Is virtual reality bad for our mental health?

Jeff Grover* likes to walk, a pastime suited to the landscape of his home on the border between Massachusetts and upstate New York. Densely forested and scored by river and trail, Grover is self-effacing about his expeditions into this hilly terrain. “Hiking is a weird kind of hobby, because when you’re halfway through it, you’re like, why is this even fun?” he says – a feeling that disappears, he adds, after catching sight of the undulating vistas of green and brown stretching out beneath the mountain.

Grover has similar feelings of wonder while roaming post-apocalyptic landscapes. An avid virtual reality gamer, he spends the most time in his headset exploring the dusty, deserted towns of Fallout 4, an RPG set two centuries after the world has consigned itself to atomic oblivion. What especially attracts Grover to this virtual setting is its sense of reality. In addition to the impressive graphics, he explains, there’s also a randomness to many of the events within the game that imbues it with an unlikely sense of verisimilitude. “Sometimes,” says Grover, “I feel like I’m living a second life in there.”

In recent years, however, Grover has begun to question how that feeling of immersion in VR has blended with reality. Nowadays, he’s more likely to spend just half an hour in the headset compared to the half-day sessions he was indulging when he first began gaming in VR five years ago. This is, Grover explains, partly down to symptoms of nausea he calls ‘simulation sickness,’ but also episodes of unreality he’s occasionally experienced after taking off the headset. He recalls one such episode while walking outside with his wife. “I’m just saying things to myself like, ‘Oh, these graphics are really good,’” says Grover. “And, I’m pantomiming these things in VR, like hovering my hand over something to learn more about it.”

Then there were the times when particularly long sessions would result in symptoms of fatigue and confusion, similar to the feeling of jolting awake mid-dream. Grover recalls meeting his friends at a local bar after an hour-long session on his headset. “I was just completely unable to hold a conversation,” he says. “Though I don’t think I looked it, I felt like I was sitting there, mouth agape with a big line of drool and just white noise playing in my brain.”

Grover’s symptoms are not unique among VR users – nor are they extreme. In recent years, medical research has found that virtual reality can induce symptoms of dissociation, while there’s plentiful anecdotal evidence pointing towards cases of isolation, social anxiety and addiction arising from sustained gameplay. The vast majority of side-effects are mild, their existence alluded to deep inside headset instruction manuals. Even so, the depth and tenor of these effects – especially as they relate to time expended in VR – are dimly understood and only occasionally discussed.

That may soon change. While VR remains a niche pastime, it’s growing in popularity, with up to 23% of US households estimated to own or have access to a headset. And now, the tech industry is touting the ‘metaverse’ as the future of the web, with Meta (formerly Facebook) CEO Mark Zuckerberg describing it “as an embodied internet, where instead of just viewing content — you are in it”.

One of the primary methods of gaining access to this alternate reality will involve donning your own VR headset, which will act as a portal to new gaming experiences and environments for social engagement. Implicit within that is a time commitment far in excess of the half-hour increments currently recommended by headset manufacturers – the effects of which remain unknown.

Experimental research into virtual reality and mental health

Stéphane Bouchard conducts a lot of therapy in his cave. A six walled virtual reality facility inside the offices of Anxiety Canada, Bouchard concedes that it’s “now kind of an outdated technology” compared to the latest VR technology on the market. Nevertheless, explains the psychotherapist and professor at the Université du Québec en Outaouais, it has proven an invaluable resource for tailoring therapy for those suffering from a variety of mental health disorders.

That starts with debilitating phobias. Resembling, according to Bouchard, “Star Trek’s holodeck,” the cave forms an intermediate stage in patients’ therapy, providing them a safe space in which to face their fears. Despite it providing only an audiovisual representation of their phobia, the hyperventilation of arachnophobic patients when confronted with a virtual tarantula is testament to the power of VR to trigger latent feelings of anxiety. That feeling of presence, says Bouchard, can also be awakened in those suffering from drug addiction.

“I can’t offer cocaine to my patients, for obvious reasons,” he explains, “but you can do that in virtual reality. Again, because of [the sense of] presence, people forget that it’s fake cocaine, or that it’s a fake spider, and the brain processes the information as if it’s true.”

This ability to trigger emotional responses using VR has also been documented in patients suffering from PTSD, several forms of addiction, and paranoia. But what if virtual reality could also awaken unwanted feelings of fear and anxiety outside a clinical context? It’s a possibility that’s only been sparingly explored in the medical literature, at least compared to the therapeutic benefits of virtual reality.

A recurrent theme in these studies, though, has been VR’s capacity to induce dissociative states. An umbrella term covering a range of breaks in the connection between the mind and body, from briefly failing to recognise oneself in the mirror all the way to thinking you’re inhabiting the wrong body, feelings of dissociation have been linked to VR gaming since at least 2006.

Almost all documented cases of dissociation in the literature fall on the mild end of the spectrum. Just how easy they are to induce, however, was revealed in an experiment conducted by researchers from Oxford University in 2018. Participants were invited to sit down on a swivel chair and don a headset that showed them a feed of themselves from a nearby GoPro camera. The subjects were then rolled out of view of the camera to behind a partition, before one of the study leads began talking into the camera. “That gave an illusion that the participant was actually present at the position of the camera, rather than in their own physical body,” says Dalena van Heugten, then a post-doctoral researcher at Oxford and one of the study’s authors.

After the experiment, participants confirmed “a mild but significant increase in dissociative symptoms,” says Van Heugten, including feelings that their surroundings were moving in slow motion or felt unreal. These symptoms didn’t seem to last very long. Nevertheless, it makes Van Heugten concerned that sustained use of VR might heighten feelings of dissociation among those already prone to experiencing them. “I wouldn’t be surprised if that would trigger something in that person,” she says.

There is also plenty of anecdotal evidence to suggest this is already happening among habitual users of VR. One user described on a VR sub-reddit how, after playing for several hours, they could “clearly see buttons, cards, texts and lines popping out of my screen,” an effect another replied was common and mostly “goes away in 1-2 weeks.” Others recalled the feeling of holding virtual weapons persisting after removing their headset, or not being entirely sure that their hands truly belonged to their bodies.

Some, meanwhile, have described how VR has led to changes in players’ personality resembling addiction. One of the most striking examples was that of Georgia, a 21-year-old student interviewed by The Mill. Afflicted with social anxiety since adolescence, Georgia found herself increasingly drawn to socialising on programs like VRChat at the height of the first lockdown. Having conversations behind an avatar, she said, gave her a sense of control she’d rarely encountered in the real world.

Gradually, though, Georgia found herself retreating into her headset, ‘spending 10 to 15 hours a day in VRChat’ at the height of her dependency. As the pandemic receded, she would eventually wean herself off the headset. Nevertheless, the sense that VR can lead to altered behavioural states is something that Grover worries about, especially after playing particularly violent games like Blade & Sorcery.

“I’ll get really, really into a session,” he says. “I start sweating; I’m jumping around the room. I’m doing these really grisly things to people. Like, my adrenaline’s rushing and I just start seeing red. And I take the headset off, and then there’s just this stark contrast [of being] dumped back in the real world.”

Into the metaverse

Grover hesitates at the suggestion that VR could play a role in inducing violent behaviour, which reminds him of the moral panic that has so far accompanied every release of a new Grand Theft Auto title. Indeed, while there is evidence to suggest that gaming and social media can lead to addictive behaviours, the collective handwringing about its effects has rarely convinced governments to take legislative action (unless, of course, you’re the Chinese Communist Party.)

Neither is there much scientific evidence that VR gaming leads to similar changes, with one study concluding that the relationship between the medium and violent behaviour was ‘virtually nil.’ Another recent study by a team from the University of Bonn also suggests that moderate use of VR also has negligible dissociative effects. In an experiment comparing the presence of these feelings in subjects after playing Skyrim on PC and VR, the team found that while those with headsets did suffer from more dissociative effects than those playing on a monitor, the feelings were temporary and clinically insignificant.

We don’t know what happens when people are playing it all day.
Dr Max Pensel, University Hospital Bonn

Even so, the study only replicates a normal gameplay session. “We don’t know what happens when people are playing it all day,” says co-author Dr Max Pensel, or the effects that might be had on children or those predisposed to dissociation. While Dr Pensel doesn’t believe now is the time for more vocal warnings about the dangers of VR, he does argue for more serious academic investigation into its impact on mental health – especially, he adds, when “big companies like Meta have such big plans to implement a ‘metaverse.’”

The problem is, says Bouchard, while “there’s definite interest” in academia to answer these questions, there’s little funding for it compared to other research priorities. That’s all the more galling for the researcher given the potentially massive social implications of the metaverse. “The latest studies done in Stanford by Bailenson, for example, and our work, shows that whatever happens in vivo translates to VR,” he says. Bouchard fears that finding a safe and immersive space to engage in reprehensible behaviour in VR could lead to greater levels of misconduct in real life. “If I loosen, too much, my inhibitions in VR,” he says, “what will be the impact on me as a person?”

For his part, Grover now finds most of the side-effects of VR gameplay manageable, especially now that he keeps his sessions to half-hour increments. He’s not so sure, though, that the same can be said for more vulnerable users. Grover remembers the experiences had by a close friend of his, a veteran of the Afghan war, who had to “lie down for long periods of time after a half-hour session” and “talk about these crazy dreams he had” after playing military-themed games.

Increasingly, Grover finds himself reassessing the value of spending even short increments of his time in VR, especially on the annual hiking trip he takes to the Presidential Range in neighbouring New Hampshire. It’s on these kinds of expeditions, as he’s slowly ascending mountains some four thousand feet high, that he begins to realise what it means to be alive.

“It reinforces my thought that, to me, gaming and VR isn’t the best way I could be spending my time on this Earth,” he says. “But goddamn it, it is fun.”

*Name has been changed for privacy