INTRODUCTION
The relevance of this paper’s topic concerns the need for precise knowledge on how to deal with mental health in the increasingly growing and dominant new reality of metaverse around the world[1]. The advent of the metaverse, including virtual reality, augmented reality, and artificial intelligence, is an undeniable issue that needs to be updated by health care scientists[2]. It influences all fields of knowledge, interpersonal relationships, and health. Regarding mental health in the post-coronavirus disease 2019 (COVID-19) pandemic period, it is important to consider and understand the potential, possibilities, weaknesses, and consequences arising from and provided by this new scenario[3].
There is an increasing need for mental health monitoring and care[4]. Statistics show that there has been a barrier to mental treatment access due to several factors, such as: Shame and prejudice against seeking mental treatment; lack of confidence and trust to share their problems and becoming fragile in front of a stranger; treatment abandonment; financial limitations[5]. Therefore, mental disorders such as depression, compulsive behavior, addictions, anxiety, and deep social phobias are underdiagnosed, and their treatments are neglected[6].
CLINICAL IMPLICATIONS
Mental health treatment requires in-depth training of therapists and long-term preparation. Time and experience are crucial to properly learn how to conduct a session. The therapists need to develop a bond and earn the patient´s trust. Also, it is important to understand patient’s subliminal behavior variations, projections, verbal speech and non-verbal communication, action eminence and concealment of 'acting out' actions or even 'passage to the act' – suicidal attempt[7-9].
Psychological urgency and emergency state, crises, panic, and lack of control situations are difficult to detect and manage without prior training. Artificial reality programming needs previous input to acquire enough data to develop and apply strategies efficient enough to prevent an undesired outcome. Currently, actual therapists require at least five years of experiential professional knowledge to be able to deal with these matters, despite the chosen psychotherapeutic approach. Psychotherapeutic treatments, alone or associated with other treatments, have shown promising results in real life experience. Even so, there is a dropout rate and difficulty in maintaining results for prolonged periods when the treatment is discontinued, or follow-up might be lost[10,11].
METAVERSE RESOURCES
The metaverse represents a more accessible means on three fronts: Prevention, treatment, and long-term adherence to therapeutic monitoring[2].
Regarding prevention, access to the internet, artificial intelligence, and augmented reality can help educate a greater number of individuals regarding the signs and symptoms of mental disorders. This information can be available to read by any individual at any time via the internet or even downloaded for future off-line access. Many digital media outlets reach a population that represents more than 60% of the statistical data regarding mental illnesses[3,12].
In addition to the resources mentioned above, virtual reality and avatar representation can guarantee anonymity, which can provide the patient with more comfort in sharing and explaining problems in a non-judgmental communication[5,12]. On the other hand, this same action that offers comfort to the patient blinds the therapist to subliminal observations, thus making the supposedly unstable patient the only one responsible for controlling the therapy session[13].
Another particularity of the metaverse is the fact that people who are displaced from their locations of origin can be served in their languages, thus achieving more accuracy in their expression[5,14]. Through augmented reality and ‘deepfake’ using virtual reality to simulate traumatic situations it is possible to generate a realistic controlled experience and help treat trauma in a more optimized way[15,16]. Through the internet it is possible to reach those in need who are in remote or hostile places, enabling accessibility and treatment[17].
Finally, accessibility, confidentiality and anonymity favor adherence to treatment and may improve therapeutic results[9,17].
METAVERSE LIMITATIONS
Despite all these promising possibilities, very little is known about the effectiveness of remote mental health treatment for specific cases. Currently, therapists do not have the training in ‘metaverse’ practice, nor are they academically familiar with the appropriate therapies to use on such occasions, or even their limitations. Due to the COVID-19 pandemic period urgent guidelines were prepared and recommendations made regarding on-line therapy. These new vehicles and tools are particularly dangerous to use in cases of emotional instability, cognitive limitations, or therapeutic inexperience, and may even worsen the patient’s condition in some cases[18].
There is no evidence that virtual reality surpasses face-to-face approaches, but it is certainly suggested that accessibility and the characteristics associated with the use of metaverse technologies may represent a new horizon of accessibility and approach tools. It is a promising framework, but not yet mature enough and still insecure regarding the object of study it proposes to focus on[19].
The fact that this reality is very recent is associated with the lack of studies and development on new mental health treatment approaches suitable for this scenario. Artificial intelligence, although gifted with the property of learning through the acquisition of experience, is still not able to perceive appropriately when lacking an active input, being subject to algorithms[15,20].
Although online care and remote medicine have already been used on an emergency basis since 2020; however, to make this modality more familiar in the modern world and open doors to new advances, psychologists require proper training. Any psychologist would need more than four years of academic maturity to graduate. Furthermore, there is insufficient safe scientific knowhow, or precise, feasible, and reliable training for therapists to be properly ready for metaverse mental health practice. Academic and scientific knowledge capable of being generalized on this topic are still not available at this time[21,22].
It can be inferred that the opportunity offered by the COVID-19 pandemic can be taken advantage of to develop the virtual modality as an option for prevention, detection and treatment of illnesses linked to mental health[23,24]. Nevertheless, to date, it is still only an optimistic and promising vision.
As progress is made in the development of tools to approach mental health via the metaverse, considering an immersive virtual experience in a safe environment, and qualified mature professionals, it is also necessary to consider the unknown possible side effects of this process[16,25].
At present, issues such as: Nomophobia; sleep circadian rhythm disorders, irritability; vision impairment; dependency; decreased interest in experiential experiences; frustration intolerance; reduction of physical activities; and development of postural conditions are attributed to the virtual environment[25,26]. However, when regarding mental functions and mental dysfunctions treated via a virtual environment, there is no scientific maturity, no evidence to prove safety, reproducibility, or feasibility.
It is necessary to develop research and observe the outcomes related to the influence of the metaverse on people and mental health so that this inevitable reality can be better utilized[27]. In mental health, taking into account the repercussions and sensitivity of the topic, systematic training and experimentation are extremely important before wide applicability. When more studies are carried out and more evidence is collected, accurate guidelines can be developed to guide conduct, develop safe training, therapeutic maturity, overcome limitations, and prevent undesirable effects[28].
ETHICAL IMPLICATIONS
Ethical concerns linked to mental health therapeutic care are specific and delicate. When addressing ethics in the metaverse, tools such as deepfake and artificial intelligence that can be used for treating and informing, can also disseminate fake news or release personal data, breaking privacy and confidentiality, thus presenting an acutely sensitive issue that needs development and stability[16,29]. Studies and development of containment methods could be the answer to reducing damage and eliminating potential risks. They are extremely necessary when entering this field of knowledge and clinical applicability.
The presentation of modern technologies does not replace other approaches. In mental health, there is no therapy that is sufficiently effective for all needs. All therapeutic approaches focus on tested systems within a theoretical rationale, a social and ontological method, clinical practical experience and generalizable evidence[30]. Some techniques are more suitable for certain conditions than others and the diversity of treatment options is welcome, opening space for a “fifth” therapeutic force to be potentially developed in the metaverse.
CONCLUSION
The metaverse is already a reality. Problems associated with mental health are a growing fact and a relevant concern around the world. Knowledge is the solution to better manage the risks of developing these diseases and increase adaptation to these new demands and contingencies. When opportunities present themselves to improve and use changes in favor of health and science, it is a win-win situation from any point of view, with advances in terms of mental health treatment in the metaverse era being of supreme urgency and relevance. Therefore, this knowledge needs to be developed, tested, trained, and applied in a responsible manner, with the patient and their safest well-being as the main point.
ACKNOWLEDGEMENTS
We acknowledge the help and support of researchers Alcina Teles, Carlos Mamede and Cesar Figueiroa in the review of this article.
Provenance and peer review: Invited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Computer science, information systems
Country of origin: Brazil
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade B
Creativity or Innovation: Grade B
Scientific Significance: Grade B
P-Reviewer: Shao JK S-Editor: Liu JH L-Editor: Webster JR P-Editor: Zhang L
