Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month’s column is written by Rohan Pooniwala and Raghav Gupta, research trainees in the Shafiee Laboratory in the Division of Engineering in Medicine. Their project, “Triloka,” earned first place in the category of Healthcare and Medicine at the 2017 “Reality, Virtually, Hackathon” competition hosted by Massachusetts Institute of Technology (MIT) Media Lab. Their award-winning project demonstrates the use of virtual reality technologies for treating depression.

The team that developed “Triloka”

Rohan Pooniwala

Raghav Gupta

Screenshots from “Triloka and an image of what the virtual headset looks like (inset)

Sometimes all it takes for life to change is a different perspective, a different environment, a vision towards a different path.

According to the World Health Organization, 350 million people suffer from depression. We, personally, see it everywhere, too. Here in Boston. Back in India. At MIT, one of our teammate’s friends committed suicide due to circumstances leading to depression. A study at University College London found that virtual reality can boost feelings of self-compassion by having patients listen to their own words of compassion that they would say to comfort a crying child. This study inspired us to build something that would help treat depression. We’ve previously worked on virtual and augmented reality and created a few applications. But our time in the Shafiee lab at the Brigham, where we work on digital health care applications, changed our views. We wanted to focus on applications that would have a significant impact. This application seemed like a great opportunity to put virtual reality to an effective use. It’s amazing how virtual reality works; it takes over your senses, and even though your mind knows it’s a simulated experience, it’s still so influential. We wanted to create a simulation where users can soak in the experience and immerse themselves in a positive ambience.

Compassion is strong. So is environment. It is well known that “Environment is stronger than will power.” It’s fascinating how surrounding yourself with the right people, an encouraging community, hobbies, etc. can change your whole perspective on life. We named our prototype “Triloka” (meaning “The Three Worlds” in Sanskrit) which symbolizes the physical, virtual and spiritual worlds.

We entered our idea into MIT Media Lab’s Reality Virtually Hackathon. It was held between Oct 6 – Oct 9 and brought participants from all around the world with diverse skillsets (audio/video, business, designers, developers, domain experts). We had to create a prototype over the weekend and were thrilled when our work won the best health care and medicine category award, a confirmation that others can see the potential of this technology to transform lives for the better.

We started out as a team of three, working with Meenakshi Sivapriya, a student at MIT. MIT Media Lab has always encouraged socialization and interdisciplinary skills amongst the team, so before the hacking started, everyone had to go to their target categories – games and entertainment, medical, mobile AR/VR, etc. and pitch their idea in front of the participants to form teams. Meenakshi’s pitch about VR for depression attracted many people who came to discuss the idea after the pitch, including Yan Liu (Master in Design Studies Program at Graduate School of Design, Harvard) and Yujia Liu (UX designer and VR generalist at Viacom.Inc). They had an idea similar to ours and also wanted to use VR to treat diseases like Alzheimer’s. We decided to form a team, and together, we had a variety of skill sets.

We decided to focus on depression and brainstormed on the idea. Initially we planned to make it like a journey, where the user had to go through a sequence of interactions and, by the end, would, regain a sense of happiness. As we researched further, we noticed a lot of factors that play a role in treating depression. One study revealed that exercising helps depression in people of all ages. Another suggested meditation helps manage pain, depression and anxiety. Yet another one found that getting close to nature alleviates depression. All of a sudden, our whole whiteboard was filled with ideas and elements that we wanted to integrate into our virtual environments. The idea matured from a journey story to a free environment where the user can relax, relive stress, alleviate depression and get encouraged to perform different activities.

Our starting scene was that of a bonfire. Camping is a great way to get closer to nature, and we felt that a bonfire creates its own unique magic, helping you form a bond with the people around you. It seems to make socializing a lot easier. It could be a perfect setup for telling your story and releasing guilt and other emotions. We thought this proves to be a good opportunity for the user to empathize and talk about problems without fear of being judged, shamed or ridiculed. We chose two online stories, where people discuss their depression and how they overcame it, and recorded them in our own voices along with the prompts. We made the prompts play when the user gazed at a character—playing phrases like “I promise things will get better. Just keep pushing on, one day at a time.” If the user asks the character to share more, it would play the recording of the story. On searching more, we found out that chatbots are also being used for helping depressed patients, like one made by Stanford. We integrated an already existing Facebook chatbot but interfaced it to give tips and talk to the user, guiding the user’s thoughts to positivity. We spent an entire night trying to make characters that felt alive—we wanted to get them just right, even though we did not have much experience with animations. It was important enough that we learned.

Our second environment was on top of a hill on an island. We wanted to create a peaceful environment for meditation. For immersion and to have a vibrant soundscape, we inserted surrounding sounds of birds chirping and the gentle sound of lapping waves.

We chose our third environment to encourage the user to exercise and replenish interests in outdoor activities. This activity is meant to have the user row a canoe down a creek. We made the environment beautiful and attractive to explore further in the canoe and are still working to implement the physical rowing component.

To make the whole simulation feel like a real experience, we did not create a menu for different scenes. Instead, the user can leap from one environment to another by saying “Change!” A cave appears from the ground which teleports the user to the other scene.

We feel that VR can, indeed, have a  major impact on treating depression—how changes in the environment reshapes your mood, how different interactions can alter perspectives, how you are directly influenced by the imagination VR provides and reciprocate the same in the real world. The biggest impact is that it can be available to anyone, and you can transport yourself into this world from anywhere. Imagine everyone had the access to treatment for depression—possibly just by tapping an icon on their phone. Even though it might not bring about the same effect as going to see a therapist in person, it might be an easily reachable, preliminary option that can make the difference – it may just change, and even save, a lot of lives.