Isolated communities. Extreme climate. Ancient Indigenous way of life and survival techniques. It takes many different factors to define a culture and influence mental health, and different methods to heal disparate wounds. To accomplish that remotely, a new psychotherapy solution combining futuristic technology with established traditions is now being tested for use in the territory of Nunavik.
With roots in the northern tip of Quebec some 1,200 km from Montréal, Nunavik's Inuit recently took a step toward that future with a novel approach to psychotherapy. A group of community members shared their knowledge with researchers from McGill University, Université du Québec en Outaouais and the National Research Council of Canada (NRC) with a view to developing remote virtual reality (VR) and personalized psychotherapy that can be provided at any geographic location.
"Because of traumatic experiences common to Indigenous populations, the suicide risk among the Inuit of Quebec is 11 times greater than that of the general population," says Dr. Outi Linnaranta, adjunct professor at the Department of Psychiatry at McGill University in Montréal, and Medical Chief at the National Institute for Health and Welfare in Helsinki, Finland. "Through a collaborative partnership with an Inuit advisory group, the NRC and McGill's Douglas Research Centre, we are addressing unmet needs in mental health and psychiatric treatment among the Inuit and other Indigenous populations in Quebec."
And what they prove in that region can work in the farthest corners of the world.
A new cog in the medicine wheel
At the core of successful research and clinical practice is producing culturally safe mental health intervention tools for Inuit populations. This means considering historic, economic and societal factors that may impact health care, and incorporating cultural traditions, language, foods and intergenerational dialogue in Inuit suicide-prevention programs. In previous studies, this has led to increased success in substance abuse interventions for Indigenous individuals.
Led by Linnaranta, the Douglas Research team developed an innovative solution using VR as a tool to conduct cognitive behavioral therapy (CBT) in remote locations. Potential Inuit test subjects had been asked whether they preferred therapy via teleconferencing from Montréal, various mobile applications or VR. "They identified VR as their preferred method of remote psychotherapy," she says. "We then adapted it to Inuit cultural needs and ensured it was safe and suitable for them."
Subjects can be treated at home or at a local teleclinic. They wear VR headsets and medical-grade fingertip sensors that test their reactions to stress before and after therapy, looking for beneficial changes as they are exposed to realistic stimuli such as a steep slope from a great height. Sensor biofeedback is an essential part of CBT, known to improve the therapy's efficacy.
The Simulation and Digital Health section of the NRC's Medical Devices Research Centre built the user interface that allows therapists to monitor the process, and its effects in real time. It also lets patients monitor their own symptoms from anywhere.
"For this research, we developed a cloud portal and tools to help us acquire data for the Douglas test platform," says NRC's David Rivest-Henault, Research Officer at the Medical Devices Research Centre. The NRC's proprietary bConnected platform was the foundation for the teleclinic development, integration of the medical-grade sensors, and analysis of physiological information.
"Our lengthy experience in technology integration, working with other researchers and adapting affordable digital structures to their project enabled Douglas to move forward."
Advanced care for remote communities
One of the globe's fastest-rising needs is remote accessibility to health care services, particularly mental health. Linnaranta points out that, as an emerging technology, VR is gaining traction in the cognitive space. "It is a validated exposure approach to CBT in anxiety disorders, including post-traumatic stress disorder (PTSD), and an adaptive treatment method for trauma-related symptoms," she says.
These technological developments using remote eHealth solutions such as this can guarantee therapy for other populations as well. Among these are humanitarian workers, the military, immigrants or minorities with limited access to psychotherapy because they are in remote geographical locations or need special cultural or linguistic skills.
"We are fortunate to be living in a truly global world where we can build approaches outside of current methods and practices," says Linnaranta. And that means making new techniques a reality.