Virtual Reality in Art Therapy: A Pilot Qualitative Study of the Novel Medium and Implications for Practice

Drawing on emotions: the evolving role of art therapy

Art therapy is a form of psychotherapy that uses art media to improve well-being. This article explores the history and development of art therapy, from the first description of art therapy in the 1940s, to the two main approaches still in use today. The benefits of art therapy with regard to its delivery, patient population, and cost are then broadly discussed. The use of art therapy in psychiatric conditions, specifically in schizophrenia and schizophrenia-like conditions, is highlighted, as well as its role in chronic and physical conditions like asthma and cancer. Furthermore, the potential for art therapy to be more broadly implemented using technological novelties, such as virtual reality, is considered, especially in light of the COVID-19 pandemic.

Exploring the Category and Use Cases on Digital Therapeutic Methodologies

OBJECTIVES

As the Fourth Industrial Revolution advances, there is a growing interest in digital technology. In particular, the use of digital therapeutics (DTx) in healthcare is anticipated to reduce medical expenses. However, analytical research on DTx is still insufficient to fuel momentum for future DTx development. The purpose of this article is to analyze representative cases of different types of DTx from around the world and to propose a classification system.

METHODS

In this exploratory study examining DTx interaction types and representative cases, we conducted a literature review and selected seven interaction types that were utilized in a large number of cases. Then, we evaluated the specific characteristics of each DTx mechanism by reviewing the relevant literature, analyzing their indications and treatment components. A representative case for each mechanism was provided.

RESULTS

Cognitive behavioral therapy, distraction therapy, graded exposure therapy, reminiscence therapy, art therapy, therapeutic exercise, and gamification are the seven categories of DTx interaction types. Illustrative examples of each variety are provided.

CONCLUSIONS

Efforts from both the government and private sector are crucial for success, as standardization can decrease both the expense and the time required for government-led DTx development. The private sector should partner with medical facilities to stimulate potential demand, carry out clinical research, and produce scholarly evidence.

Examining the potential of VR program Tilt Brush in reducing anxiety

Recent advancement in technology has made virtual reality (VR) more accessible and immersive than ever before, resulting in its increasing utility in various industries. Despite this, VR has remained an underutilised tool within clinical psychology. This study aimed to explore the potential of using VR for therapeutic benefits through examining the level of flow and anxiety-reducing effects of freeform drawing in real life (on paper) versus drawing in VR (using Tilt Brush) via a randomised-controlled trial with 40 participants. State and trait anxiety was measured using the State-Trait Anxiety Inventory, level of flow was measured using the Long Flow State Scale, and level of presence was measured using the iGroup Presence Questionnaire. Overall level of flow was not significantly different between both groups, implying drawing in VR induces as much flow as drawing in real life. Level of flow was positively correlated to level of presence experienced in the VR group (p < .01). Although there was no significant interaction effect, both groups experienced an overall decrease in state anxiety, with the VR group experiencing a significant reduction of state anxiety from pre- to post-test (p < .01).

Application of Artificial Intelligence within Virtual Reality for Production of Digital Media Art

As technology changes, virtual reality generates realistic images through computer graphics and provides users with an immersive experience through various interactive means. In the context of digitalization, the application of VR for digital media art creation becomes a normalized method. Today's digital media art creation is closely related to vigorous technological innovation behind it, so the influence of modern technology is inevitable. Virtual reality and artificial intelligence have gradually become the main technical means in line with the development aim for digital media art creation. This work proposes an art object detection method AODNET in virtual reality digital media art creation with AI. Aiming at the particularity of object detection in this direction, an art object detection strategy based on residual network and clustering idea is proposed. First of all, it uses ResNet50 as backbone, which deepens network depth and improves the model feature extraction ability. Second, it uses the K-means++ algorithm to perform clustering statistics on the size of the real annotated boxes in the dataset to obtain appropriate hyperparameters for preset candidate boxes, which enhances the tolerance of the algorithm to the target size. Third, it replaces the ROI pooling algorithm with ROI align to eliminate the error caused by the quantization operation on the characteristics of the candidate region. Fourth, to reduce the missed detection rate of overlapping targets, soft-NMS algorithm is used instead of the NMS algorithm to post-process the candidate boxes. Finally, this work conducts extensive experiments to verify the superiority of AODNET for object detection in virtual reality digital media art creation.

Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.

Shifting to tele-creative arts therapies during the COVID-19 pandemic: An international study on helpful and challenging factors

The COVID-19 pandemic has led to an unprecedented shift to online treatment. For the creative arts therapies (CATs) - a healthcare profession that involves the intentional use of the visual art, drama, music, dance, and poetry within a therapeutic relationship - this shift has been highly consequential for practice. This study examined (a) how the COVID-19 pandemic has impacted clinical practice in the CATs, and (b) the features characterizing online practice in an international sample of 1206 creative arts therapists aged 22-86 (92% female). It aimed to identify changes in the use of the arts in therapy, resources that contributed to the delivery of therapy, and the role of therapists' creative self-efficacy in adapting to these changes. Respondents completed close and open-ended questions providing examples of what does and does not work in online practice. The results indicate that creative self-efficacy plays a meaningful role in buffering the impact of therapists' computer comfort on their perceived difference in online clinical practice; confidence in one's abilities positively contributed to their adaptation to online practice. The qualitative analysis yielded four main categories: the challenges of tele-CATs, continuing the therapeutic process through tele-CATs, adaptations for tele-CATs, and future directions. Overall, the results present a timely report on the inevitable transition of the CATs to online practice.

VR Health Experience: A Virtual Space for Arts and Psychomotor Therapy

Introduction: Mental health and well-being are under pressure because of the corona pandemic. Arts and psychomotor therapists said that they had almost no experience with working online, but despite the fact that they felt incapable, they were positive towards it.

Method: This qualitative action research was aimed at how arts and psychomotor therapists can become more skilled in offering online arts and psychomotor therapy and how they can methodically enlist the VR Health Experience (a virtual arts and psychomotor therapy space) in therapy. It is envisaged that the arts and psychomotor therapist could be telepresent in order to offer arts and psychomotor therapy remotely. In online training that made use of the Lean Startup Method, participants (n = 5) integrated their working knowledge with the VR Health Experience. The interventions were immediately tested by the participants and in practice. Participants were interviewed retrospectively and their experiences were thematically analysed.

Results: The VR Health Experience came forward as an innovative addition to the usual arts and psychomotor therapy. Often, clients were encouraged to play and experiment, and the VR world offered several options. The VR Health Experience lowered the threshold, expanded the training areas and held a great attraction for play.

Discussion: This project offered an innovative quality boost for arts and psychomotor therapy. Arts and psychomotor therapy have proven to be possible remotely via telepresence of the therapist. The therapist is present together with the client in the VR Health Experience, the virtual arts and psychomotor therapy space, where connectedness can be felt and new experiences can be gained. VR also offers further possibilities in arts and psychomotor therapy.

A Systematic Review of the Use of Art in Virtual Reality

Brain injuries can create life-altering challenges and have the potential to leave people with permanent disabilities. Art therapy is a popular method used for treating many of the disabilities that can accompany a brain injury. In a systematic review, an assessment of how art is being used in virtual reality (VR) was conducted, and the feasibility of brain injury patients to participate in virtual art therapy was investigated. Studies included in this review highlight the importance of artistic subject matter, sensory stimulation, and measurable performance outcomes for assessing the effect art therapy has on motor impairment in VR. Although there are limitations to using art therapy in a virtual environment, studies show that it can feasibly be used in virtual reality for neurorehabilitation purposes.

Art Therapy in the Digital World: An Integrative Review of Current Practice and Future Directions

Background

Psychotherapy interventions increasingly utilize digital technologies to improve access to therapy and its acceptability. Opportunities that digital technology potentially creates for art therapy reach beyond increased access to include new possibilities of adaptation and extension of therapy tool box. Given growing interest in practice and research in this area, it is important to investigate how art therapists engage with digital technology or how (and whether) practice might be safely adapted to include new potential modes of delivery and new arts media.

Methods

An integrative review of peer-reviewed literature on the use of digital technology in art therapy was conducted. The methodology used is particularly well suited for early stage exploratory inquiries, allowing for close examination of papers from a variety of methodological paradigms. Only studies that presented empirical outcomes were included in the formal analysis.

Findings

Over 400 records were screened and 12 studies were included in the synthesis, pertaining to both the use of digital technology for remote delivery and as a medium for art making. Included studies, adopting predominantly qualitative and mixed methods, are grouped according to their focus on: art therapists’ views and experiences, online/distance art therapy, and the use of digital arts media. Recurring themes are discussed, including potential benefits and risks of incorporating digital technology in sessions with clients, concerns relating to ethics, resistance toward digital arts media, technological limitations and implications for therapeutic relationship and therapy process. Propositions for best practice and technological innovations that could make some of the challenges redundant are also reviewed. Future directions in research are indicated and cautious openness is recommended in both research and practice.

Conclusion

The review documents growing research illustrating increased use of digital technology by art therapists for both online delivery and digital art making. Potentially immense opportunities that technology brings for art therapy should be considered alongside limitations and challenges of clinical, pragmatic and ethical nature. The review aims to invite conversations and further research to explore ways in which technology could increase relevance and reach of art therapy without compromising clients’ safety and key principles of the profession.

Making Art Therapy Virtual: Integrating Virtual Reality Into Art Therapy With Adolescents

In recent years, the field of art therapy has sought to adapt traditional treatment approaches to today’s innovative technological environments when working with adolescent “digital natives.” In their clinic, art therapists often struggle with lack of cooperation when treating adolescents during sessions. This article presents two case studies that explore how Virtual Reality (VR) technology can be combined with traditional art therapy to treat adolescents suffering from anxiety and social difficulties. It is suggested that this type of technology may lead to a better understanding of the needs of adolescents by adopting their vantage point and hence better outcomes.

Outcomes of Visual Self-Expression in Virtual Reality on Psychosocial Well-Being With the Inclusion of a Fragrance Stimulus: A Pilot Mixed-Methods Study

Aims

In this pilot mixed-methods study, we examined the participants experiences of engaging in virtual drawing tasks and the impact of an olfactory stimulus (calming fragrance blend) on outcomes of affect, stress, self-efficacy, anxiety, creative agency, and well-being (satisfaction with life).

Methods

This study used a parallel mixed-methods, simple block randomization design. The study participants included 24 healthy adults aged 18 to 54 years, including 18 women and six men. The participants completed two 1-h immersive virtual art making sessions and were randomly assigned to receive either a fragrance or a non-fragrance condition for the first session. Quantitative (standardized self-report measures) and qualitative (open-ended survey responses and virtual artwork) datasets were collected concurrently and integrated during data analysis.

Results

The quantitative results indicated that the fragrance condition demonstrated a significant reduction in negative affect (e.g., feeling hostile, jittery, upset, distressed, etc.), namely, reduced feelings of negativity when compared to the non-fragrance condition. A trend toward improvement in self-efficacy was also seen in the fragrance condition. No significant changes were found for fragrance or non-fragrance conditions for positive affect, anxiety, and creative agency. The qualitative findings included five themes related to art making experiences in virtual reality in both conditions: fun and joy; novelty of virtual media, experimentation, and play; relaxation and calm; learning curve; and physical discomfort and disorientation. Four themes were identified for virtual art content and visual qualities: nature imagery, references to memories and personal symbols, fantasy and play within imagery, and depiction of everyday objects.

Conclusions

Overall, the participants reported positive responses to the novel virtual art making experiences which were further heightened by the inclusion of the fragrance stimulus for negative affect. These preliminary findings need to be replicated with larger sample sizes to confirm the outcomes and the trends that were seen in this pilot study. Further research is recommended to examine the differences between experiences of virtual and traditional art media and to examine different olfactory stimuli promoting focus and concentration.