In cybertherapy, avatars assist with healing

His talk was going just fine until some members of the audience became noticeably restless. A ripple of impatience passed through the several dozen seated listeners, and a few seemed suddenly annoyed; then two men started to talk to each other, ignoring him altogether.

“When I saw that, I slowed down and then stopped what I was saying,” said the speaker, a 47-year-old public servant named Gary, who last year took part in an unusual study of social anxiety treatment at the University of Quebec.

The anxiety rose in his throat — What if I’m not making sense? What if I’m asked questions I can’t answer? — but subsided as his therapist, observing in the background, reminded him that the audience’s reaction might have nothing to do with him. And if a question stumped him, he could just say so: no one knows everything.

He relaxed and finished the talk, and the audience seemed to settle down. Then he removed a headset that had helped create an illusion that the audience was actually there, not just figures on a screen. “I just think it’s a fantastic idea to be able to experience situations where you know that the worst cannot happen,” he said. “You know that it’s controlled and gradual and yet feels somehow real.”

For more than a decade, a handful of therapists have been using virtual environments to help people to work through phobias. But now advances in artificial intelligence and computer modelling are allowing them to take on a wider array of complex social challenges and to gain insight into how people are affected by interactions with virtual humans — or by inhabiting avatars of themselves.

Researchers are populating digital worlds with autonomous, virtual humans that can evoke the same tensions as in real-life encounters. People with social anxiety are struck dumb when asked questions by a virtual stranger. Heavy drinkers feel strong urges to order something from a virtual bartender, while gamblers are drawn to sit down and join a group playing on virtual slot machines. And therapists can advise patients at the very moment those sensations are felt.

The emerging field, called cybertherapy, now has annual conferences and a growing international following of therapists, researchers and others interested improving behaviour through the use of simulations. The Canadian military has invested heavily in virtual-reality research; so has the United States Army, which has been spending about $4 million annually on programs with computer-generated agents, for training officers and treating post-traumatic stress reactions. The trend has already generated a few critics, who see a possible downside along with benefits.

“Even if this approach works, there will be side effects that we can’t anticipate,” said Jaron Lanier, a computer scientist and author of “You Are Not a Gadget: A Manifesto” (Knopf, 2010). “And in some scenarios I would worry about defining humans down: defining what’s normal based on what we can model in virtual environments.”

But most researchers say that virtual therapy is, and will remain, no more than a therapist’s tool, to be used only when it appears effective. “There’s a real and understandable distrust of technology,” said Albert Rizzo, a psychologist at the University of Southern California.

Virtual humans, real therapy

“My abilities are somewhat limited,” says a female voice. “For example, I can speak and listen to what you say, but I can’t do any physical activity.”

In an office at the Institute for Creative Technologies at the University of Southern California, a virtual woman named Angelina is addressing a college student from a computer screen.

Angelina looks to be about 30 or so, a pretty, athletic figure with an open, intelligent face framed by short black hair. Her eyes and expression, guided by video cameras and microphones, stay in sync with the student’s, as an empathetic therapist’s would. “What are some of the things you hate about yourself?” asks the voice.

The student stalls for a moment. “Well,” she says, in a video of the exchange, “I don’t like that I can be really quiet in social situations. Sometimes people take that as me being rude, but it’s just me being quiet.”

Angelina nods sympathetically and then asks another question, about what the student fears most. Interacting with a virtual human programmed to be socially sensitive in this way is oddly liberating. The figures are clearly not human; some are balky with language, others mute. Many have a two-dimensional graphic-arts quality.

But the faces are mobile, blinking, alive, the body language and gestures seemingly natural; in some cases, the voice recognition and choice of replies are good enough to conduct a stiff but convincing conversation. The result is a living presence that is responsive but not judgmental.

In a recent study using this virtual confidant, researchers at USC have found that Angelina elicits from people the crucial first element in any therapy: self-disclosure.
People with social anxiety confessed more of their personal flaws, fears and fantasies to virtual figures than to live therapists conducting video interviews, the study found.

“It does not give a diagnosis,” said Jonathan Gratch, a co-author of the Angelina study with Sin-Hwa Kang, also of USC “But the idea is that the SimCoach would ask people if they would like to see a therapist; and if so, could then guide them to someone in their area, depending on what it has learned.” Once people are in treatment, therapists can use virtual technology to simulate threatening situations — and guide patients through them, gradually and incrementally, calibrating the intensity of the experience.

Using virtual environments, therapists can run entire drill in their offices. At the Virtual Reality Medical Centre in San Diego, psychologists have treated hundreds of patients using gradual virtual exposure, for post-traumatic stress and agoraphobia, among other anxieties. At USC, Dr Rizzo has designed a program specifically for veterans of the Iraq war.

In one scenario, wearing a headset, the patient is in a virtual Humvee, motoring along a desert road toward a small Iraqi village. To the right is a passenger, another soldier; behind and above rides a gunner; in front is another Humvee. As the motorcade approaches the village, engines rumbling, there is a flurry of gunfire, and more. A roadside bomb goes off, bullets pierce the window — your fellow soldier on the right is wounded badly, now dying — all of it under control of the therapist.

“We can control the intensity of the experience, and then work on the patient’s response,” Dr Rizzo said.

When it works, the therapy breaks the association between reminders of an upsetting experience and the racing heart, the flushing, the panic that the person has been struggling with. Adding autonomous virtual humans to the landscape allows therapists to begin addressing some of the most complex problems of them all — social ones.

Mini-me in action

In the virtual studio at the University of Quebec, patients wearing a headset can have a short conversation with a diminutive, attentive virtual therapist. Except for slight stature, it is a ringer for Dr Bouchard: the same open face, the same smile, the same pelt of dark hair around a bald pate.

“Mini-Me, we call it,” Dr Bouchard said.

The hologram-like figure seems at first to be minding its own business, looking around, biding time. Then it approaches, introduces itself and kindly asks a question, like some digital-age Socrates: “What is the best experience you’ve ever had?”

For now, Mini-Me cannot do much more than cock its head at the answer and nod; the scientists are adding more language-recognition software, to extend interactions. “You could scan in a picture of your mother or someone else significant and, with some voice recording samples, use a system that would automatically and quickly recreate a virtual facsimile of that person,” said Dr Rizzo of USC, where programmers have set up a bar scene, complete with a life-size, autonomous virtual bartender, a waitress and a bad guy. Anyone could rehearse the dance of social interaction, until the steps feel just about right.

“The great thing about it,” said Gary, “is that you get to practice.”