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Walter Greenleaf PhD
Immersive Environments, Machine Learning,
Neuroimaging, & Wearable Sensing
Technology
Treating Depres...
Walter Greenleaf PhD
Treating Depression, Addictions, and Facilitating
Behavior Change
Using A Precision Medicine Model
The Stanford Laboratory for
Brain Health Innovation and
Entrepreneurship
VR-IT
Stanford Virtual Reality
Immersive Technolo...
My Non-Academic Affiliations
Healthcare Crisis:
Aging Populations
0
50
100
150
200
250
300
350
400
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 20...
Transforming HealthCare with Technology
Digital Health
Revolution
• Mobile Health / eHealth
• Wearable Sensors
• Patient Centered
• Leverages Internet:
social, qu...
Every Medical Device Reinvented
Medical Applications
of Virtual Reality &
Augmented Reality
Technology
Digital Health Revolution
Now is the time for VR & AR
VR technology is now affordable,
scalable and accessible
Facebook - Oculus
Samsung - GearVR So...
• Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• ...
My Journey….
VR Collaborators and Colleagues – Over the last 30 Years
Academic research has indicated that Virtual Reality can effectively treat a
wide variety of clinical problems – ranging f...
Treating Post
Traumatic
Stress
With Virtual
Reality
2008 Sichuan
Earthquake
Treating Post
Traumatic
Stress
With Virtual
Reality
2017 Mexico City
Earthquake
Every Medical Device Reinvented
Entering the Era of Medical Wearables
Digital Health Platforms deliver interventions to patients, and
parse data for enhanced analysis and improved protocols
Digital systems are not just measuring the physical parameters of our health.
New methods are being developed that will al...
Mindstrong tracks five digital biomarkers
associated with brain health: Executive
function, cognitive control, working mem...
Ellipsis Health analyzes natural conversations using Deep Learning to
generate a real time emotional status vital sign.
Th...
Facial expressions reflect emotional status
Collecting and analyzing emotional and physical
responses in VR
Cognitive function assessment at the primary
care level – using AR and smartphone
sensors
10 minute test
Diagnostic accura...
Standardized Environments for Neurocognitive Evaluation
New Approaches for Cognitive Assessment
Migrates traditional paper...
Standardized Environments for Neurocognitive Evaluation
New Approaches for Cognitive Assessment
Lea Williams - PanLab
Precision Psychiatry and Translational
Neuroscience
Using VR as an assay of brain circuits in action
Mindfulness-
based. TMS
New stratification: biotypes
Using VR as an assay of brain circuits in action
Mindfulness-
based. TMS
New stratification: biotypes
We focus on brain ci...
Using VR as an assay of brain circuits in action
Mindfulness-
based. TMS
New stratification: biotypesThe goal of the ENGAG...
We use brain circuit biotypes to connect
brain imaging with VR
Neuroimaging measures
1. Scan brain at rest
2. Emotion regu...
We envision a precision health model using VR to elicit
biotypes to help refine the intervention choices
Cognitive trainin...
Brain during cognitive control
NIH “ENGAGE” project
n=100 people scanned 5 times over 2 years
During a behavioral intervention for depression and weight ...
Jeremy
Bailenson, PhD,
Stanford
Jun Ma, MD PhD
Univ Illinois Chicago
Lisa Goldman
Rosas, PhD MPH,
Stanford
Mark Snowden, M...
Standardized platforms and norms
Williams et al. invited revisions
We are developing the first norms for VR to be used as
...
Standardized Environments for Neurocognitive Evaluation
Standardized Environments for Neurocognitive Evaluation
New Approaches for Cognitive Assessment
Digital Health Platforms deliver interventions to patients, and
parse data for enhanced analysis and improved protocols
Stroke and Traumatic Brain Injury
Physical / Occupational Therapy
New Approaches to Physical Medicine & Rehabilitation
VR & AR - A Key Part of a Combination Therapy
Digital Health Platform
Patient-facing software
designed to enhance
medicati...
A Fully Integrated, Closed Loop Solution for Mental Health and Wellness -
Enabled on a Mobile, Digital Health Platform
Min...
Portable Telemedicine Platform
The Neuroscience of How VR Promotes Behavior Change
The Neuroscience of How VR Promotes
Behavior Change
VR can promote behavior change by
taking advantage of the way our brai...
Neuroscience Rationale
Repetition is required
It is critical to engage the
brain's reward systems
It is necessary to activ...
Ability to change attitudes and behavior after “being” one’s future self.
Leveraging Mirror Neurons
Your Future Self
Students interacted with 3-D avatars of future self.
Participants who interacted with future self put mor...
August 5th & 6th 2019
Denver
VR for Mental & Behavior Health Conference
Walter Greenleaf PhD
Immersive Environments, Machine Learning,
Neuroimaging, And Wearable Sensing Technology
Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology -- Treating Depression, Addictions, ...
Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology -- Treating Depression, Addictions, ...
Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology -- Treating Depression, Addictions, ...
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Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology -- Treating Depression, Addictions, and Facilitating Behavior Change Using A Precision Medicine Model

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Walter Greenleaf's presentation to the Virtual Medicine 2019 Conference at Cedars-Sinai Medical Center

Immersive Environments, Machine Learning, Neuroimaging, And Wearable Sensing Technology - Treating Depression, Addictions, and Facilitating Behavior Change Using A Precision Medicine Model

Based on the methods used in the ENGAGE Study

Walter Greenleaf, PhD
​Virtual Human Interaction Lab | Stanford University

Precision medicine models for treating depression, managing addictions and achieving sustained behavior change are largely outside of current clinical practice. Yet, changing self-regulatory behavior is fundamental to the self-management of complex lifestyle-related chronic conditions such as depression and substance use disorder - two top contributors to the global burden of disease and disability.

To optimize treatments and address these burdens, methods to facilitate behavior change and self-regulation must be better understood in relation to their neurobiological underpinnings. Treatment strategies can then be developed that leverage the recent advances in immersive environments, machine learning, and wearable sensing technology and apply them to treat depression, manage addictions, and facilitate behavior change using a precision medicine model that is personalized to the individual.

This presentation will review the conceptual framework and protocol for a large multi-subject longitudinal study named Project ENGAGE. The ENGAGE study integrates neuroscience with behavioral science to better understand the self-regulation related mechanisms of behavior change for improving mood and weight outcomes among adults with comorbid depression and obesity. We collect assays of three self-regulation targets (emotion, cognition, and self-reflection) in multiple settings: neuroimaging and behavioral lab-based measures, virtual reality, and passive smartphone sampling.

By connecting human neuroscience and behavioral science in this manner within the ENGAGE study, we can develop a prototype for elucidating the underlying self-regulation mechanisms of behavior change outcomes and their application in optimizing intervention strategies for multiple chronic diseases.

https://www.ncbi.nlm.nih.gov/pubmed/29074231

Behav Res Ther. 2018 Feb;101:58-70. doi: 10.1016/j.brat.2017.09.012. Epub 2017 Oct 7.

The ENGAGE study: Integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model.

Leanne M. Williams, Adam Pines, Andrea N. Goldstein-Piekarski, Lisa G. Rosas,
Monica Kullar, Matthew D. Sacchet, Olivier Gevaert, Jeremy Bailenson, Philip W.
Lavori, Paul Dagum, Brian Wandell, Carlos Correa, Walter Greenleaf, Trisha Suppes,
L. Michael Perry, Joshua M. Smyth, Megan A. Lewis, Elizabeth M. Venditti, Mark
Snowden, Janine M. Simmons, Jun Ma

Published in: Health & Medicine
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Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology -- Treating Depression, Addictions, and Facilitating Behavior Change Using A Precision Medicine Model

  1. 1. Walter Greenleaf PhD Immersive Environments, Machine Learning, Neuroimaging, & Wearable Sensing Technology Treating Depression, Addictions, and Facilitating Behavior Change Using A Precision Medicine Model Presented at the 2019 Virtual Medicine Conference
  2. 2. Walter Greenleaf PhD Treating Depression, Addictions, and Facilitating Behavior Change Using A Precision Medicine Model
  3. 3. The Stanford Laboratory for Brain Health Innovation and Entrepreneurship VR-IT Stanford Virtual Reality Immersive Technology Clinic My Academic Affiliations
  4. 4. My Non-Academic Affiliations
  5. 5. Healthcare Crisis: Aging Populations 0 50 100 150 200 250 300 350 400 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2015 2020 2025 Age 85+ Age 75-84 Age 65-74 Age 45-64 Age 5-44 Under Age 5
  6. 6. Transforming HealthCare with Technology
  7. 7. Digital Health Revolution • Mobile Health / eHealth • Wearable Sensors • Patient Centered • Leverages Internet: social, quantitative, collaborative
  8. 8. Every Medical Device Reinvented
  9. 9. Medical Applications of Virtual Reality & Augmented Reality Technology Digital Health Revolution
  10. 10. Now is the time for VR & AR VR technology is now affordable, scalable and accessible Facebook - Oculus Samsung - GearVR Sony – PlayStation VR Microsoft - HoloLens HTC - Vive Google - DayDream
  11. 11. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
  12. 12. My Journey….
  13. 13. VR Collaborators and Colleagues – Over the last 30 Years
  14. 14. Academic research has indicated that Virtual Reality can effectively treat a wide variety of clinical problems – ranging from addictions, to stroke, to PTSD
  15. 15. Treating Post Traumatic Stress With Virtual Reality 2008 Sichuan Earthquake
  16. 16. Treating Post Traumatic Stress With Virtual Reality 2017 Mexico City Earthquake
  17. 17. Every Medical Device Reinvented
  18. 18. Entering the Era of Medical Wearables
  19. 19. Digital Health Platforms deliver interventions to patients, and parse data for enhanced analysis and improved protocols
  20. 20. Digital systems are not just measuring the physical parameters of our health. New methods are being developed that will allow us to collect and analyze biomarkers that reflect our cognitive and emotional status. Here are four examples… Brain Health BioMarkers - Passive Data from Smart Phones Voice Analytics as a BioMarker of Depression Facial expressions in response to a VR Challenge Cognitive function assessment using AR and smartphone sensors
  21. 21. Mindstrong tracks five digital biomarkers associated with brain health: Executive function, cognitive control, working memory, processing speed, and emotional valence. These biomarkers are generated from patterns in smartphone use such as swipes, taps, and other touchscreen activities, and are scientifically validated to provide measurements of cognition and mood. Brain Health Biomarkers - Passive Data from Smart Phones
  22. 22. Ellipsis Health analyzes natural conversations using Deep Learning to generate a real time emotional status vital sign. The system provides a simple, cost effective way for providers, care teams, and healthcare systems to continually screen their patient population for depression, anxiety and other behavioral health issues. Voice Analytics as a BioMarker of Depression
  23. 23. Facial expressions reflect emotional status Collecting and analyzing emotional and physical responses in VR
  24. 24. Cognitive function assessment at the primary care level – using AR and smartphone sensors 10 minute test Diagnostic accuracy of 94% FDA Class II Medical Device Continuous data of everyday functions 250 features assessed at 300Hz 3D trajectory neuromotor parameters
  25. 25. Standardized Environments for Neurocognitive Evaluation New Approaches for Cognitive Assessment Migrates traditional paper and subjective evaluations to a more sophisticated level. Provides robust assessments that can challenge cognitive skills in a more natural, standardized, objective and reproducible manner.
  26. 26. Standardized Environments for Neurocognitive Evaluation New Approaches for Cognitive Assessment
  27. 27. Lea Williams - PanLab Precision Psychiatry and Translational Neuroscience
  28. 28. Using VR as an assay of brain circuits in action Mindfulness- based. TMS New stratification: biotypes
  29. 29. Using VR as an assay of brain circuits in action Mindfulness- based. TMS New stratification: biotypes We focus on brain circuits within a new brain-based taxonomy for depression. Specific dysfunctions in these circuits form specific “biotypes” of depression and accompanying anxiety. These biotypes may inform different types of interventions.
  30. 30. Using VR as an assay of brain circuits in action Mindfulness- based. TMS New stratification: biotypesThe goal of the ENGAGE project is to identify assays that can assess these biotypes in the natural world. We use lab-based imaging to assess the biotypes in the lab setting, VR to create virtual environments that reflect these lab-based circuits (a first step in moving to the natural world, but in a still controlled way), and then use Mindstrong passive sampling to assess the relations to natural world behaviors.
  31. 31. We use brain circuit biotypes to connect brain imaging with VR Neuroimaging measures 1. Scan brain at rest 2. Emotion regulation task 3. Cognitive control task Virtual Reality: 1. Relaxing scene 2. Emotion regulation task 3. Cognitive control game
  32. 32. We envision a precision health model using VR to elicit biotypes to help refine the intervention choices Cognitive training TMS Eliciting biotypes using normed environmentsHeterogeneous Disorder Quantify and refine biotypes Relaxation Negative Scene Positive Scene Cognitive Game 1st line Antidepressants Mindfulness-based. TMS Non-drug and new drug options Matching biotypes to the intervention “menu” Default Mode Negative Affect Positive Affect Cognitive Control
  33. 33. Brain during cognitive control
  34. 34. NIH “ENGAGE” project n=100 people scanned 5 times over 2 years During a behavioral intervention for depression and weight management study Phase Baseline Repeat sampling and outcomes Week 1 Week 8 Week 24 Week 52 Week 104 IMAGING of brain circuits X X X X X VR-elicited regulation of brain circuits X X X X X PASSIVE SAMPLING X ® ® ® ®
  35. 35. Jeremy Bailenson, PhD, Stanford Jun Ma, MD PhD Univ Illinois Chicago Lisa Goldman Rosas, PhD MPH, Stanford Mark Snowden, MD , Univ Washington Elizabeth Venditti, PhD, Univ Pitts William Haskell, PhD Stanford Megan Lewis, PhD RTI Philip Lavori, PhD Stanford Lan Xiao, PhD PAMFRI Olivier Gevaert, PhD, Stanford Leanne Williams, PhD Stanford Joshua Smyth, PhD Penn State Univ Paul Dagum, MD PhD, Mindstrong Trisha Suppes, MD PhD, Stanford Brian Wandell, PhD, Stanford Walter Greenleaf, PhD, Stanford The “ENGAGE” team Williams PanLab for Precision Psychiatry and Translational Neuroscience Co-PIs. Jun Ma and Leanne Williams NIH Science of Behavior Change “ENGAGE” Project: UH2HL132368.
  36. 36. Standardized platforms and norms Williams et al. invited revisions We are developing the first norms for VR to be used as assays correlated with brain circuits Lab-Based Virtual Reality Naturalistic fMRI Head Movement 288 Continuous Smart-Phone Sampling Variables Behavioral task Performance Screen Capture Self-Report Self-Report Self-Regulation Cognitive Emotional Self-Reflective
  37. 37. Standardized Environments for Neurocognitive Evaluation
  38. 38. Standardized Environments for Neurocognitive Evaluation New Approaches for Cognitive Assessment
  39. 39. Digital Health Platforms deliver interventions to patients, and parse data for enhanced analysis and improved protocols
  40. 40. Stroke and Traumatic Brain Injury Physical / Occupational Therapy New Approaches to Physical Medicine & Rehabilitation
  41. 41. VR & AR - A Key Part of a Combination Therapy Digital Health Platform Patient-facing software designed to enhance medication efficacy Medication with clinical benefit eFormulation- pharmaceutical product with enhanced efficacy =+
  42. 42. A Fully Integrated, Closed Loop Solution for Mental Health and Wellness - Enabled on a Mobile, Digital Health Platform Miniaturized, programmable, low power electronic architecture w/extensive therapy delivery options
  43. 43. Portable Telemedicine Platform
  44. 44. The Neuroscience of How VR Promotes Behavior Change
  45. 45. The Neuroscience of How VR Promotes Behavior Change VR can promote behavior change by taking advantage of the way our brain’s learning and reward systems function Activate neuroplastic change via reward systems Shorten the reward feedback loop – show progress Leverage mirror neuron systems VR systems can:
  46. 46. Neuroscience Rationale Repetition is required It is critical to engage the brain's reward systems It is necessary to activate the associated brain system to enable neuroplasticity
  47. 47. Ability to change attitudes and behavior after “being” one’s future self. Leveraging Mirror Neurons
  48. 48. Your Future Self Students interacted with 3-D avatars of future self. Participants who interacted with future self put more than twice as much money into retirement account.
  49. 49. August 5th & 6th 2019 Denver VR for Mental & Behavior Health Conference
  50. 50. Walter Greenleaf PhD Immersive Environments, Machine Learning, Neuroimaging, And Wearable Sensing Technology

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