An Interview with Professor Donna Davis
Donna Davis, Ph.D. is an Associate Professor and Director of both the Oregon Reality Lab and the Strategic Communication Master’s Program at the University of Oregon (Portland) and is an expert in psycho-social virtual reality (VR) utilization.
Stephen Alexanian: Thank you for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Stephen Alexanian, research intern at Seattle Anxiety Specialists. I'd like to welcome with us Dr. Davis, who is Associate Professor and Director of the Strategic Communication Master's Program at University of Oregon, and also the head of the Oregon Reality Lab in Portland. Her work has encompassed potential uses of immersive media, virtual reality, with special interests and marginalized and vulnerable people. Her newest publication she co-authored is, “Virtually Real, But Not Quite There: Social and Economic Barriers to Meeting Virtual Reality’s True Potential for Mental Health.”
Great to have you here and helping us understand these interesting, complex issues. First of all, would you like to introduce yourself a little bit more, and tell us what made you interested in VR research?
Donna Davis: Sure. I am Donna Davis and, as you just said, direct the Oregon Reality Lab and Strategic Communication. The work I've done is at that intersection of how we think about communication, how we think about creating communities, and how we create identities in virtual worlds, and the effect that that ultimately has on us and others.
And I got interested in this space because, working on my PhD at the university of Florida in 2008, I took a class in virtual worlds and it blew my mind. I had no idea this technology was out there at the level that it was. You figure game spaces in that moment in time were still pretty primitive. And the course that I took was actually using the platform of Second Life to explore the potential uses of virtual worlds. And Second Life was just three or four years old at the time also, really in a primitive state, both graphically and technologically.
But when I saw what was happening in that environment, I just thought, "This is crazy. It's the Wild West, and there is so much potential here. I need to try to figure out what's going on in this space."
And so, I wrote a dissertation on the efficacy of social capital that's formed with between people in virtual worlds when they only know each other virtually. Avatar to avatar, people fall in love, they build communities, they create support that's very, very real. And of course, it also has sometimes some very real, sometimes very positive, and sometimes very negative consequences. It got me on that path where I basically started the PhD program with an expectation to focus on family media literacy. I identified a medium that had even more potential to be both, there was promise and peril. And I just took that hard right and never looked back. Came to the University of Oregon from there, and I have stayed in that space as a researcher since then.
Stephen Alexanian: Thank you for that. For our audience who may not know what virtual reality is, can you explain what it is? What makes VR very immersive or effective?
Donna Davis: Sure. Well, and it's interesting because the term virtual reality is so often misused and misunderstood, because you read anything right now, and they talk about the future of work is in reality. They're talking about zoom as virtual reality. And in its literal sense, this is our virtual reality. We're experiencing real time, synchronous interaction face-to-face, but it's entirely remotely and digital. It is virtual.
But virtual reality also, among people that are in the field, typically they're talking about virtual reality as the experience that we have in a virtual reality headset, that really immerses a person in that virtual space. Because with a headset on you, don't see the world around you anymore. And if you've got earphones on, you don't hear the world around you anymore, and your brain actually takes you there, and you feel completely immersed in this built and virtual environment, and in an embodied way.
The virtual reality that I've been working in for now almost 14 years, is screen-based, so these are screen-based virtual worlds, again, that are entirely computer-generated, animated. And what makes them work, and so powerful, are a couple of different things. One of the key pieces of that is the concept of presence, feeling like you are actually present in that space, that there's a social presence where it's, I am socially present with others. There is an environmental presence where I feel like I am present in that space, in that moment in time. And feeling physically present that it's my body, and that I'm interacting with an environment that affects me in an embodied way. So, the self-presence, that you feel present in that space and that you're interacting in that space in a way that also, part two, is immersiveness. And that, like I said, with a headset on, you're even that much more immersed. And you feel completely immersed and present in that environment, where you don't necessarily feel present in your physical environment anymore.
So, there's almost a spectrum of both presence and immersion, based on which hardware or platform you're operating in, and at what level of built environment versus a camera, video environment. And the other part that is really important to the work I do is that sense of embodiment. That is where you have a digital body in that virtual space, that built environment, typically known as an avatar. And even as we think about avatars, I always ask in class, or when I'm presenting around the world, if people have an avatar, and a couple of people might raise their hands. The audience is, the more they do, because the younger audiences are gamers and are in many platforms such as Roblox or Animal Crossing or Fortnite, the big ones right now that are virtual environments.
And so, they all have avatars and they’re like, “Yeah, I do.” But if you also create a Memoji for your phone, or on Facebook, or on any other virtual platform where you have a digital representation of yourself, that is your avatar. That’s the other real important piece of this that I have found one of the most important parts of the work I do, because that sense of identity that comes through your virtual body can also be incredibly powerful in good, bad and ugly ways.
Stephen Alexanian: Very interesting. One of the questions I was most interested in talking to you is, I know some people may have just heard of virtual reality. I heard about it a couple years ago. For you, how has research in VR changed over time since you first started exploring these areas?
Donna Davis: The research is exploding right now because the spaces are so much more accessible. Early virtual reality research was done, and even if you were to Google the historical development of virtual reality, you'll see the Sensorama, these huge machines, or these headsets that were connected, that looked almost like you were in a Jules Verne undersea adventure, where the technology was very big, bulky, clunky, uncomfortable. And, just as early computers, what would be the size of my building we can now operate with my cellphone. Similarly, the technology is changing now in a way that you can buy a very good quality of virtual reality headset for $299 or $399, as in $399, $400, and have access to multiple experiences in virtual reality.
And while much of that has been driven by the game space, there are other people now recognizing its potential and its power, and really beginning to explore the uses of virtual reality that go way beyond gaming and entertainment, where that is still the primary driver. There are now multiple use cases of virtual reality in healthcare, especially as we look at pain management, and some work that's been done with burn victims, where you can put them in a VR headset and they're in a snow cave and playing a snowball game. And they find that the brain takes over and thinks they're in the snow. And the body responds physiologically to what the brain is thinking. So, they're able to change the bandages of burn victims with much less pain medication because the brain is so preoccupied with what they think they're doing that they are not paying as much attention to the pain.
Similarly, work in PTSD, in physical therapy, and now there's a much bigger, bigger recognition of the potential as well in dealing with people with isolation or other emotional issues, where they can see that virtual reality can be a really safe space and an accessible space to potentially explore alternatives to things like pharmaceuticals. Or it's just even practicing. There's been research done for more than a decade now with people with autism in virtual environments, where they can actually practice and experience virtually, similarly, agoraphobia or arachnophobia, and multiple phobias.
I was familiar with research that was being done with people who were afraid of water, and wouldn't go in the water. And they had their avatar just stand at the edge of the water. All the physiological fear issues kicked right up, sweat, heart rate increase, terror, terror, and they weren't even touching virtual water, much less real water. And it's like, all right, let's get you through this process of it's not even real. Why are you so terrified of it? Until they could put their toes in it, till they could put their feet in it, till they could go ankle deep. Now let's try that in real water. And they've been able to practice working through the response. Similarly, people with autism. Similarly, people with PTSD.
So, there's been a lot of research in that space for well over a decade now. But now, with the access that we have with more commercially available headsets and experiences, there's research that's really starting to take off, especially with the elderly, who often live in isolation. And people with dementia, where they can put them in a headset and they can remember a dance or a song or an experience incredibly explicitly. It's like everything lights up. There are just so many possibilities. If you can think it, you can build it, and you can test it right now. You can do that now.
Stephen Alexanian: Thank you. You brought up the idea about pharmaceuticals, people are trying to avoid it. I know depression is a huge issue with that as well. Where is the development with helping people with their depression?
Donna Davis: I think that I'm not as familiar with people that have been doing experimental studies with depression in VR yet. However, I can also point to some of the work that I've done that is... Again, when you're talking about social capital, it's how do you create connection in social spaces, especially in immersive virtual social spaces? And some of the early work I did was with the Parkinson's community, where an 84-year-old woman with Parkinson's discovered that she could... her son introduced her to Second Life. And because she was living in isolation, he and his sister were in opposite corners of the country. And he said, "Mom, let me help you to create avatars, and we could log in at night and hang out together and do things." And one of the things she loved to do was go ballroom dancing. So, she could log in, her avatar could put on a ballgown. Her son, on the opposite corner of the country, could log in and put on a tux, and take his mother ballroom dancing.
And the next morning when she would get up, she would've just experienced, to her, the night before, she'd gone ballroom dancing with her son. The experience was incredibly real. And that connection, and joy that she experienced, she felt, "I should share this." So, she actually started a Parkinson's support group in Second Life. And I worked with that group for over nine years, and I watched the level of support that those people were able to create from anywhere in the world. They could log in, and every Thursday morning at 10:00, we would have a Parkinson's support group in Second Life. And consistently these people reported how important it was to them to be able to have that connection with people that actually understood their situation, which, in the physical world, especially one of the women in the group was a woman that had early onset Parkinson's. She did not want to go to a Parkinson's support group in the physical world because, overwhelmingly, she would go and find that they were older than she was, further along in Parkinson's than she was, and it terrified her.
So, in the virtual world, she could log in with her very healthy, vibrant, beautiful avatar, and do amazing things, and connect with other people with Parkinson's, and have fun and do joyful things, and become friends. And people shared things in that community that they said nowhere in their physical world would they ever have felt comfortable enough to share. It's almost like people who are in any of the “As”, like AA or NA or those organizations where people may have a fear of going to one of those meetings because, even though it's anonymous, you see each other's faces, and you might bump into each other in the grocery store or at an event. It's your avatar. You could be anywhere in the world. Whether or not you share anything about your physical world identity is entirely up to you.
And people really open up in ways that they said they would never have done in the physical world because they felt it was a safer place to do that. But the mental health industry has been slower to adopt that because there are also risks, like if you're working with someone, especially who suffers from depression, or is at risk in any way of harming themselves, if something were to trigger them, and they live on the other side of the world, and you have no way to protect them, there are issues there. It's complicated legally, it's complicated clinically. But, after working with the people with Parkinson's, I got a National Science Foundation grant to work with people with broader disabilities.
And we found a community of people, again in Second Life, who were part of an organization called Virtual Ability. Many people with disabilities also are often addressing depression, and based often by their isolation, or by the circumstances of their disability. And we would host events, and one of the people in our community also started a depression organization in the virtual world, and they have thousands of members of that support group in the virtual world. Again, because they have a sense of anonymity and support where they feel like they can express themselves more openly than in any other situation they've ever been.
And they can express their emotions in really interesting ways. Sometimes it's by the way their avatar appears. I know many people have multiple avatars, and they say, "Well, this is my joyful avatar. This is the avatar I use when I'm feeling really dark. Or this is the avatar where I just want to let loose. Or this is my work avatar." They pick an avatar for the moment that they're in. Again, some people might think that comes with big risk, and that's where more research is needed. Are you creating greater potential for people who might suffer from multiple personalities? There's so many ways to approach this, and we're just at the very tip of the iceberg, I think right now, as a field, and in research, and in the technology.
Stephen Alexanian: Just for our audience that doesn't know Second Life, is it easy for them to sign up free? Anyone can use it. Can you explain a little bit about that just for our audience who doesn't know about Second Life?
Donna Davis: Sure, sure. And it's really funny because anytime I mention it, I will have people go, inevitably, there'll be at least one person in the room that'll say, "It's still around?" Second Life has been around for 18 years. And it's a 3D virtual environment, graphically created environment, that you can download for free on any computer at secondlife.com, and create an account at no cost.
There's different viewers you can download, but the Second Life viewer works just fine. And any computer with a graphics card and an internet connection, that's a contemporary computer, is pretty much going to operate Second Life. I've actually found that it were works on a Microsoft surface, but it does not work on a phone or an iPad, or most tablets will not run it. So, it's got to have enough beef to the graphics card, and your engine, that it'll run the graphics. But any laptop, any PC, for the most part, if it's been built in the last five years, is absolutely, probably even 10 years, is going to be able to run Second Life. You just need an internet connection and a decent graphics card, and it'll go.
Stephen Alexanian: Okay. Thank you. Like I mentioned to you, your last published article that you did was about certain barriers to having VR reach true potential. It seems like the pandemic is really speeding up the need for telehealth solutions like VR. Can you talk about the main challenges for implementing VR in healthcare? Any social, technology or cultural issues?
Donna Davis: Sure. One of the pieces that we wrote, that I co-authored with colleagues here in Eugene, we're talking specifically about the barriers to adoption of VR. Part of that is that the technology has been slow to market, and the pandemic actually exacerbated that with supply chain issues. But at the same time, things started to really grow during the pandemic because people were all, instead of... In working with people with disabilities, my colleague, Tom Boellstorff, from UC Irvine, who worked with me on the National Science Foundation grant, he and I always refer to people as, there are people with disabilities, and then there are tabs. And we're tabs. That means we are temporarily able-bodied, because as we age, some things about our body will... increasingly, you'll need glasses, you might need hearing aids, you might need a walker. But all of us will experience different levels of ability and disability as we age.
So, during the pandemic, we found that all people were living with the same level of isolation as people that had traditionally only been marginalized had experienced. So, they were finding new ways to connect, and all of that was digital. It's also driven a lot of the innovation in what's coming in VR in terms of headsets, and through which technologies. Everybody's scrambling to try to figure out how can we access these things on tablets and phones, because everybody has a phone in their pocket almost entirely today. We're not all walking around with a PC. And part of the obstacle is that headsets are still expensive as the globe thinks about the economy. I say, oh, they're just $400. $400 is a lot to a lot of people, and it requires a higher end computer to run it. So, there's an economic barrier.
There is to a certain extent, a technology barrier, although those barriers are coming down rapidly. Part of the technological barrier is even, some people will find, certainly the people that I worked with in the disability community, couldn't wear a headset. And it might be that they had a muscular-skeletal issue where their head couldn't support the weight of a headset. For some, it was a claustrophobia. For many, it was motion sickness. And while they're doing lots of things to remedy all of those things, it's still a barrier to a lot of people.
And the final barrier has been one of content. So, building the content is an issue in terms of... The primary content creation to date has been in the game space. And although there are many companies blossoming that are creating content in other ways now, we're starting to see it being more widely adopted across industries, so people are using VR and AR in lots of creative ways right now that... Pre-pandemic and at the beginning of the pandemic, it was just really hard to find content that was easily accessible. At the same time, we're in this moment where, any minute now, we should be hearing that Facebook is about to get a new name because, famously, a couple of weeks ago, Mark Zuckerberg said they're moving away from an internet or a social media company to a metaverse company. And the metaverse is entirely about virtual reality. When you have the biggest social networking site in the western hemisphere saying, "We're moving away from social and into metaverse," I think it says a lot about the direction that technology is going.
Stephen Alexanian: Right. That seems like they're trying to get toward the, if you've ever seen the movie Ready Player One...
Donna Davis: Of course.
Stephen Alexanian: Quick question. How close are we to, how many years would you say till we get to that point of everyone being Ready Player One? Not the chaotic outside, but within the virtual reality world.
Donna Davis: It's hard to know. And Ready Player One, and a lot of reporting about virtual reality, is very dystopic. And this is one of the things that I, this is the drumbeat that I am always banging on, and that is one, virtual reality should be an augment to our physical world, not a replacement of. And we know that game addiction is now officially recognized by the world health organization. So, there are other questions about, how do we create a balance, a healthy balance, of digital and physical in a way that we don't ignore the world around us that needs us, including our families, our children, the environment, all of those other things that we need as a healthy culture, we can't abandon because the virtual world is more fun, more entertaining, more loving, more all of the things that we think of that makes it utopic, creates a dystopia.
I think we're very close to the potential of just about anybody being able to log in. And I see, if some people have their way, that that would be the preferred method of work, of communication, of relationships, of many of the ways that we as human beings connect and communicate. That this wonderful technology is going to open the world up to us and connect us in incredibly more powerful and supportive ways. And where some of that is true, the dark side is also true. If we want to go down Ready Player One, it's not far off.
Stephen Alexanian: Okay. Gotcha. My last question is a two-parter. You mentioned some people experience cyber sickness, other issues, problems. What would be your main advice, as a researcher, to clinicians who are wanting to work with VR therapy or getting involved with it, and talk about their reservations for getting them involved with this kind of research, because not a lot of clinicians are actually trained in this area. And then what would you say to patients who are interested in this, but have reservations?
Donna Davis: Okay. Couple of things there. And let me start with the clinicians who would be interested, and how do they go about it. Very interesting is that, in our NSF work with the disability community, many of these people, and we didn't specifically say that people had to have any type of particular disability, so we had people with both physical and invisible disabilities. We had people in our community that had bipolar disorder, or who had PTSD or depression. And we had several people who were in therapy due to their condition, and one of them in particular was diagnosed with bipolar disorder and PTSD. Her issues were very psychological, and that she had a therapist who worked with her, but independent of what she was doing in Second Life, her therapist had never been in Second Life.
And she went to her therapist and said, "I've created an avatar that is my young child self, my young teen self, my young adult self, and my current self." I think she actually had five different ages. And what she wanted to do was try to experience where her trauma occurred, to be able to work through it in and embodied way. And found that her youngest self was so triggered instantly that she had to log out, and she couldn't log back in for a month, so those are the risk parts of it. But she was doing it entirely on her own, not with professional therapy. But she'd go to her therapist and say, "This is what I did." And her therapist said, "If I weren't about to retire, I'd totally be about trying to figure out how to do this with you."
I think that, again, as we think about telehealth and the future of telehealth, and we think about the future of these technologies as therapies, that we have to look at the legal implications. What are we allowed to do and not allowed to do, legally, when it comes to therapy? And when I say we, I think of it as a researcher, and I have to go through IRB approvals. Anytime I'm working with people, we have to make sure that we do no harm. In the same vein that people that are offering professional counsel to these people obviously want to do no harm. They need to be exploring, what are the technologies that are already available, where their clients might even be? And how do we meet them there in a way that informs everybody in a really productive, safe way, and potentially very innovative and supportive.
Obviously, it won't be for everybody. When I was working on my PhD, so this is almost 14 years ago, one of the people that I met, one of the first people and friends that I met in Second Life, was a therapist who worked with the criminally insane. He was working with people who were hospitalized by virtue of the crimes they had committed. And many of them had suffered from pretty severe addiction issues with pretty severe drugs. And he said that he was working with some of them in game spaces, whether it was Second Life or in a game environment, and he found that they really were drawn to it in a way that potentially could be addicting or addictive. And at the same time, he said, "But if I can addict them to a game instead of heroin, I consider it a win." And this is 14 years ago. So much has changed since that time.
Similarly, one of the women in our community who was also getting therapeutic support, said that her therapist was concerned that she would get lost in the digital environment, that she would spend too much time there and be addicted. So, we have certain biases already built into our minds about the way we look at some of these technologies, especially from the dystopic perspective. And her therapist is basically scolding her about the amount of time she was spending in the virtual world. The woman in our community said she doesn't have a social life in the physical world. It's not like she's going to a restaurant and sitting on her phone during dinner. When she's at dinner, she actually is having real face-to-face conversations with people. Then, in the virtual world, they might go to work for that, or they might go to other events for that. This is where she would go for that.
I think that, for people that are looking at this space, that they need to really open their minds to its potential, rather than automatically discount it as a bad or evil space, which often happens. Understand where the patients are, and where you can think about these platforms as ways to augment experiences in productive, safe, and positive ways. And to also look at them with really critical eye, in ways that we protect the people that are there, so we don't become that dystopic Ready Player One, and we are replacing our physical relationships and world with the digital.
And I think it has immense potential, both in positive and negative ways. The more we all are looking at that with a critical eye to look for what are the goods, and then what do I need to do to protect the people so they can experience that good, is going to be really important.
I live in Oregon. It's well known as a wine country. And this is one of those things, that I've had people actually yell at me after presentations in conferences about the evils of these platforms. And my response has always been, "I live in wine country, and I do really enjoy a fine glass of wine with a good meal. It doesn't mean that when I open the bottle, it's the beginning of a three-bottle night every night." Some people are going to be prone to go that way. How do we put protections in place? Other people find it as a really fine experience on an occasion that can augment their life in really positive and wonderful ways.
Stephen Alexanian: Gotcha. Do you think more researchers, last question, researchers should build their own company, like Oculus or something, to have more safeguards? Because we're basically trusting a lot of Facebook, these other big tech companies. Is there a way, do you think, that researchers can get more into this, that are independent from these companies? So, people don't feel as worried about the evils of Facebook.
Donna Davis: Of course. And Oculus is the number one VR headset out there, owned by Facebook. And beginning this year, you have to actually set up an Oculus with a Facebook account, so they have locked you in. And a lot of people have pushed back against that and say, "Well, I'll use a different headset." And there are options out there. And there are other world builders out there. And there are experienced builders out there. There are companies today that new positions in the companies are Chief Metaverse Officer. They're saying, "We've got to be in this space." Especially as we look at Gen Z. The millennials, plenty, but Gen Z totally are growing up in these environments. We're way behind if we're not already thinking about those things. And there are big companies, like the biggest gaming companies, that are creating platforms for multiple uses.
I think that you'll have plenty options in the future. And I think it's really important to know who's hosting where you are. Are you creating your own space? And you certainly can do that. And I think, ultimately, it'll be much like subscription services as we experience them now, where you can pay to have a private environment, and keep it very exclusive to your space. But if you want people that are able to experience a blend of both the native what's already out there, and create a safe space, I think that finding a blend is going to be probably optimal, depending on your use and your audience.
And that's the other drumbeat that I'm always talking about, is what is the use and who is your audience? And so, the answer is going to be different in every single one of those cases. But any option is available.
Stephen Alexanian: Thank you, Dr. Davis, for being with us, spending all this time. I'm sure our audience and myself are very interested in all of this and learned a lot. Thank you so much for being on this installment of the Interview Series at The Seattle Psychiatrist. Thank you.
Donna Davis: My pleasure. Thank you.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.