Sunnybrook using VR to ease 'misconceptions' about electroconvulsive therapy

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

"I didn't know physically what to expect," she told CBC Newsas she satin her Toronto apartment. "It was the first surgery I'dever 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-oldwatched as doctors rolled her gurney to apreparation room, explained the pre-operative procedure and started herI.V.

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"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."

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

The studyfound experiencing a procedure through virtual reality (VR) first reducedanxiety during the actual treatment.

Now, the lab is trying to build on those results by launching astudy atSunnybrookHospital in February looking at whether VR can educate, as well as decreaseanxiety in psychiatricpatients before they receiveelectroconvulsivetherapy (ECT).

"We know that there may be some apprehension when it comes to receiving a procedure like ECT," said Dr. PeterGiacobbe, a psychiatrist and the clinical head of theHarquailCentre forNeuromodulationatSunnybrook.

"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."

The results are also important because of patient outcomes, according to Dr.FahadAlam, an anesthesiologist who is thedirector of research at the SunnybrookCanadian Simulation Centre andco-founder ofCHISIL.

"When you look at any patient coming in for any procedure in the operating room, [anxiety] hasbeen 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."

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 thestigmatizationof the procedure and actually hopefully enhance the education around it,"Alamsaid.

Immersive experiences

Watch what the Sunnybrook ECT VR video will look like

6 years ago

Duration 0:44

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.

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 seethemselves 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.

Doctors will explain the equipment they'reusing and talk about theprocedure, which involvesusingcylindrical 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 toSunnybrook'swebpage, and that's what doctors are hoping to alleviate through VR.

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

"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) andBaycrestHealth Sciences. It's considered60 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 losslasting 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 hasalready 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.

In the future, Alam ishoping 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.

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The additions aregood 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."