Virtual Reality (VR) for Depression: CBT and Other Techniques

Since the 1990’s, doctors have been leveraging Virtual Reality (VR) exposure therapy to treat phobias and PTSD. Does VR also hold promise as a tool to treat one of the most common mental disorders, depression?

recent article in Frontiers in Psychology highlights various ways in which Cognitive Behavioral Therapy (CBT) and other techniques for the treatment of depression can be translated into therapeutic VR experiences that result in positive outcomes for patients.

Among them are imagery re-scripting, a VR therapy that has been found to improve the mental
state of people with depression. It often times “involves the patient using mental imagery to
either recreate a memory (rescripting) or expand upon an example scenario in a prompted
direction (positive imagery training), in their mind. The patient is tasked with finding alternative
solutions to the imagined situation that reduces their distress, and then rehearses a novel solution
in greater and greater detail.”

Another technique, avatar therapy allows the patient to create an avatar that then engages in verbal hallucinations that would typically be internalized by the user, and then verbalizes them to the patient, which in turn can help them disprove these notions, and help restructure their mental state.

Social skills training is also a generic CBT technique which can be translated to VR. “Such skills may include correctly interpreting and norm-appropriate responding to verbal and non-verbal social cues, conversational skills, assertiveness training, and relationship building. VR is uniquely well suited for training social skills via virtual conversational agents and immersive scenarios.”

Overall, the authors identify a number of areas in which CBT could be translated into VR including:

Foretell Reality is a virtual reality platform for various behavioral and mental health applications including individual or group therapy sessions, support groups, and social skills development. We work with our partners to develop experiences tailored to the needs of their business and patients. Schedule a demo here.

Vince Cacace, Founder of Vertebrae – Forbes 30 Under 30

Congratulations to Vince Cacace, founder of Vertebrae, a Venice California based company that helps brands reach consumers through virtual-reality based advertising. Vince has been named to the 2017 Forbes List of 30 Under 30 in the category of Marketing and Advertising.

Vince Cacace

Incredibly inquisitive and analytical, this Boca Raton native spent his time at Florida State University seeking the right train. While doing well in school he also started a small business and competed in the campus wide business plan competition – the InNOLEvation Challenge. After receiving a Bachelor of Arts & Science degree in 2013 from Florida State University in Finance and Accounting with a minor in Computer Science, Vince moved to Austin, Texas and worked in data analytics for General Motors.

Always one to pursue mentoring, perpetually network and seek the right train, in 2015, Vince moved to Venice, California and launched Vertebrae. Having assembled an incredible team, in September of 2016, Vertebrae announced a Series A funding round of $10 million and was recognized as one of the top virtual reality firms in Los Angeles

Congratulations again to a wonderful young man, a great team and a bright future!

RIDE – Rare, Impossible, Dangerous, Expensive

“VR at its best shouldn’t replace real life, just modify it, giving us access to so much just out of reach physically, economically. If you can dream it, VR can make it.”

– Matthew Schnipper, “Seeing Is Believing: The State of Virtual Reality”

Will Oremus, Slate’s senior technology writer, in a fascinating article (Insert shortened link below), spoke to Stanford Professor Jeremy Bailenson’s contends there are four adjectives to describe experiences worthy of creation (or recreation) in virtual reality. Virtual reality can enable us to experience the rare, the impossible, the dangerous and the expensive.

This worthiness is, in part, a function of the current cost of creating virtual reality. Given that virtual reality is not free, Professor Bailenson advocates focusing on experiences that are meaningful and not readily available in our everyday lives.


As noted by Will Oremus, “You could go whale-watching a dozen times without seeing a humpback breach right next to your boat. Or you could do it once in VR.” Watching a humpback breach right next to your boat is a spectacular experience. Watching a whale breach as you “hang glide” around the world on Disney’s Soarin’ ride is equally spectacular.

Disney’s EPCOT and Animal Kingdom give you a wonderful glimpse of Earth’s continents. Virtual reality offers each of us the opportunity to be totally immersed in these continents. The opportunity to be immersed in each country, its geography, culture, museums, and landmarks. According to museum professional Mark Macleod; Most museum’s exhibit less than 10% of their collection. Larger museums like the Louvre and National Collections are closer to 2 to 3%. A virtual museum could display its entire collection.


Will Oremus further noted, “You can’t travel back in time, grow a third arm, or experience life as a person of a different race or gender. But VR can give you a surprisingly visceral taste of what it would be like if you could.”

I’m fascinated by the opportunity to travel back in time. In the words of one of my favorite Jimmy Buffett song, “Yes I am a pirate, two hundred years too late. The cannons don’t thunder, there’s nothing to plunder, I’m an over-forty victim of fate. Arriving too late, arriving too late.” Perhaps Jimmy has a slightly fantasized perception of piracy. Can Jimmy truly lament being born too late for churning seas, barnacle covered wooden vessels, drowning, dehydration, scurvy and being hung from the yardarm to mention just a few? Through the wonders of virtual reality it’s Yo ho, yo ho, a virtual pirate’s life for me. Most of the “glamour”, none of the foul stench.


“Part of the point of virtual reality is that you really have to experience it to know what it’s like, but it’s safe to say it’s unlike anything you’ll have tried before. With headphones on, playing in a dark room, it’s entirely possible to forget the outside world as sounds, flashes and objects bombard you from all sides.”

TELEGRAPH REPORTERS, “Oculus Rift: What you need to know as virtual reality headset goes on sale in the UK”, The Telegraph, September 20, 2016

I was flying out of San Francisco and the young Stanford graduate student sitting next to me shared how he hand signaled to other surfers the size of the shark swimming beneath him. My first thought was, “Wow, you have an incredible future, perhaps you should be a little more risk adverse”. My second thought was, “It must really be a rush to surf otherwise why would anyone be out there?” I’m a bit of a chicken. My arms were locked out holding on for dear life at Disney’s Soarin’. But I’d love to surf in virtual reality.


I’m blessed to be pecking away on my laptop at Disney World in Orlando after which I’m immediately headed to Disneyland in Anaheim for a day. The Disney experience is enchanting. It’s uplifting to observe families from such a diverse range of social-economic backgrounds enjoying the parks. Many of these families are making, admittedly joyfully (at least until a nap is needed), a substantive financial sacrifice. Bless them!

Unfortunately, there are families that simply cannot afford the trip to the Magic Kingdom or similar experiences. There are young people who don’t have parents, don’t have a family. I’m a big advocate of the Unconquered Scholars Program at Florida State University. As noted on their web site the Program provides an array of support services promoting overall success to youth who experienced foster care, homelessness, relative care, or ward of the State status. Many Scholars have faced profound hardships during childhood that may increase their risk of leaving academia without a degree. In fact, research indicates former foster youth are far less likely to earn a degree than their foster care peers. Florida State University is committed to meeting the unique needs of Unconquered students so they experience the long-term professional and personal benefits associated with educational attainment. My wife and I are funding a documentary about these students incredible first visit to Disney World. The documentary should be released in March of 2017.

Travel In Virtual Reality

“Americans who travel abroad for the first time are often shocked to discover that, despite all the progress that has been made in the last 30 years, many foreign people still speak in foreign languages.”

– Dave Barry, Pulitzer prize winning author and columnist

I’m always amazed when I hear an American in Europe say, “That’s not how we do it in the US”. Why spend all that money to travel abroad if you are looking for that “back home” experience? Traveling, particularly traveling abroad, changes your prospective on the world, on life. I’ll never forget a thirtysomething, college educated corporate manager bursting into my office to ask, “Did you know Jewish people don’t believe in Jesus”. Where do you start if you want to address that question?

I can’t quite put my finger on it but there is something different, something unique about college students who have traveled/studied abroad. Maybe there is something different about them to begin with, something which inherently leads them to want to see the world. Students with international experience tend to be more optimistic. They tend to believe there are more opportunities in the world. They tend to explore more career trains. That said, some students simply don’t have the money and/or interest to travel or study abroad. For those with the interest, virtual reality travel is the next best thing. For those who currently don’t have the interest, virtual reality is an opportunity to reconsider the possibilities.

“The most interesting thing about virtual reality that you can’t find out anywhere is the actual feeling of presence, and feeling of being in virtual reality. It’s not something that can be communicated by talking about it…. You very quickly accept the fact that you’re in a different place. That feeling is something incredibly novel. It’s a visceral experience to be able to just trick yourself into believing you’re somewhere else.”

– Aaron Koblin, interview, PSFK, June 9, 2015

Virtual reality truly is the ultimate mind hack. Virtual reality can create incredible gaming and thrill ride experiences but VR can also emulate experiences around the globe. Better yet, virtual reality can emulate experiences today, in the past, and into the future.

“Virtual reality could add a lot of culture to our lives. The technology could instantly transport users to the Louvre in Paris, the Acropolis in Athens and the Guggenheim in New York City, all in one day. In fact, a number of museums have already collaborated with developers to create virtual spaces where people can experience the museums’ physical collections.”

– Knvul Sheikh, “Beyond Gaming: 10 Fascinating Uses for Virtual Reality Tech”. Livescience

I grew up going to Sunday school and church almost every Sunday. I’d read about, seen pictures and watched TV shows about the Holy Land. None of those experiences gave me the sense of what it’s like to truly be there. I had no sense that from below sea level at the Dead Sea you needed to climb high into the mountains to reach Jerusalem. Today, I could walk the streets of Jerusalem in virtual reality, have a sense of presence and relive the entire experience.

“Virtual reality is all about selling the illusion that we’re being transported somewhere entirely new. The challenge is getting users to suspend their disbelief in an immersive format, which presents hurdles not present in two-dimensional media. We accept that representations on a television screen aren’t exact or even remotely accurate, but when we’re standing in the middle of a computer-generated landscape, our real-world experiences come into conflict with simulated sensations.”

– Michael Futter, “The Virtual Reality FAQ”, gameinformer, #273

The creators of virtual reality content has considerable poetic license when it comes to what is a real-world experience. As Chris Milk has noted, “In virtual reality, it’s more about capturing and creating worlds that people are inhabiting. You really are a creator in the way the audience lives within the world that you are building.” And yet, in the best of both worlds, the audience has a sense of liberty and freedom to walk around and explore the world you build.

“It is a conundrum. If you’re going to make the virtual experience so good, why should you have to go to Hawaii to experience it. How do you entice people to go if in fact they can see everything they want to see virtually?”

– Jim Blascovich, “Virtual Paradise Aims To Lure New Tourists”, Hawaii Public Radio, September 29, 2016

We are all constrained to varying degrees by time and money. What better way to determine where you want to spend yours than to go there virtually ahead of time? Who hasn’t taken a trip and then wished they’d gone somewhere else? Who hasn’t stayed at a modern day version of the Bates Hotel? No question, virtual reality will create new challenges for marketers and the travel industry. But virtual reality will allow you to experience more of the world and be more discriminant about when and to where you do in that crammed little, flying box – the airplane.

What Do I Want To Do When I Grow Up – Virtual Reality Could Be Your Guide

(need a graphic of our characterized Rocinante wearing a VR headset)

“Adults are always asking kids what they want to be when they grow up because they are looking for ideas.”

– Paula Poundstone

I’m blessed with highly supportive, loving parents. One morning, more years ago than I’d like to admit, my father took me to a major highway overpass at rush hour. As we sat there watching the bumper-to-bumper commuters, Dad asked, “What do all these people do for a living?” I had no earthly idea, nor much of an answer. Finally, Dad ended my torment by stating that no one knew, that the government compiled massive lists of occupations and still couldn’t begin to capture them all. The secret, Dad said, was to find an occupation that you enjoy and find intellectually challenging. My bio today is a direct consequence of that quest, a reflection of those few short minutes on an overpass and many similar moments and conversations. My Dad is gone now but his wisdom and guidance are my daily companions.

As an Entrepreneur-in-Residence, I try to meet with at least a couple of college students one-on-one every Friday afternoon. I frequently find myself feeling like the Cat in Alice in Wonderland:

“Would you tell me, please, which way I ought to go from here?”

“That depends a good deal on where you want to get to,” said the Cat

“I don’t much care where…” said Alice

“Then it doesn’t matter which way you go,” said the Cat

Except, I don’t agree with the Cat. It does matter which way you go! In this blog, we will introduce you to young people who found their calling and are on a quest. Their stories are phenomenal. Their likes are exciting. They are forces of nature changing the world. Very few stumbled into their passion. Most spent a substantial amount of time and effort in quest of their passion. If you have similar stories you’d like to share, please contact us.

A partial tip of the hat to students who at least ask, “which way I ought to go from here?” That’s a better approach than merely wandering aimlessly hoping that everything will work out. You significantly decrease your chances of having an exciting and rewarding career if, much like Don Quixote let Rocinante choose his path, you optimistically wander about hoping life will somehow work out.

“There’s no difference between a pessimist who says, “Oh, it’s hopeless, so don’t bother doing anything,” and an optimist who says, “Don’t bother doing anything, it’s going to turn out fine anyway.” Either way, nothing happens.

– Yvon Chouinard, founder of Patagonia

How does the question of which way should I go tie to virtual reality? Virtual reality can provide young people not only a view from the overpass but virtually send them off to work in occupations they might want to consider. I believe you could find at least one individual, probably many, in any “chosen” career field who wished they’d made a different career choice. One of my dearest friends wasn’t particularly interested in Accounting in college. He’s now into his fourth decade of being an accountant. Time is too valuable. Time is your most precious asset. The majority of your time should be committed to your passion. But first you have to find it.

While I love to meet one-on-one with students, in my instructional role I teach an online business strategy simulation to as many as 800 students a semester. While I miss the banner/interaction of the classroom and it stills seems a little strange to sit in my office alone, talking to my iMac, there is something highly intriguing about being in an online classroom. Where else can you regularly interact with students studying abroad in Florence, London or any where across the globe? I will confess I don’t miss the coughs and colds in-class students have so graciously shared over the years. Even more intriguing is the idea of interacting with students in a virtual environment specifically designed to emphasis targeted learning goals while broadening their exposure to life’s possibilities.

It does matter which way you go! It also matters which industry you choose as well as which firm you join or start in that industry. In future blogs, these ideas will be explored and as stated at the end of the Conan the Barbarian movie, “this story shall also be told”.