant Depression since January of 2020. During this time, we as a clinic have introduced various interventions to maximize and capitalize on the positive effects of the medications. We have also introduced interventions to improve the negati ... The Neuromodulation Clinic at the San Diego VA has been administering derivatives of Ketamine to treat Treatment Resistant Depression since January of 2020. During this time, we as a clinic have introduced various interventions to maximize and capitalize on the positive effects of the medications. We have also introduced interventions to improve the negative effects of the medication and or overall experience. Many veterans experience anxiety simply by walking through the facility doors, surrounding themselves by people, triggers, and memories. Meditation and mindfulness have proven to reduce the anxiety experienced by these veterans. The lack of staff to provide the guided meditation proved to be a barrier. Combining Virtual Reality and guided meditation has provided the patients the opportunity and flexibility to put themselves in the right frame of mind while not being an impact on clinic flow and staffing.

Original team

Kevin Sojourner, MSN, RN

Neuromodulation Clinic RN Coordinator

Andrew Bismark Ph. D

Psychologist

Search tags

Data and Analytics Emergency Care Extended Reality (XR) Hospital Medicine Information Technology Mental Health Moving Forward Nursing Outpatient Care Primary Care

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