Psychedelic replications in virtual reality and their potential as a therapeutic instrument: an open-label feasibility study

Abstract

Background: Recent research has shown promising results for the therapeutic benefits of psychedelics. One popular view claims that these benefits are mediated by the subjective experiences induced by these substances. Based on this, we designed a virtual reality experience, Psyrreal, that mimics the phenomenological components of psychedelic experiences.

Aims: We aimed to investigate the therapeutic efficacy of Psyrreal and psychedelic VR experiences in treating depressive symptoms as well as explore the effect of Psyrreal on subjective factors which have been suggested to mediate the therapeutic benefits of psychedelics.

Methods: In this open-label feasibility study, thirteen participants with mild-to-moderate depression underwent a 2-day therapeutic intervention implementing Psyrreal. Depressive symptoms were evaluated by the Emotional State Questionnaire (EST-Q2) at the start of the intervention and 2 weeks after. A thematic analysis of semi-structured interviews after Psyrreal was also conducted as an additional assessment of the method.

Results: A 2-day intervention implementing Psyrreal led to significant decreases in depressive symptoms at the 2-week follow-up (n = 10, p = 0.007, Hedges' g = 1.046) measured by the Emotional State Questionnaire (EST-Q2). The analysis of semi-structured interviews suggests that Psyrreal could lead to insight and alterations in the sense of self in some people.

Conclusion: This work proposes a novel method using virtual reality to augment the treatment of psychological disorders as well as to precisely investigate the mediating subjective factors of the therapeutic effects of psychedelic substances. Our preliminary results suggest that VR experiences combined with psychological support show potential in treating depressive symptoms and further research into similar methods is warranted.

Keywords: VR-augmented therapy; altered states of consciousness (ASC); depression; depressive disorder; psychedelics; therapeutic mechanisms of psychedelics; therapy; virtual reality.

FIGURE 1

Screenshots of some of the environments in Psyrreal shown in sequence to exemplify the diversity of visuals presented to the user during the experience. The experience starts in a temple (top left), progresses through different levels of varying abstraction and intensity, and culminates in outer space (bottom right). See also Supplementary material 1 for more illustrations of the environments and Table 1 for more detailed descriptions of the implemented concepts. CEV stands for “closed-eye visuals.”

FIGURE 2

An illustration of the procedure of the experiment on day 1 and day 2, as well as measurements conducted on the 2 days of experiments and during the follow-up after 2 weeks. The green lines highlight the comparison groups used for the statistical analyses.

FIGURE 3

A raincloud plot of the EST-Q2 depression scale (A) and anxiety scale (B) scores as measured before the experiment and 2 weeks after. Depicted are individual scores, as well as boxplots and density distributions of the results (N = 10).