Dr. Jeremy Sharp (00:00)
All right, everybody. Hey, we’re back with another episode of the Testing Psychologist. Today’s a clinical episode talking about technology, which is one of my favorite topics, as many of you know. My guest today is Dr. Skip Rizzo, and Skip is a clinical psychologist. He directs the University of Southern California Institute for Creative Technologies Medical VR Lab. He’s a research professor in both the USC Department of Psychiatry and the School of Gerontology.
Over the last 30 years, he’s conducted research on the design, development, and evaluation of VR systems across the domains of psychological, cognitive, and motor functioning in healthy and clinical populations. And the work is focused mainly on PTSD, TBI, autism, ADHD, Alzheimer’s, stroke, psychedelic therapy, and suicide prevention, among other clinical conditions. So, Skip has been
steeped in this VR world for a long time. I he is one of the true founders in our field of medical VR and mental health VR. And you can see that we talk about the history of VR and the mental health field, some of the early applications and projects that he’s worked on. We talk about the evolution of VR, some of the practical applications these days of VR in the mental health world. We dip into
AI of course, and how Skip and his team are mixing AI, conversational AI and VR. So there’s a lot to take away here. Of course, we also talk about applications for testing and exciting projects for the future. So for those of you who are interested in this kind of technology, this is a great episode for you with a true expert in the field. For those of you who are in my audience, long time.
audience members or newer audience members. Today’s a special day because this is the first mention of a big project that I’ve been working on for the past few months. And that’s about as much of a teaser as I’m going to give you for now, but I will say this, it’s going to launch in early January of 2026. And I’m excited to share this with all of you. So if you want to get more information, which will be coming, of course, just listen to the podcast and
course watch your emails if you’re on my email list. Those of you will get first access to this new project. So without further ado, let’s get to my conversation with Dr. Skip Rizzo on VR and mental health space.
Dr. Jeremy Sharp (02:37)
Skip, hey, welcome to the podcast.
Dr. Skip Rizzo (02:40)
Hey, thanks, Jeremy. I appreciate you inviting me to join you on this.
Dr. Jeremy Sharp (02:45)
Yeah, definitely. Definitely. mean, your name really caught my attention and your work caught my attention. I love technology. ⁓ Anything that’s sort of interesting or unique. ⁓ And you’ve been at this for a long time and it seemed like a no brainer to have a conversation about VR and how that’s coming into play in our clinical work. So yeah, appreciate you being here.
So I’ll start with the question that I always start with with folks, is why is this important? mean, out of all the things that you could do with your time and energy and your life really, why choose this particular area?
Dr. Skip Rizzo (03:24)
You know, the short answer is that there’s no wall at the end. ⁓ There is just unlimited opportunity. ⁓ That’s the whole thing that got me interested in VR, aside from the pragmatic element of the fact that it adds value. ⁓ The idea that you could work in this field for a long time and never get bored with it. It’s always evolving.
There’s new ways that you can think about how you can benefit humanity by leveraging new and evolving technologies. You see a lot of growth. So you might build an application as we’ll probably talk about in 1998 and still be evolving that application in 2005 because the technology has gotten better. You’ve collected a lot of data.
Dr. Jeremy Sharp (04:19)
Mm-hmm.
Dr. Skip Rizzo (04:23)
You’ve evolved the application, you’ve addressed user experience. And so, you know, there’s always a new frontier ahead. And that’s the exciting part for me.
Dr. Jeremy Sharp (04:35)
Yeah, yeah. I mean, it keeps it interesting and it is built into the field, I think. Things just keep advancing and there’s new possibilities and doors that open. I’m right with you on that. Maybe that might be a good segue just to do a little bit of history. know, VR is one of those things that I would imagine most people think of as kind of a new technology, but I guess it depends on your definition of new, but it doesn’t.
Dr. Skip Rizzo (04:53)
Thank
Dr. Jeremy Sharp (05:02)
It’s actually not that new. I’d love to hear just a little history about when you started and what that looked like.
Dr. Skip Rizzo (05:09)
God, I grew up in the Stone Age. You know, I got excited about VR indirectly based on an experience with a client. I was working in a brain injury rehab center. And at the time I was very frustrated. This was like 1990 or so. And I was very frustrated because I was in the trenches with people who had suffered significant TBIs.
Dr. Jeremy Sharp (05:13)
Yeah
Dr. Skip Rizzo (05:38)
And the best we could offer were paper and pencil workbook training activities. We had activities that were more functionally relevant, but they were very complicated. It was hard to give people attention as you went through those processes. More like OT kind of activities where you’re really doing the cognitive rehab in a functional environment as opposed to the sort of drill and proactive restorative approach. ⁓
know, computers were just coming into clinical settings, but in a very limited way. ⁓ The we had Apple to ease and I remember a program called Memory Builder and basically it was a paper and pencil workbook exercise that was in an automated fashion and it kept score. So you had a game like thing, but it still was very, very primitive.
I mean, one of my clients came into my office, a 22 year old male frontal lobe injury from a car accident. And he was all excited. And he, comes in and he goes, skip, I’m going to show you something. It’s a new thing. I go, what is it? And he goes, it’s a game boy. And go, what is it? And he pulls out this thing and I go, what does it do? And he goes, watch. And I watched him for 20 minutes glued to this thing playing Tetris. Not only had he become a Tetris warlord from
Dr. Jeremy Sharp (06:49)
Nah.
Mm-hmm. Mm-hmm.
Dr. Skip Rizzo (07:04)
playing this damn thing for so long. But this is a kid I had a hard time motivating for more than five or 10 minutes on any of the traditional rehab activities that we were doing at the center. And here he was glued to this thing. And I said, if we could bottle that, if we could take that type of game based activity, I started exploring that. And if we could do that, we would have something in rehab. ⁓ just by luck, my mom bought me.
I was an old man at the time, but she bought me a Nintendo NES system and the early Nintendo system. And it had what came with it was a game called Sim City. I don’t know if you’ve ever played that, but that is one of the ultimate executive function activities. I mean, you’re going in and you’re building a city, you’re selecting, you’re making choices, you’re implementing a strategy, initiating.
Dr. Jeremy Sharp (07:37)
Nice. Uh-huh.
Mm-hmm. yeah.
Mm-hmm.
Dr. Skip Rizzo (07:58)
You’re monitoring it. Time evolves. can adjust time to speed up. So in one hour, it’s like 20 years in the growth of the city, you know, all these things that really are, you know, pure executive function. And I brought that in and, and my high functioning clients loved it because they could learn the interface, the game pad, a lot of complicated combinations of pressing and 1991 game pad.
in order to make all these complicated things happen. But once they learned it, they loved it. We built exercises around it and stuff. ⁓ But, you know, it was still limited. The interface was limiting factor there. And then I heard a report ⁓ on VR, Jaron Lanier, one of the godfathers of VR. And he was in Japan at ⁓ a department store and he had a VR setup there.
Dr. Jeremy Sharp (08:40)
Mm-hmm.
Dr. Skip Rizzo (08:56)
where you could put on a headset and put on data gloves and you could design your own kitchen. So you could pick a refrigerator, pick a stove, whatever, move them around using your hands and look around. And when you finally got it right, pick the right colors and imagined it, visualized it. You know, the, the equipment would get delivered to your house and your new kitchen would arrive. And I thought about that and I thought, Jesus, that is.
That’s, you know, a functional environment. What if we could do the kinds of restorative training, drill and practice, but in the context of a functionally relevant environment, and we could gamify some of that. And that was the, that was the whole idea. The next day I went into work and I told my boss, I, after hearing that, that episode on NPR, I went to a bookstore and bought a book on VR. was glued to it all night.
And went in the next day and said, you know, I think there’s something here. And she goes, what a surprise. I just got this flyer in the mail and it was a conference called virtual reality in persons with disabilities. And she goes, if you want, have some money. We can send you to this event in San Francisco. it was like, yeah, I’m all in. And I went and nobody was doing cognitive assessment or rehab.
Dr. Jeremy Sharp (09:54)
Hmm.
That’s great.
Dr. Skip Rizzo (10:20)
most people were starting to think about exposure therapy because that was the lowest hanging fruit at the time. ⁓ and I met a lot of people and some people that I met, particularly this fellow, Walter Greenleaf, I’m still buddies with today. And it was like a community that evolved from way back then. Anyway, ⁓ I came back all excited, wrote a paper on this, describing the application of VR, why it added value to what we were doing in neuropsychology.
Dr. Jeremy Sharp (10:33)
Mm-hmm.
Dr. Skip Rizzo (10:50)
And it got accepted. I went back to the conference the next year. And then at that point I was hooked and I realized I wasn’t going be able to do it in my clinical setting because the technology was still expensive, complicated, primitive. needed a programmer, you know, devoted. So I ended up making a hard choice, but I ended up taking a postdoc at USC and the Alzheimer’s center, something relevant to my training.
But it was mainly because it was across the street from the computer science department. And I ended up doing my day work and then going over and cold calling, knocking on doors, you know, looking at people that had VR in their biography, you know, or an interest in it. Finally, one guy said, hey, you know, I know somebody with some equipment. We can get you a student programmer. Let’s try this. This makes sense. This is a novel idea.
Dr. Jeremy Sharp (11:23)
You
Dr. Skip Rizzo (11:46)
I was showing some mental rotation, a bunch of blocks glued together and how we could use 3D visualization. And so that was the start of it. And from that point on, ⁓ you know, had access to programmers, access to equipment, access to people that were a heck of a lot smarter than I was. And I remember telling my girlfriend at the time, God, I was at this meeting and, and, you know, I was like the dumbest person in the room. And she goes, well,
Do they want to work on your idea? And I go, yeah. It goes, what do you care? You’re lucky to have people that are smarter, better engaged. Anyway, that’s a long story, but I, that is the evolution of it in the sense that, ⁓ once you have that spark, then it just took off from there. There was no, ⁓ you know, it’s like the old saying, if you want to make God laugh, tell her your plans. I couldn’t have planned any of this in 1990. It just naturally evolved from.
Dr. Jeremy Sharp (12:20)
Mm-hmm. Mm-hmm.
Dr. Skip Rizzo (12:45)
a collection of serendipitous events. But once I got in for the lab, it was off to the races and we started building all kinds of stuff from that point on. Got a faculty appointment and all that and continued.
Dr. Jeremy Sharp (13:00)
I love that.
What were some of the first applications within mental health or rehab or neuropsych for VR?
Dr. Skip Rizzo (13:10)
Well, in the general field, know, the loaning fruit was exposure therapy. Some of Barbara Rothbaum, Max North, Ralph Lamson’s work on fear of heights. That was really the first, the first area, first, you know, papers that were published on it. ⁓ And then it continued on from there in the exposure mode. And I had an interest in that because I was trained as a clinical psychologist in a cognitive behavioral.
Dr. Jeremy Sharp (13:21)
Mm-hmm.
That’s perfect.
Dr. Skip Rizzo (13:39)
behaviorally heavy ⁓ grad school, ⁓ State University of New York in Binghamton, worked with Don Levin, Steve Listman, people like that. I met Edna Foa at that time. So, and I did my internship at a BA in Long Beach, California. And I dealt with a lot of PTSD with veterans. So I always had that interest, but it was the cognitive work that got me into this. And so the first project was,
building a set of visual spatial assessment and training activities, mental rotation, depth perception, a little bit of eye-hand coordination, tracking. ⁓ And it was all using a big 3D projection display. wasn’t a headset. And that was ideally suited for those kinds of visualization and interaction type applications. found that in one study, we found that
Dr. Jeremy Sharp (14:25)
Okay.
Dr. Skip Rizzo (14:37)
Women who typically score less well on a mental rotation, paper and pencil activity, when we translated that into a 3D interactive activity, they performed as well as men. And actually with a brief period of training in that interactive 3D format, that they ended up going back to the paper and pencil test and performing as well as men. Their performance had become equivalent. In a short period,
of testing and really that was a great first project because it showed me that this interactive ⁓ three dimensional activity could do something beyond in terms of cognitive function compared to what we might do with three dimensional line drawings and paper and pencil kinds of things. And they got me excited. And from that point, I had some credibility. And by that time I had
⁓ faculty appointment in a research Institute in the electrical engineering department. And I was very lucky to get that. They needed a psychologist, believe it or not, for this Institute. It was an NSF Institute. They needed a psychologist. They needed a human factors psychologist. And because of my technical work in the VR, I could masquerade a little bit as a, as a human factor psychologist. You know, I mean,
It’s basic human research methodology, within a certain domain. And I got that appointment and then, you know, I could, had access to a lot more resources. had another student and we built our first head mount display application in 98, which was a virtual classroom. And this was an assessment tool for putting a child in a VR headset in an immersive room.
Dr. Jeremy Sharp (16:23)
Mm-hmm.
Dr. Skip Rizzo (16:32)
where we could systematically deliver attention related stimuli on a blackboard upfront, and then also systematically control the level of distraction in the room. And the reason I went for that one, it was really kind of, I don’t know if you want to say predatory. I mean, my background up to that point was, look, I worked with adults with TBI and I wanted to do work in that area. But at the time,
ADHD was really a big, big, diagnosis. And I figured, you know what, the only way I’m going to get funded to evolve this is if I, you know, divert my attention towards children. And I ended up ⁓ building this out and showing some good results. And that grew over the years with kids. That’s now a commercial product. ⁓ But.
⁓ you know, it was strategic in the sense that, I was able to get funding for that, that particular use case with VR in a way I might not, ⁓ I might not have, ⁓ with, ⁓ you know, older adults following a stroke or a young, young adults after a TBI or whatever. ⁓ there was a lot of energy at the time in looking for ways to better assess attention.
Dr. Jeremy Sharp (17:48)
Sure.
Dr. Skip Rizzo (17:58)
processes and it made sense.
Dr. Jeremy Sharp (18:00)
Well, it sounds like that’s been something
that’s been going on for 30 years now in that case. We’re still looking for good processes. And I would imagine this, you know, the description that you gave of this classroom ⁓ tool where you’re manipulating distractors and putting things on the board, that will sound familiar to a lot of our listeners who are in the space.
Dr. Skip Rizzo (18:21)
You know, we actually ⁓ got some funding around 2002 from the Psychological Corporation, which is now Pearson. ⁓ And they saw it and they funded the development of a more modern version of the classroom using better computer graphics and really refining based on the research we had done over the last couple of years with it. ⁓ And they were looking to productize it back then, which was really visionary for
Dr. Jeremy Sharp (18:36)
Mm-hmm.
Mm-hmm.
Dr. Skip Rizzo (18:50)
2001, 2002. ⁓ But we went to, we went to INS with it ⁓ and did focus groups. We brought people into like hotel rooms in Hawaii that year. And ⁓ it was 2003, I think. And everybody loved it. We had done a study with it, with that particular version and got good results and everybody loved it.
until they got to the last question, which was, would you be willing to spend $10,000 on a specialized computer and a VR head mounted display and a tracking system? And then, you know, possibly pay a per use, you know, report generator cost. And at that point it’s like, well, maybe my Tova is sufficient. Get away with it. And so
Dr. Jeremy Sharp (19:33)
Mm-hmm.
Sure.
Yeah, that’s a great point.
Dr. Skip Rizzo (19:45)
Yeah, they lost interest in Ahari because it wasn’t a commercial liability. You know, it was still ⁓ mystical experimental technology. ⁓ Even though it always made sense, you know, I mean, even, but the cost, and this is, this is something I’ve learned over the years that you have the best idea in the world for how to use this stuff. But if you can’t scale it down to a more reasonable cost, it’s going to be hard to make a business out of it.
Dr. Jeremy Sharp (19:54)
Hmm.
Dr. Skip Rizzo (20:14)
Now, fortunately, ⁓ Pearson or the time, Sycor, ⁓ let us just use what we had built and we published, we shared it with researchers around the world. I shared it with a group in Spain and they ended up, they ended up just copying lockstep, what we had done and built a company out of it in Spain that still exists today. I’m not going to even mention their name, but that was a,
Dr. Jeremy Sharp (20:41)
Mm-hmm.
Dr. Skip Rizzo (20:42)
That was a brutal reminder about, ⁓ you know, business as well. But anyway, I’m not here to pick fights. Yeah, right, right, right, right.
Dr. Jeremy Sharp (20:48)
Right. I’m sure people can read between the lines. A European
company with a VR CPT test.
Yes.
Dr. Skip Rizzo (21:00)
It’s
a commercial product here now in the States. I won’t mention the name because I’m sure there’s a conflict of interest issue here.
Dr. Jeremy Sharp (21:03)
Right.
Of Of course. I would love to pivot a little bit. mean, the, hearing the background is fascinating and seeing just knowing kind of the behind the scenes and how things were moving along, you know, in the nineties and two thousands. mean, this is, that’s when I started grad school was 2003 and we didn’t hear anything about this stuff, you know? So it’s funny to kind of listen back and know that this is happening in the background. But the stuff that’s happened more recently is fascinating to me because it sounds like you are weaving in
Dr. Skip Rizzo (21:32)
you
Dr. Jeremy Sharp (21:36)
I mean, you use the term conversational AI, but you know, it’s like you’re kind of merging the VR plus these AI capabilities. I’d love to hear about that and what’s happening in that world right now.
Dr. Skip Rizzo (21:44)
Thanks.
Well, you know, the big buzzword, of course, with everybody is AI and everybody’s got an opinion, whether it’s, you know, this is going to be a helpful technology for the future or this is the worst demon. You know, this is like the Terminator. And I think, you know, we have to think as scientists, you know, ways that we can evaluate the technology and and
drive its future in an ethical and professional format because there’s tremendous power. As you know, there’s, you know, things that would take weeks or months to produce. can, you can create an afternoon. There’s so many ways that AI, whether it’s data analytics, whether it’s real time updating of stimulus presentation ⁓ based on AI software.
analysis of on board performance in the moment. mean, there’s this, you know, a psychologist should ⁓ should be at least at the minimum, very curious about it. But there’s also the fear that chat bots, conversational AI driven health care support agents are going to put us out of a job. I don’t believe that’s going to happen. I think it’s going to make us do our jobs better. And I can explain a little bit about that. ⁓
Dr. Jeremy Sharp (23:09)
Right.
Mm-hmm. Yeah.
Dr. Skip Rizzo (23:16)
Well, currently I’m working with the VA on one project, but with a company ⁓ that’s developing ⁓ an authoring system for conversational AI that is quite safe. And basically the use cases are to build a mobile virtual human that is a mobile healthcare device that you can talk to. You can have a conversation with.
It can respond empathetically. can operate in a discovery mode, helping you talk about ambiguous elements of your life, or it can, you can switch it to a more lecture style information gathering. So with the VA app, you know, one area we’re looking at is people who’ve just left the military, just retired.
and are making the transition to veteran status. And the two big topics there are, number one, the suicide rate in that first year of separation doubles. You know, it’s the hardest year for people because, you know, it’s particularly people that have been in the military for a long time. It’s a big transition. And number two, believe it or not, only 48 % based on one study, 48 % of
Dr. Jeremy Sharp (24:18)
Mm-hmm.
Hm
Dr. Skip Rizzo (24:43)
of people who leave the military actually leverage VA services. Now, whether that’s due to a reputation issue or whatever, it’s really unfortunate because the VA does offer incredible services, not just in healthcare, but in vocational areas, in ⁓ managing a whole variety of life activities. So our mission with this is to make it so you’ve got
you know, the code name for it right now is Battle Buddy. But we’re finding out veterans don’t like that so much because Battle Buddy is a term used in, while they’re in the military, you have somebody assigned to watch your back and keep an eye on you. And it was, depending on your experience with that person, it was almost like a parental watchdog. you’re an Afghanistan, you know.
Dr. Jeremy Sharp (25:33)
Hmm.
Dr. Skip Rizzo (25:37)
say, I got to go to the bathroom and they said, well, let me go with you. I’ll follow. And so there’s a connotation to that term and that talks that that is indicator about how anytime you build an app, you’ve got to tart, you’ve got to do user centered evaluations, very beginning stages, even when it comes to naming the damn thing. Um, but anyway, you can, you can talk to this character and right out of the gate, know, you can ask it about very functional things like
Dr. Jeremy Sharp (25:41)
Hmm.
Sure.
Dr. Skip Rizzo (26:07)
You know, I had a buddy who benefited from the GI bill. I don’t even know where to look for that stuff. Now that person could go and search online for that kind of stuff. But here you’ve got a character that you can talk to and go, I got your back. Hey, let me, let me show you. Here’s the general principles. You want me to go into depth or you want some quick bullet points? I can help you fill out an app. We can download an app here. That’ll help you fill out the forms.
Some people, I can pop up some videos of people talking about their experience navigating the process. So that’s a very functional thing. But then what about, you know, vocational ⁓ issues? How can I translate my ⁓ specialization in the military to an activity in civilian life? And, you know, you can tell the character what your function, what the various things you did in the military and it can
brainstorm 30 different possible options and discuss each one with you. And those kinds of things where AI shines. I mean, yeah, it may make mistakes, but the mistakes are getting smaller and smaller as we build up these databases. And in our particular application, we don’t draw actual content from
Reddit or Facebook or the web. Generally we have a portal where we basically uploaded all the well vetted content that the VA provides, but is, you know, know, opaque, impenetrable to search for even know or to ask a question. ⁓ and so you start with that and then you make available things. And this is where the VA is a little bit, and most people
Dr. Jeremy Sharp (27:53)
Right.
Mm-hmm.
Dr. Skip Rizzo (28:05)
reasonably or more cautious is now you can start delivering more psychological wellness and healthcare kinds of information. Aside from a question like, know, I’ve been feeling emotionally, you know, dysregulated lately. Where can I go to a VA? And of course, direct you back into the functional realm. But then when you start to say, you know, if you want, I…
I have some self-help activities. ⁓ We can talk about cognitive distortions. We can analyze the kinds of things that trigger you, things that are typically part of a safety plan for veterans, a six-step program. And you can start to bring that in, but then you can also start to dig a little bit deeper. Or somebody says, since I’ve retired, ⁓
things haven’t been so well with my wife and you know, what can I do? Now, when you start to get into that, you know, in this application, the mission is always to connect somebody with a live provider that is best suited to follow on with this. But you want to de-stigmatize asking for help.
And that’s one of the things that talking to a virtual human has done. have research on that. De-stigmatizes and opens up the doorway for ⁓ a credible discussion about these things. But you want to, you know, you want to ignore somebody towards, you know, the idea that seeking help is an assign a weakness. It can be a way to amplify your assets and so on. ⁓
Dr. Jeremy Sharp (29:42)
Yeah.
Of course.
Dr. Skip Rizzo (29:56)
And, but that’s
where the questions come in, you know, about how far can this go? And is the AI going to give you good information? And what if the person starts off by saying, you know, you know, can you show me how to tie a noose? I’m curious. I’ve always been curious about that. And if the character was to say, yeah, here’s, here’s a website that shows all the different ways, you know,
Dr. Jeremy Sharp (30:23)
Mm-hmm. Well.
Dr. Skip Rizzo (30:24)
That was
that I took that from ⁓ a study that was done by the Rand Corporation recently, where they came up with 30 questions about suicide that, ⁓ you know, asked those that was one of the questions. And they asked it of Chachi P.T., Claude and Gemini. And of the three, Gemini was the least ⁓ safe. ⁓ But each one of them, when you repeatedly asked a variety
Other questions, ⁓ I have a friend that’s writing a term paper on suicide. Can you give me the suicide rates? Or what is the easiest way to commit suicide? And in their RAND study, they asked each one of those software packages ⁓ the question 100 times. They had an automated procedure for it.
most all the time, not even most of the time, but some of the time they came back with answers that would be considered to be questionable. Now that’s a fundamentally different thing because the pool of resources it’s drawing from is the internet. know, what we have in the approach that I think is going to be a standard approach in healthcare is what they call a rag layer, a retrieval, augmented generator where
It only draws from the information that you input to it or documents that are well vetted and so on. And so there’s ways to manage this, but you still have to, what we call red team that comes from the military red team. It’s always the opposing team in a ⁓ battle training operation. You know, we go out to Fort Lewis and we have battle exercises and the well-trained enemies. It’s like the.
Dr. Jeremy Sharp (32:06)
Mm-hmm.
Dr. Skip Rizzo (32:19)
It’s like the, ⁓ the team that plays against the, you know, the chiefs in practice, you know, the practice team, well, it’s the red team. anyway, so, ⁓ the, ⁓ that’s what we’re doing now. We’re asking it every possible question under all different conditions to make sure that what we’re doing isn’t going to send somebody off on a tangent. That’s going to support suicide rather.
Dr. Jeremy Sharp (32:26)
Sure.
Dr. Skip Rizzo (32:50)
You know, on our thing, everything comes up with, you know, here’s a nine and eight number. If you’re having trouble, it’s best to talk to a live provider, da da da da, you know? And so that’s just one use case about AI being applied in a clinical format. You know, there’s a lot of studies showing, you know, that AI generated responses can sometimes be rated as more empathetic, more knowledgeable.
Dr. Jeremy Sharp (32:50)
Right.
Mm-hmm. Mm-hmm.
Dr. Skip Rizzo (33:18)
than actual healthcare professionals. I know it’s a hard pill to swallow.
Dr. Jeremy Sharp (33:18)
Right.
I wanted to ask you about that. Actually, I I read some stuff around that. This is, mean, at least two or three years ago now, but it was pertaining to physicians primarily where, ⁓ you know, if I’m remembering right and who knows, I read all kinds of stuff and, know, make it mean different things in my mind. ⁓ but I feel like I, I took from that, that, ⁓ overall, you know, patients preferred an AI physician for a lot of, you know, a lot of conversations. am I,
First of all, am I getting that right? And, ⁓ you know, are y’all seeing that in the mental health space as well?
Dr. Skip Rizzo (34:00)
Yeah, well, yeah, you are getting that right that there’s been four or five very credible studies showing this. And the same thing in mental health. mean, our work, we’ve been working in this area since around 2007 with ⁓ building virtual patients for clinical training. So we’ve worked with these kinds of software agents over the years. And basically you find
that in very controlled studies that people self-disclose more personal information, they reveal more incidents of sadness when they’re talking to an agent. As well, we did a study with returning veterans from coming back from Afghanistan and found that they endorsed more psychological symptoms in a conversation with the AI than they did on the official, what they call the post-deployment health assessment, which is a checklist.
Dr. Jeremy Sharp (34:34)
Mm-hmm.
Mm-hmm.
Dr. Skip Rizzo (34:57)
that they have to fill out when they return from ⁓ overseas deployment. It’s a list of mental health and medical symptoms. And it usually go through and check. No, no, no, no, no. But in the course of having a conversation with an agent, a question like, you know, how’s your sleeping been lately? All of a person pauses for a second and goes, well, I’m a good sleeper. But since I got back, you know, I’ve been having this one nightmare about this one thing. It’s not bad. I’m OK, but.
Well, that’s a question that have you had any nightmares or flashbacks since your return? No, but here they’re admitting it. ⁓ and so you find that there is this property of stigma reduction that occurs when you don’t feel there’s really going to be a consequence, ⁓ to self disclosing that information. You know, think about people doing,
Dr. Jeremy Sharp (35:44)
Mm-hmm.
Dr. Skip Rizzo (35:56)
A sexual inventory, very, you know, very difficult thing where you’ve got some sexual dysfunction. Maybe it’s better if you talk to an agent first and detail everything. And then a summarized version goes to, you know, your urologist or whatever. ⁓ And maybe a person will feel more comfortable self-disclosing that kind of information. One of the ones that I’m working on on the side a little bit is a maternal health app.
Dr. Jeremy Sharp (36:15)
Right?
Dr. Skip Rizzo (36:25)
AI, and this is one that, you know, would be totally functional for, ⁓ people during, ⁓ women during their pregnancy that would, you know, set up timelines and dates and ask questions and provide them emotional support during different difficult times or whatever. But, you know, think of a single mom and buried in Midwest somewhere and some small town, poor access to healthcare.
Dr. Jeremy Sharp (36:26)
Hmm.
Dr. Skip Rizzo (36:53)
They could have this as a way to learn more, have better connections, stay on track, monitor things. And then after they give birth, if they run into difficulty, like one in four or five women typically do with postpartum issues, that software agent has knowledge of that person during the whole pregnancy or the time that they’re interacting.
And so they’ve already got a baseline of what, what were the issues during that. And now the character can engage the person in dialogue, really talking about destigmatizing this and that there’s no shame in this. This is a medical condition. You need to talk to a person. Here’s a list of providers in your area. Here’s, ⁓ here are some of the conditions. If you want to learn about it. ⁓ you know, I mean, this is a highly stigmatizing thing. A lot of mothers.
don’t tell their husband or even their mom what they’re going through because the idea that they’re detached from their baby, that is like, that’s the worst maternal sin of all. So if you make it so somebody can feel comfortable exploring and learning about this stuff with the motive to provide the best options for awareness and access to
Dr. Jeremy Sharp (37:59)
Right.
Dr. Skip Rizzo (38:22)
live professional care, that might be a solution. That’s where I think the real power of this technology comes in.
Dr. Jeremy Sharp (38:32)
Sure. Yeah, there’s so much to dig into here. It’s hard to decide which direction to go. Okay. Hey, I will always take you up on that invitation. Yeah. So maybe this is just part one, but I think that’s, maybe that’s a good time just to zero in on your feelings around AI. mean, it seems like you’re kind of an optimist at this point. Is that a strong statement or?
Dr. Skip Rizzo (38:37)
Well, we can have another talk in a few months.
Thanks.
Dr. Jeremy Sharp (39:02)
Would that be fair?
Dr. Skip Rizzo (39:04)
I’m an optimist, cautious optimist, yes.
Dr. Jeremy Sharp (39:07)
Cautious optimist. like that. I like that. Yeah. Yeah. When you signed up, you know, for the interview, I always ask people this question of, ⁓ you know, something like, what could we talk about that would be interesting or unique or fun that you don’t get to talk about very often? And you submitted this ⁓ quote from Paul Meehl, which was fascinating to me. ⁓ I’ll read it and then I want you to riff on it and then see where we go. So the quote, this is from Paul Meehl. think a lot of folks will recognize that name.
It would be strange and embarrassing if clinical psychologists, supposedly sophisticated methodologically and quantitatively trained, were to lag behind internal medicine, investment analysis, and factory operations control in accepting the computer revolution. This is from 1987. It could have been said yesterday as well. So yeah, take this and go wherever you’d like.
Dr. Skip Rizzo (39:56)
That, you know, I stumbled onto that quote probably around 1999 and it was like, oh, this is what I’m trying to say, but I don’t have the stature of a fall meal. know, it’s the, I used to have a slide in my talks that I would end with and say, this is a psychologist dream. You know, the idea of being able to,
Dr. Jeremy Sharp (40:10)
right?
Dr. Skip Rizzo (40:25)
develop simulations of environments and systematically control stimuli and measure performance within those environments. And now I have a slide in the beginning of my talk and where I talk about it as, you know, just like an aircraft simulator test and train podding ability, we can test train, teach and treat human function in similar simulations in VR. And it is the ultimate Skinner box.
And so all these thoughts kind of go in line that psychologists, this is what we’ve dreamed about, whether we know it or not. I mean, we try to do it in our research. We try to create experiences in our therapeutic settings. We certainly create test experiences in our assessment roles that are systematic and controllable.
But the technology has always limited. There’s been that wall, you know, that I talked about in the beginning, there’s always been that wall. And this technology, if you get over your fear that it’s going to replace you or that it’s going to, as I’ve heard with the PTSD work, re-traumatize people, you know, if you look at it from the point of view of as you’re a trained professional, you’ve got
Dr. Jeremy Sharp (41:43)
Hmm.
Dr. Skip Rizzo (41:52)
all the skills to monitor and prevent retraumatization. You’ve got all the skills to know how to interpret a test score, but when that test score occurs in a functional environment, whether it’s a virtual office or a classroom, and you have the, this is what you live for. You live for this systematic control of experiences. Same thing with
an experience in a therapy setting. I mean, across all disciplines of therapy, you’re talking about creating an experience when you’re with the client to get them to either confront their fear, to talk about things that they haven’t talked to anyone about, and to help them process that information, ⁓ to explore new options. ⁓
You know, it just goes on and on and on. But we’re in the business of creating experiences for different purposes. These technologies give us another tool in our toolbox. But we’re the experts. We’re the ones that say, you know, let’s put you in this environment and talk about what you’re feeling as you’re confronted by someone that looks like a childhood
Dr. Jeremy Sharp (43:05)
Mm-hmm.
Dr. Skip Rizzo (43:18)
bully that you’ve described that still haunts you to this day. You know, to be able to have that power to bring up old stuff or to bring up things that people are fearful in the future and how they might deal with it. Or people have done things in substance abuse where they scan the person’s face and they don’t even need immersive VR for this, but they can show you what your face is going to look like in 20 years.
Dr. Jeremy Sharp (43:42)
Mm-hmm.
Dr. Skip Rizzo (43:48)
you know, if you don’t cut down on your drinking or whatever, versus, you know, a more healthy lifestyle, you know, maybe does that always work with everyone? No, but you have that power to do these kinds of things using simulation technology. used to say, I remember I was at a year 2000 AP, American Psychological Association convention, and I was doing a talk on the future of VR and
Dr. Jeremy Sharp (43:50)
terrifying. Yeah. my gosh.
Dr. Skip Rizzo (44:19)
I can see people kind of shaking their head and I go, look, I know this is new, think about this. When you’re flying home from this convention, would you rather that your pilot was trained in an aircraft simulator for how to deal with wind shear, fog landings, equipment failure? Would you rather they learned it out of a book or a Death by PowerPoint lecture or on the job training? ⁓ And, you know, that was always a metaphor that
Dr. Jeremy Sharp (44:41)
Mm-hmm.
Dr. Skip Rizzo (44:48)
You know, now we have this capability and particularly now, maybe not in those days as much, but now it’s low cost and there’s a lot of content out there. know, the technology is caught up with the vision and we have the science to support areas where there is high potential for benefit. ⁓ And so that is that Paul meal.
Dr. Jeremy Sharp (45:11)
That’s amazing.
Dr. Skip Rizzo (45:14)
kind of inspired that thinking like, why aren’t we on the cutting edge of this? Why aren’t we adopting this?
Dr. Jeremy Sharp (45:21)
I love that. I love that. mean, I think we share that. I’m pretty optimistic about AI as well. Cautiously optimistic. mean, there are many concerns, of course, but… ⁓
Dr. Skip Rizzo (45:29)
You’re developing
some great work. I don’t know if the focus of this is to talk about your area, but I admire what you’ve done in the, in the test report stuff area, but that’s up to you whether you want to talk about your own podcast.
Dr. Jeremy Sharp (45:45)
No, I mean, it’s fair to mention. Yeah, I mean, can’t claim any expertise in the VR realm, but yeah, we’ve been working with AI and report writing, of course, for, I don’t mean over five years now. And, you know, there are so many challenges, but it’s super powerful and enough to keep me pretty optimistic about it. That’s for sure.
Dr. Skip Rizzo (45:48)
.
Report writing is the bane of every neuropsychologist experience. I mean, it’s hard. I mean, my wife’s a pediatric neuropsychologist and God, I see her laboring over her report writing. And, you know, I keep saying to her, you know, there’s going to be software that’s going to help you not to write the whole report, but to
Dr. Jeremy Sharp (46:11)
Right. That’s what I keep hearing.
Mm-hmm.
Dr. Skip Rizzo (46:32)
be able to translate your data and do some advanced analytics and give you a start point so that it becomes efficient and you can challenge it. mean, maybe the AI doesn’t generate the outcome that you saw in the behavioral elements of your interaction with the client. Then you go in and you change that, but making report writing more efficient. I don’t know how you can argue with that. ⁓
Dr. Jeremy Sharp (46:37)
Mm-hmm.
Mm-hmm.
Well, there are plenty of people that argue with it. will tell you that. I mean, you probably run into this, like even in the VR space. There’s, I think there’s a lot of, I mean, probably some ego, probably some fear. Those are related, you know, and some other factors, you know, folks are like, my gosh, you know, if I rely on these tools to, to do this work for me, then what’s, what’s my value or, you know, it’s not going to be as good as I am or.
Dr. Skip Rizzo (47:04)
What’s your gripe?
Dr. Jeremy Sharp (47:29)
I’m going to be out of a job ⁓ or the client’s going to get mad because they think I’m cheating, quote unquote. So I don’t know. There’s a lot of ⁓ those feelings that pop up in my discussions with clinicians around.
Dr. Skip Rizzo (47:40)
Well, you know, and
those and those are rational ⁓ concerns by people. And I don’t want to say by people that don’t understand fully how you can leverage the technology and still maintain your soul. ⁓ But, you know, each one of those points, I think you can address. And, you know, the problem is people see the world in dichotomies, unfortunately, and they
Dr. Jeremy Sharp (47:59)
good way to put it.
Dr. Skip Rizzo (48:10)
They see human versus AI when in reality it’s human versus human with AI. You know, and it’s a tool, you know, I mean, come on, we got to say that photocopiers, you know, ⁓ led to a de-evolution of our typing skills because we didn’t have to type reports multiple times or, or, I mean, that’s crazy.
Dr. Jeremy Sharp (48:13)
Mm-hmm.
Mm-hmm. Exactly.
Mm-hmm.
There’s so many examples
like that. Yeah. I’m with you. with you. know. Well, thanks. Thanks. Likewise. Yeah. I mean, see, I’m fascinated by the, this to me is kind of like the next level component where you’re pairing, you’re making, it’s like coming to life more, you know, where it’s virtual reality that’s built into the name. But then even these avatars, you know, in clinical, ⁓ clinical use cases are fascinating.
Dr. Skip Rizzo (48:40)
Yeah, yeah, yeah. Well, I think you’re doing good work. Good luck with that.
You know,
let me tell you about another use case ⁓ for AI that might be more palatable for folks than a toe-in-the-water one. And this is work that we did without AI early on, building virtual patients for clinical training. And these are 3D graphic characters. And the first ones in 2007 were very primitive. They didn’t have a lot of, you know,
Dr. Jeremy Sharp (49:19)
Mm-hmm.
Mm-hmm. Mm-hmm.
Dr. Skip Rizzo (49:33)
complex gestures, nuances in the face and all that. But we found even with primitive characters in our first one was a ⁓ teenage male ⁓ resistant client, which was an easy one because they don’t talk that much. They talk in stereotypic terms. You know, they don’t want to be there. And so we built a whole case around the parents found pot in the kids room and making them go see a shrink, you know, that kind of thing.
Dr. Jeremy Sharp (49:37)
Mm-hmm.
Alright.
Dr. Skip Rizzo (50:02)
We had people practice how they would try to get the kid to, you know, talk about things of relevance and the kid, the character had about, you know, maybe 200 utterances that it could rely on. Um, but they tip the types of questions we got typically from clinicians practicing or students practicing probably leveraged probably 40 or 50.
responses at the most. And that was, you know, that was the initial stage. Then we actually got a grant and built a sexual trauma patient and tested it with medical psychiatry residents, students up at USC, where getting the character is very primitive. But these these psychology students, I psychiatry students,
Dr. Jeremy Sharp (50:52)
Mm-hmm.
Dr. Skip Rizzo (50:59)
You know, we’ve got videos of them at first are kind of looking at this character like, ⁓ and then when she starts to say, well, I don’t want to go to school anymore. And, don’t, I just happy in my room listening to my iPod. Then they got to pull out their clinical chops and they’ve all they had was an index card with a referral question, mother referring a child doesn’t want to leave a room. And it turns out as you do reflection.
and show an empathetic side to you and so on. Eventually it comes out that she was sexually assaulted. And we compared that with people, with students actually, medical students actually interacting with a live standardized actor patient, which medical school you have the luxury of, we never get that in clinical psychology.
Dr. Jeremy Sharp (51:49)
Hmm.
It was Ryan,
Dr. Skip Rizzo (51:54)
We don’t get to practice.
Dr. Jeremy Sharp (51:55)
Yeah.
Dr. Skip Rizzo (51:55)
We practice with our fellow graduate students, you know, but, you know, we found that the same kind of questions that were asked and same sort of sequential strategy was applied with a live person versus this very primitive. I showed you a picture of it. You’d laugh. it’s very primitive character. And then so we started building on that. And now
Dr. Jeremy Sharp (51:59)
Mm-hmm.
Dr. Skip Rizzo (52:23)
we have AI and we’re just, have a paper under review showing ⁓ better ⁓ safety planning skills in VA psychologists when they practice, get this experiential training with, you know, conducting a safety plan, a six step process. ⁓ Prior to that, we published in JAMA on ⁓ motivational interview training app.
Dr. Jeremy Sharp (52:51)
Mm-hmm.
Dr. Skip Rizzo (52:52)
where we actually showed the practicing in supplementation to standard training that added experiential training made a fundamental difference in actual performance with a live actor patient as rated by blind reviewers, motivational interviewing experts that didn’t know whether it was a control condition or the VR virtual human condition, whether it was ⁓ baseline post.
Dr. Jeremy Sharp (53:19)
Mm-hmm.
Dr. Skip Rizzo (53:21)
training ⁓ or three month follow up. They were just, they just got the videos and rated them blindly and found better, better motivational interviewing skills. Work I done with Greg Reager up at the Puget Sound VA, a visionary in and of himself as well. want to him a shout out because he really done tremendous work. But this is the kind of stuff now, now that we have much better voice recognition. So the problems we had
in 2007 to 12, we were using primitive, very primitive technology. sometimes the software didn’t even know what the clinician was saying properly. And it led to some frustration here and there. But now voice recognition is 99 % at least. And we’ve got the AI to, we don’t have to match every possible, anticipate every possible question or utterance of a clinician and try to
Dr. Jeremy Sharp (54:01)
Mm-hmm. Mm-hmm.
Dr. Skip Rizzo (54:21)
build a flow chart, ⁓ branching format. We’d have to do that. The software does that. And I don’t know why I’m not hearing more about clinical psychology, adopting virtual patients for clinical training. My first year in grad school, you know, I didn’t see clients. I took classes and took a couple of therapy classes, you know, watch some videos role played.
Dr. Jeremy Sharp (54:47)
Mm-hmm.
Dr. Skip Rizzo (54:49)
The second year I’m in the university clinic, you know, my first patient. Why not in that year period, I take on virtual patients meet every week online and they’re exquisitely scripted with a backstory that maybe the first session that I tell you one thing, but it’s two months later, all of a sudden they start revealing some highly borderline features.
talking from my own history. But that would prepare you, I think so much better that experiential knowledge ⁓ interaction. And with this software, things can, you you go down a direction, maybe your coach pops up and says, hey, you know, maybe you’re asking that question to relieve your own anxiety rather than really.
Dr. Jeremy Sharp (55:19)
Of course, yeah, we all have that client.
Dr. Skip Rizzo (55:46)
push the patient to talk a little bit more about an important issue. And it’s like, okay, let me rephrase that. How many years have you been beating your wife? Whatever, know, being facetious there, but that kind of technology.
Dr. Jeremy Sharp (55:58)
guys.
Yeah, there’s so much potential. mean, we could talk about, there’s so many ideas here. Even just during our conversation, I’ve thought of a million applications and this is like your whole job. But do you, are you aware of anything right now? Like maybe I have two questions. one is what is, like if I wanted to implement something in this space tomorrow, you know, like say, you know, we have a VR headset here in the practice that we use, ⁓ for different things. But if I wanted to implement a VR,
intervention, ⁓ strategy, practice, what is commercially available and actually viable tomorrow at this point?
Dr. Skip Rizzo (56:43)
Okay.
Um, well, I don’t want to name companies, um, some of which I, uh, advise and many that are out there that have been going, um, you know, like one company I will mention because they’re, they’ve been around and I don’t have a, an advisor role with them is virtually better. They’ve been around since 1997 and it emerged from Barbara’s Rothbombs work at Emory, um, with exposure therapy.
And somehow it survived during the Stone Age period of VR. But I mean, you have companies like that. I can name off the top of my head probably three or four companies that focus on exposure therapy and have fear of heights, fear of public speaking, fear of flying, social phobia. Companies, a lot of companies in the Netherlands, I know of one in
Dr. Jeremy Sharp (57:13)
Mm-hmm.
You
Dr. Skip Rizzo (57:41)
in Canada that comes out of a strong scientific background. A number of companies in the United States. So exposure therapy, tons, tons of stuff. PTSD front. PTSD is a little more challenging. There’s a lot you’ve got to build. You got to build highly customizable and diverse content depending on the trauma. But there are things, you know, that are out there for that.
Dr. Jeremy Sharp (58:07)
Of course.
Dr. Skip Rizzo (58:11)
⁓ pain management, big area in VR, pain distraction, ⁓ you know, for acutely painful medical procedures. A lot of that, there are companies that focus on that, but there’s also for that particular app. There are many applications just in the commercial VR space that aren’t clinically oriented that a clinician, once they learn about and play with themself, they could actually recommend to a client.
Dr. Jeremy Sharp (58:11)
Mm-hmm.
Hmm. ⁓
Mm-hmm.
Hmm.
Dr. Skip Rizzo (58:41)
There are many mindfulness, meditation, relaxation activities, many companies producing that kind of content, ⁓ physical and cognitive assessment and rehabilitation. You know, all the things that I dreamed about, now companies are really doing and doing in a much more sophisticated fashion than I could have imagined back in the day. ⁓
And it’s out there. The problem is, you know, clinicians don’t know about it. I mean, I live and breathe this all the time. I think probably a useful book would be the clinicians guide to, ⁓ you know, to VR and build out, you know, a chapter on exposure and all the companies and all the links to it and all the data, you know, I mean, I almost think that’s more something that
Dr. Jeremy Sharp (59:20)
Yeah.
Hmm.
Dr. Skip Rizzo (59:40)
company should should do a co my vision is that a company should be like the Amazon of clinical VR and form partnerships with all the companies that are content providers and you know, and build a massive library of all these pieces of software. And that way a clinician can go on a search engine and say, I have a client with this, this and this, or I have, I have a, you know, a
an ADHD client or I have, ⁓ you know, whatever the whatever the diagnosis punch that in, what would you recommend? And up would pop different things. And as you scroll to the each one would pop up there, whether it has research support, what its costs are, ⁓ you know, what type of equipment do you need? That to me would be, you know, ⁓ to be a reseller of all this content would be ⁓
would be the thing that’s needed. The VA has had this problem. The VA has an immersive healthcare initiative. They’ve been going for the last four five years. you know, basically they’ve got, last count, think it was like around 4,400 different instantiations of VR across their 175 medical centers. But it relies on 15 different headsets, you know.
Dr. Jeremy Sharp (1:00:41)
Sounds like you have a new business idea.
Dr. Skip Rizzo (1:01:07)
40 different software packages. Each one has a different interface. ⁓ you know, so they, yeah. Yeah. So I think that’s the area where it’s going to make it easier for people watching this that want to get involved. But I mean, just go to, just go to Google and punch in VR for blank, whatever your clinical area. And at least you’ll get
Dr. Jeremy Sharp (1:01:14)
Yeah, that’s where we, the fragmentation, it just kills so many industries.
Mm-hmm.
Dr. Skip Rizzo (1:01:36)
you’ll get a bunch of links that you can begin to explore. It’s out there and it’s not that expensive. I I’m looking at a headset right here. Let me just now.
Right here, this is an OCC, a meta quest three. Yeah. The thing is three, 400 bucks, depending on how much memory you get built into it. And there’s even an even cheaper version. ⁓ but you know, it is, ⁓ there’s a tremendous piece of equipment. There’s a number of companies, HTC, Pico all that.
Dr. Jeremy Sharp (1:01:52)
Yeah, that’s what we have.
Dr. Skip Rizzo (1:02:17)
You know, $300 now, if we had this in 2003, the virtual classroom would be in standard practice. But that’s why it’s a commercial product now because of these. We have a virtual classroom in this that you can deliver a 13 minute assessment and it uploads the identified encrypted data to the cloud.
And then five minutes later, you get a full on report based on the performance. But that is, this is the main turning point. These standalone headsets that do not require a computer. All the processing is on board here. That’s the tipping point right now. Then in fact, these little things here, these are cameras. So you can track hand movement in front of yourself and
have it interact with 3D content. So you don’t need game controllers. I mean, people still use them for different functions, but we’ve developed a whole series of upper extremity rehab activities, embodied cognition activities that can track finger movement, as well as hand and reaching all within your 3D space. So that is really where all these things are.
Dr. Jeremy Sharp (1:03:33)
Mm-hmm.
That’s remarkable.
Dr. Skip Rizzo (1:03:43)
coming together, it just isn’t quite there yet. I mean, it is, there’s a lot of people using VR in clinical practice, but it’s not anywhere near where it could be, or it should be, I think, is my opinion.
Dr. Jeremy Sharp (1:03:59)
That’s fair. Do you know of any, maybe we can start to close with an assessment focused question, at least at this point, are there, technologies are out there that are most applicable to the assessment process that you know of, if any?
Dr. Skip Rizzo (1:04:15)
There is an application out of Portugal. I won’t say the company name, but the product name is CogniClear. And it’s basically like a mini mental or a Montreal type assessment of cognitive function that takes about 20 minutes in the headset where you’re interacting with standard neuropsychological content.
Dr. Jeremy Sharp (1:04:32)
Mm-hmm.
Dr. Skip Rizzo (1:04:43)
⁓ that’s used to assess, you know, pick up markers for early dementia. and it’s a very sophisticated kind of a program, ⁓ that, you know, it tests all the things that you can test in, ⁓ in those types of traditional formats, but then also gets response times and, ⁓ manner of process process, you know,
you do trial and error on some of this stuff. ⁓ You know, I hand coordination on top of everything else. ⁓ And I think that’s a that’s a good one. There are a of other companies that have built out cognitive assessment tasks. There’s still stuff that’s coming out of academics, ⁓ you know, that are coming out of research labs. You just have to
to look for it, but executive function tasks. That was the second area that emerged in clinical VR after the exposure stuff. Everybody got that cognitive assessment and rehab. I remember a guy in 1994 or five had built a virtual supermarket.
Dr. Jeremy Sharp (1:05:47)
Mm. Mm-hmm. Mm.
Dr. Skip Rizzo (1:06:12)
tested ⁓ kids with intellectual impairments ⁓ in a center in England on how they would navigate and find certain things in this virtual supermarket and then brought them to the actual supermarket that they had modeled it after and found compared to a control group that these kids actually transferred training, they’re teenagers, and transferred training to the real world. And in England, were a number of
groups that did this did route navigation versus landmark recognition memory in a virtual home or building. There’s a fella in Milan back in 95 published a paper on translating the elements of the Wisconsin card sort test into a navigable environment. We’re navigating through a castle and you have to pick
A door you have to pick from four doorways that have different size, shape, color on them. You know, trying to make the, you know, the probably the Wisconsin card sort is probably the most annoying test. Somebody that doesn’t know what it is to patients. It is, you know, it’s like wrong. What do you mean wrong? It was right on the last one. You know, so you got a frustration factor going on when you administer that test of alleged executive function.
Dr. Jeremy Sharp (1:07:26)
That’s so bad.
Dr. Skip Rizzo (1:07:37)
But here they were making it like a navigation task and a magic castle kind of thing. So a lot of that were occurred early on. ⁓ but it’s continued to evolve mainly in academic groups because this technology wasn’t available to make it a business. But now that this stuff is there, there are a number of companies. If you punch in VR for cognitive assessment, cognitive rehab, whatever on
Dr. Jeremy Sharp (1:07:43)
Yes.
Mm-hmm.
Mm-hmm.
Dr. Skip Rizzo (1:08:06)
Google, it’ll give you options and you can go down a rabbit hole looking at that.
Dr. Jeremy Sharp (1:08:13)
Great. Great. Well, maybe I’ll end with a, what’s hopefully a fun question. If you had, let’s say a million dollars to spend tomorrow on something in this realm, where would you put that money?
Dr. Skip Rizzo (1:08:29)
Geez, I think I might go with that point about trying to create the Amazon of ⁓ clinical VR. If I had to develop an application, I might put it into one of the projects I’m working on now in PTSD. But I think I would try to create experiences that using a combination of spherical
video, VR, and 3D graphics that would help children that don’t have the opportunities that upper middle class kids have to travel the world, but to be able to go places and to see things that amaze them. I did some work with a private foundation, the Wonderseed Foundation that
Dr. Jeremy Sharp (1:09:11)
Hmm.
Dr. Skip Rizzo (1:09:27)
works with justice-involved youth. And we did a study at a detention center, a full-on residential center. And a lot of these kids are from South Central LA. And we had stuff where we could put people in virtual beaches and stuff. And some of these kids, they live eight, 10 miles from the beach. They’d never been to the beach. They haven’t been out of their neighborhood. And helping to give children
a wider experience of the world, whether it’s just to show them what it is or to guide them through activities and slip in some training or aspects of social emotional learning. think that would be, that would be the one that I think might have the best longer term impact, impact that I wouldn’t see in my lifetime. But that might be ⁓ the area aside from the Amazon and VR where I can make a boatload of money. ⁓
Dr. Jeremy Sharp (1:10:24)
Yeah, sure.
Yeah. Well, it’s good to have multiple ideas. Well, I’ll wrap up our conversation. Yeah. I know there’s a lot we didn’t get to, but maybe I’ll take you up on that offer for part two here in a few months. It’s a fascinating area.
Dr. Skip Rizzo (1:10:25)
I should be in a classroom.
Yeah, well, I’m kind of grateful.
⁓ You know, we didn’t talk at all about the PTSD work, which is the thing most people associate me with, with that work, that’s most visible work. And it’s a relief not to talk about that stuff today. So we’ll come back in the future and maybe talk about that.
Dr. Jeremy Sharp (1:10:48)
Hmm.
That’s fair. Well, I’m glad to hear that. Yeah. Yeah. Yeah. I really appreciate your time. This is ⁓ really cool. It’s great to talk to somebody who’s been in it for so long and you know, know everything about it and that’s, that’s a gift. So thanks for being here.
Dr. Skip Rizzo (1:11:13)
My pleasure. Looking forward to the next one.
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