#1150: Innerworld VR: Scaling Peer-to-Peer Counseling & Mental Health Interventions in Social VR

Noah Robinson’s Innerworld launches today on the Quest Store after slowly cultivating an engaged peer-to-peer counseling community that is providing affordable mental health interventions across multiple social VR and 2D platforms on Mac, PC & iOS. Robinson is getting his Ph.D. in clinical psychology, and Innerworld is a research project studying how the effects of what he calls “Cognitive Behavioral Immersion,” which is an adaptation of Aaron T. Beck’s Cognitive Behavioral Therapy Model. Robinson took inspiration from Dennis Greenberger and Christine A. Padesky’s “Five-Part Model to Understand Life Experiences” that includes Physical Reactions, Thoughts, Moods, Behaviors all within an Environmental Context that was first published in their 1995 book Mind Over Mood: Change the way you feel by changing the way you think. The main idea that your feelings are difficult to directly control, but that you can alter your mood by changing your thought patterns, behaviors, embodied physiology within the context of a different environmental context.

Greenberger & Padesky’s Five-Part Model to Understand Life Experiences

Robinson has found some powerful anecdotal evidence that providing mental health interventions within a social VR world can lead to some profound transformative moments as it provides a significant shift in environmental context that can lead to different thoughts, physiological reactions, and behaviors that ultimately can shift someone’s mood. He’s in the process of conducting three randomized-control trial studies to provide more scientific evidence on the impact of immersive environments on these types of mental health interventions, and is collecting lots of anonymized data within his social VR app to study what works and does not working within the process of peer counseling.

Robinson is also careful to point out that Innerworld this is not providing therapy, it’s not medical advice, and it’s not crisis intervention, as it is peer-to-peer counseling from non-professionals within a social VR context. He says that many of the primary benefits of therapy are “non-specific effects” that include having someone to talk to who is warm and listening to you in an empathetic and non-judgmental manner. All of these main methods can be provided within a peer-to-peer counseling context that doesn’t claim to be therapy.

Robinson is hoping to provide an affordable and scalable mental health intervention and social VR refuge for people searching for virtual support groups as he’s paying people to be present 24 hours a day and 7 days a week, with many support groups listed throughout the day. There will be a subscription cost of either $199 per year or $30 per month, which will provide unlimited access to all of the groups. Robinson says, “It’s also anonymous with avatars, lowering barriers for those who might be intimidated by a therapist’s office. We train everyday, empathetic people to guide live mental health groups and teach evidence-based skills. Our data suggest it can be effective at reducing symptoms for things like depression, anxiety, and more.”

Innerworld launches today on the Quest Store, and the next weeks and months will be a challenging load balancing and scaling process from their organic growth during their time on App Lab. It’s a fascinating story, and one that shows the real power in cultivating a peer-support community within virtual reality. It also goes against some of the dominant skeptical takes on the Metaverse. Many say that the Metaverse is a searching for a problem to solve, and Robinson’s response to that is that there are many mental health crises right now and that he has found that the Metaverse can help deliver some scalable mental health intervention solutions within his social VR app of Innerworld.

This is a listener-supported podcast through the Voices of VR Patreon.

Music: Fatality

Rough Transcript

[00:00:05.452] Kent Bye: The Voices of VR Podcast. Hello, my name is Kent Bye, and welcome to The Voices of VR Podcast. So in today's episode, I'm talking to Noah Robinson of InnerWorld, which is a mental health intervention. It's a peer counseling social VR application that has been on the App Lab for a number of years and is graduating and being promoted into the traditional Quest store. This is a really fascinating story because Noah Robinson is getting his PhD in clinical psychology and has been using virtual reality as an intervention into all sorts of different contexts, starting with addiction and substance abuse. As he was expanding out into dealing with the opioid crisis, he noticed that there was a lot of people that were coming in looking for traditional mental health type of treatments for depression, anxiety, and a whole wide range of mental health issues. There's a differentiation between what is considered a medical application versus what is considered a peer counseling, non-medical, non-therapy application. The inner world is non-medical advice. It's not therapy. It's not doing crisis intervention. It's only relying upon this peer counseling modality, which essentially means that these are non-trained professionals, they have a little bit of training, but they're a guide who is able to facilitate group conversations. And it's through those group conversations that is able to transmit what is called these non-specific effects, meaning that there's someone that you can talk to, that they're warm and non-judgmental and empathetic and they're listening to you, and that it's these type of non-specific effects that are really driving the effects of therapy. through this peer counseling method. And it's a subscription model where you pay either a monthly or a yearly fee and you get access to all sorts of different types of support groups. Noah says there's around 2000 monthly users, but there's on average, the length of engagement for each of these sessions is around an hour because people are going into these support groups or finding a lot of value. And people are really finding it as a transformational experience to be able to get access access to these different types of mental health interventions, to learn about a lot of these evidence-based techniques and frameworks, to be able to help people through these various different mental health issues that they may be having. So it's a really fascinating story, and for me, I think it's a testament to the power of these types of real-time interactive virtual environments, what we largely refer to as the metaverse. And so this is an application that is from the grassroots, organically building up a really solid community, as well as something that is a very niche contextual frame, saying that this is an opportunity for you to get access to this type of peer counseling. So that's what we're covering on today's episode of the voices of VR podcast. So this interview with Noah happened on Thursday, November 3rd, 2022. So with that, let's go ahead and dive right in.

[00:02:55.808] Noah Robinson: So I am Noah Robinson, I'm founder and CEO of inner world. And we have built a scalable mental health platform in the metaverse. So we train everyday empathetic people to lead mental health groups and teach evidence based techniques to coping with mental health issues. I'm also a PhD candidate in clinical psychology at Vanderbilt University, and I'm studying under Steve Holland, who is a protege of Aaron Beck, the creator of Cognitive Behavioral Therapy. So my main focus over the past decade, basically, at this point, is how we can take virtual experiences and translate them into scalable mental health interventions.

[00:03:37.989] Kent Bye: Maybe you could give a bit more context to your background and your journey into VR.

[00:03:42.612] Noah Robinson: Sure. So my journey started when I was 13, actually. So when I was 13, I realized I was gay and became depressed and escaped into a metaverse. And let me just back up and define how I define metaverse, because I know that it's a buzzword these days. So there's lots of different definitions. But I see any kind of internet connected virtual environment that has avatars in which humans can communicate with one another as part of the metaverse, similar to how different websites are part of the internet. They can be disparate. They don't have to be interconnected. That's how I kind of view the metaverse. And so when I was 13, I realized I was gay and became depressed and escaped into RuneScape, which is like World of Warcraft, the MMO. And I was an avatar and RuneScape ultimately saved my life. When I was a teenager, you know, it stopped me from harming myself and It was, you know, waking up every morning at 5 a.m. before school and hiding it from my parents like a drug, basically, spending 10,000 hours throughout my teenage years living in RuneScape, basically, avoiding my real-life thoughts and feelings of shame and guilt. And, you know, as I leveled up my strength in RuneCrafting and things like that, I was getting hit to dopamine, and those actually kept me going and literally were my motivation to get out of bed. and stay alive and same with my community as well. I led a clan of 400 people in RuneScape and I consider that my first startup in some ways because wrangling a bunch of teenagers in that way is pretty much maybe even more difficult than my startup now. But I had a community there, I had a place, I had a world and ultimately I was able to come out of the closet to my clan. I mean, it took me like five years. And 10,000 hours is like a full-time job, 40 hours a week for five years. And I came out to my clan. They accepted me because I was anonymous and more comfortable. And then I came out in the real world and was able to overcome my depression and wanted to pursue a PhD in clinical psychology. I wanted that since I was 10 before I realized I was gay, actually. This whole journey led me to be really interested in seeing how we can use technology to help people. And after I wanted to pursue my PhD in clinical psychology, I worked at the NIH for two years before I applied to programs to become more competitive. I got exposed to virtual reality there. in a lab that did functional rehabilitation for muscular disorders and things like that. And the second I tried the headset, I was sold. I was like, this is incredible. This is going to be powerful for psychology. You know, I immediately saw, like, I could have been in RuneScape. And what if RuneScape had been designed to help people? And really, the moment, there were two key moments. There was trying virtual reality, the DK2. This was in 2014. or maybe 2015. And then the second moment was trying social VR, which was Converge, which Sean Whiting and Hayden Lee had created back then, one of the first social VR apps. And when I was talking to Chris Madsen and some other people, Deep Rifter on there, and we were in a treehouse, and he was like, just imagine the potential for mental health intervention. I was like, yes, I'm thinking about that. This is so powerful. So those two experiences, trying VR for the first time and doing the spaceship demo, and then going into social VR, connected things to me and led me on this journey. And I applied to grad school as well and was basically told not to talk about VR. No one was doing research in clinical psychology, really. Maybe there's one person. No one doing social VR. And I almost didn't get into grad school. I almost got kicked out of grad school during grad school. But my mentor took me in and has been fully supportive. So yeah, that's how I got to where we are today.

[00:07:09.180] Kent Bye: Yeah, I think we had an interview that I recorded with you at Oculus Connect 6 in 2019, a few months before the pandemic set in. And so I remember at that time you were doing different research with VRChat. So maybe you could catch up for what you were doing then and then sort of leading up to what you're doing now with Interworld.

[00:07:28.302] Noah Robinson: Yes. So basically, when I started, you know, I started out in my first year of grad school, actually before grad school, I was going into VR chat and I was hosting an event and kind of seeing that there were a lot of people with social anxiety, people on the autism spectrum disorder, people with depression, there were trans folks, there were a lot of people who were struggling with mental health issues, trans folks who had not come out yet. I will say not all trans folks struggle with mental health issues, but there were some who were struggling with their identity at that point and had depression or anxiety. You know, I started hosting support groups. Part of this came, my interest in doing that was because I knew I wanted to be a clinical psychologist when I was in college. I couldn't just go do therapy with patients. I wasn't allowed to go see patients. But I was allowed to do this thing called peer counseling. I was allowed to work on a hotline, answer calls, be trained in a lot of different methods of open-ended questions, empowerments, you know, all these kinds of techniques. But I was never allowed to see someone repeatedly. We could only have people calling in anonymously. And so this question of, well, what is the line between what I can do as an undergraduate student and what can I do? All of a sudden, why is it that when I'm a first year PhD student in clinical psychology, like one year later after being a senior, all of a sudden I can, quote unquote, do therapy? Where's that line? And so when I was at NIH for two years before I applied to grad school, I started hosting support groups. And I was kind of pushing that line a little bit in terms of, I wasn't claiming to do therapy, but I was hosting the same group of people meeting every week, which was different from undergrad. And it was just incredible. I mean, people were just talking about their problems more open. They were more engaged. They just opened up right away. And it felt like, and again, that social presence was a key, key factor because we felt like we were with each other. It felt like a group. And so during my research at Vanderbilt, my first year of grad school, I was with a different mentor who tried to kick me out of grad school. And during that time, I was doing substance use research and working at an inpatient treatment facility. And I was allowed to bring the virtual reality with me. This facility was very flexible and allowed me to do this. I brought the VR with me and started putting people who were in detox, detoxing from heroin and alcohol and barbiturates and other kinds of substances into virtual reality. And the most incredible thing started happening where people started to say, like our first person, we put in the headset, she was detoxing from heroin. And, you know, it was just the vibe at that point. So, you know, she went into like Tilt Brush and some other places and painting and things. And when she took off the headset, she had this bouldered look on her face. And she said, All of my anxiety is gone. And I remember my supervisor and I looked at each other, because you just don't see these kinds of clinical changes in a patient who's experiencing withdrawal symptoms from heroin, just not really heard of. And this kind of change is reminiscent of some of the research in the pain research, where we've seen that virtual reality can be as effective as opioids in reducing pain. It was pretty profound, but this was emotional pain, essentially. And so I started doing this with more and more patients and seeing just these complete transformations in them. And then I wanted to bring them into social experiences to go into it with them instead of just being on the outside and watching them in VR. I want to be with them. So I started using a social platform, VRChat, which I had been in the community. I was one of the first 50 people in VRChat. I know the team really well. They're amazing. And I started going in with them into a private world and drawing and teaching them concepts from cognitive behavioral therapy. And we started to see that they were just learning these concepts very quickly. I'll just do a quick example of one woman who, she was young, she was like 25, and she was in recovery from opioids. And she had a lot of trauma in her history, especially with her parents. And it was family weekend. And we'd had one session, one session where I teach her the cognitive behavioral model, which we can talk about if you want. But the idea is to take a step back and learn that you can't control your feelings, but you can look at your thoughts or behaviors and change those. to indirectly improve your feelings. And family weekend comes around and her mom doesn't show up to family weekend. And she goes into the bathroom, she's crying. And she said that she was able to visualize the model that I had drawn in VRChat and think about it and see it in her head, think about how to reframe her thoughts and basically was able to overcome her negative emotions in that situation. And that normally doesn't happen until you're like two to three months into therapy, you know, eight to ten sessions of therapy are required to get someone to automatically be able to do that. We got it in one session. And so these profound changes based on the virtual reality experiences and the social experiences was with them teaching them things. is really what led to this journey to see that, hey, there's something here. One other thing to mention in that same patient is that she talked about her childhood trauma in our first session. And she told me later that normally she would never have opened up like that, especially to a male therapist. So yeah, people open up more, they learn more effectively. And then there's all the other things about accessibility and cost, which we can get into too. Yeah, so that was kind of what initiated the journey to seeing that there were profound clinical changes that could happen as a result of quote unquote, the metaverse, or I'll say immersive experiences in the metaverse.

[00:12:27.469] Kent Bye: Well, when was the moment when you decided that you wanted to make your own app with your own environments and your own tool set? Because last time I talked to you, you were using VRChat. But you know, obviously, there's constraints, it's likely not HIPAA compliant, even though what you're doing is not necessarily There's a lot of disclaimers as I go through the onboarding that this is not therapy, this is not medical advice, but you're still in this peer counseling sort of realm. And so maybe talk about at what point did you make the decision to go off and build your own environments and own world and create your own social graph within inner world?

[00:13:00.746] Noah Robinson: Yeah. So, I mean, there were a few reasons for it, but in the beginning I was using VRChat because I didn't have funding and I didn't have developers. I had undergraduate computer science students at Vanderbilt. We launched an experiment on Steam actually called Psych Lab VR, where we collected data on social anxiety. And as a prerecorded paradigm, it was our first live experiment demonstrating the idea that you could actually collect data automatically. Just put up an app, a VR experience, have people go in and collect data, which now there's more examples of that on an app store like Quest or Steam. So I didn't have the developers to build something. And once we started to see at the rehab center that these things were really profoundly changing patients, I started to get some funding to be able to do this. And the main reason I decided to build our own application, there's a couple. One is complete control over the environment. So if you imagine, like I'm trained in clinical psychology. Almost done with my PhD. I'm a candidate. I will finish in the next one to two years. And I'm trained in this. And so every single design decision, from how the quick menu is designed, from how people interact with each other, how the emojis are, what emojis are available, how the avatars are expressing themselves, are there facial expressions, are there artificial facial expressions, is there eye contact, how much eye contact is there, how are the tools displayed, how are the worlds designed? I mean, VR allows you to control everything in the environment. And so I had a very strong gut feeling that building our own experience and having complete control over that, like you had. You had that first experience in our tutorial that tells you that we collect data, that tells you that this isn't therapy, that we can't do crisis intervention. There's disclaimers posted on the wall. So having complete control over that person's experience was a key factor. Two was the security. So VRChat is a peer-to-peer networking structure, and we have authoritative networking structure where we are able to support HIPAA compliance. We're working towards that now, but we are just a lot more secure than most of the other apps out there are. One of my co-founders and CTO Callum Golds, he built PhotonBolt. They're one of the main developers on PhotonBolt, which is used by a lot of developers to add networking to their games, but it's peer-to-peer. There's things like pun, but we use a secure networking structure. Then the third thing related to the security is the control of data. So we do collect a lot of data. We tell people that their interactions are recorded similar to how a training clinic and therapy would be recording interactions to give feedback and monitor and make sure the quality is good. So we ask people not to talk about identifying information. We store things under non-identifying digits, like a random digit and number, like a research study would do. That's important because we need to know, one, is it working? Two, what about it works? And then also, we can personalize things. So we can figure out what works best for whom, because the same thing is not going to work well for everybody. And then the fourth thing is also allowing people to come in and have their own identity. You know, we have people from VRChat or Rec Room and other places come in and create a new avatar and a new username and a new identity and talk about their social issues that they're having in these other places. So it's kind of like a mental health community center so that people can come in, have a different identity, learn skills, and then they can go back to the other apps and not have as much anxiety or overcome their depression, things like that.

[00:16:04.944] Kent Bye: I imagine that you're also trying to prevent people from coming in and trolling. And because this is such a sensitive context for people who are being really vulnerable, that type of damage that could be done could actually be even more if someone gets in there and is being disruptive. And so when I went through, there seems to be a number of different phases where you're a visitor when you first come in and you have to attend an event and promote it and remember. But because things are being recorded, I imagine that is. another possible way to understand different dimensions of troll prevention, harassment prevention. And so maybe you could talk about special considerations that you have in terms of trolling and harassment.

[00:16:42.568] Noah Robinson: Yeah, so places like VRChat or RecRoom have people running around screaming and trolling, and there's a lot of things happening that can be very distracting. And one thing that we really work on is having psychological safety, essentially. Trolling is something that violates people's psychological safety. to promote psychological safety. I think people, especially in virtual reality, need to know how to expect what's going to happen in their environment. They need to understand when they are safe, when they are not, if someone's in a public world. And VRChat has this, to some extent, as well. If you're in a public world versus a private world, are there visitors who could be in there? And so we do have a promotion system. Our promotion system is different. Actually, it's just a human-driven one right now. So actually, you have to go to a meeting or interact with someone who has the ability to be promoted. so that it's kind of making sure that someone's on a troll. And then, you know, we are able to make sure that if someone's saying things like, go kill yourself or things like that, that that is detected and basically activates a system where we can respond to it. And I can't go into too much detail about the specifics, but I think that we built it from the ground up for making sure that it's a secure, safe space. The other thing is that what's interesting, I think, is that What is trolling? You know, trolling is a maladaptive behavior that people are doing to get some kind of validation and attention. It's kind of like the junk food of social validation or maybe it's one step below even. I would call like Facebook or Instagram likes or things like that reviews on a video is the junk food validation. But this is like Maybe it's more like a substance, like a drug, but you know, it's more, there's not withdrawal from it, but it's giving a hit and a high to someone basically when they're doing it. And especially if they're streaming on Twitch and things like that. But it's also maladaptive, like people who are trolling are real people who are engaged in this negative maladaptive behavior because they desire attention and social validation and things like that. And so I think one thing that we've also given a lot of thought to is, how do you give someone who has trolled another chance and teach them better behaviors? Because if we're only just banning the people who are trolls, then they're just going to keep going from app to app and kind of acting like that. We don't want to put a signpost on our app saying, trolls, come here. We want to be careful there, because it could get pretty bad. But we do want to explore how we can create remediation techniques and trainings abilities for people to learn how to improve their behaviors and how to gain real social validation as opposed to the kind of negative attention that they are receiving, you know, really I think as a desire to connect with other people.

[00:19:15.733] Kent Bye: Yeah, one of the other things that I thought was really striking about your app was that once you become a member, you get access to these tool sets and these graphics that are describing all these different interventions and techniques. And I was struck by the cognitive behavioral immersion technique that you have that has the different axes of the feelings and the physiological reactions, behaviors, and the thoughts. And so I thought it was kind of mirroring different aspects of my theories of presence when I talk about mental and social presence, which are related to the thoughts, the active presence, which are the behaviors, the embodied and environmental presence, which are the physiological aspects, and then the emotional presence, which is feelings. But you're taking this in the context of cognitive behavioral immersion. I'd love to hear you expand upon that as a theory of how that may be different than cognitive behavioral therapy, and that when you're immersed within these environments, how it combines all these different aspects of the feelings, the physiological reaction, the thoughts, and the behaviors.

[00:20:13.232] Noah Robinson: Sure. So I think a really cool thing is that immersion or presence, as defined by Mel Slater, is the extent to which someone thinks, feels, and behaves as if a virtual environment is real. And in cognitive behavioral therapy, the cognitive model, which was kind of adapted by Greenberger and Podesky, is basically thoughts, feelings, behaviors, and physiology all interact with each other within the context of our environment, which is like a circle around it. So, there's this really cool overlap between the definition of immersion and presence as defined by Mel Slater and cognitive behavioral therapy. And Mel Slater is a psychologist as well, so that kind of makes sense as well that it's there. But cognitive behavioral immersion, so cognitive behavioral therapy, the idea of that model, we have thoughts. feelings, behaviors, and then what's happening in your body, physiology, that occur within our environment. And the idea is that we can't just decide not to feel a certain way. We can't just decide not to feel anxious, depressed, guilty, or ashamed. This is what I taught the person at the rehab center when we were in our first session, introducing the model. And we can't decide how to feel, but because our feelings are connected to what we're thinking, what we're doing, our body, so our body can include things like exercise or putting substance into our body, physiological changes, basically meditation, So thoughts, behaviors, physiology, and our environment, they all affect our feelings. And so we can't control our feelings, but we can change these other things to indirectly improve our feelings. So if we can teach someone how to examine their thoughts to maybe reframe their negative thoughts that they're experiencing in social anxiety, like everybody's judging me, let's see evidence that that's true or not. We can teach people to change their behaviors, like in depression. where really depression is an issue of motivation to engage in behaviors. And people with depression actually enjoy doing things just as much as others. But it's that deficit of actually getting them to go do things. And so that's behavioral activation for depression, where you get someone to go do things. So we have thoughts. We have behaviors. Physiology. So most of the VR stuff out there right now is just meditation, which we're excited about. And we have in our app apps like Trip and things like that. But that's just a component of the model. Meditation is a physiological adjustment that's powerful. but really also teaching people how to reframe their thoughts, change their behaviors. And then the last thing is changing your environment, which is also what you can do with virtual reality. And so cognitive behavioral immersion is the idea that you can change the context of someone's environment to change their thoughts, feelings, behaviors, and physiology. And that that is an entry point into delivering interventions that could be more effective than delivering intervention, looking at a 2D screen, you know, when someone's in their home environment in their office or whatever. So that's kind of the basic idea of cognitive immersion. And we also think some of the mechanisms are similar to things like psychedelics, psychedelic assisted therapy, where you're changing someone's perceptual experience, essentially, and thought stream. to help them see the world from a different perspective and realize that they're stuck in their ways or thoughts and things like that and they don't have to be. So yeah, that's kind of the idea of cognitive behavioral immersion.

[00:23:09.617] Kent Bye: Okay. So I noticed that in your app, you have different grants like national science foundation and other places. And so maybe talk about some of the funding that you have, because it is a project that is providing this peer counseling context for people, but it's also a research project. And so maybe talk about some of the funding and the research that you're doing with inner world.

[00:23:29.424] Noah Robinson: Yeah. So when I was an undergrad and I knew I wanted to be in clinical psychology, the PhD programs in clinical psychology are very difficult to get into. They're more competitive than medical school. It's like a 1% acceptance rate or something. So I was freaked out from my freshman year on from college. I was like, oh my God, new research experience, all this stuff. But I worked in a lab where they recorded psychotherapy sessions, like therapy sessions. And I got to watch the tapes and record them for all these different kinds of things. Silence laughter crying. I wrote my undergrad thesis and published it on crying and therapy and attachment and how that's all related Everything basically just coding everything and it was a training clinic And so that was a component of it as well and the power of being able to understand what's happening in a therapy session allows us to understand the process of therapy and how to improve it how to train people and and basically how to change people's lives in the best way. And so I took that experience and put that into practice with Interworld. So we are able to record data on how people are interacting and what is working and what's not working. And we're trying to use that to understand what works about intervention. It's not therapy, but it's support. And how can we personalize it and make it as scalable and effective as possible? So I have funding from, first our grant was from the National Science Foundation. We got an innovation core grant. It was like a 50K grant basically for me to go around the country and interview people. I was thinking about starting a business and it allowed me to interview people. And I had this funding and I can only spend it on travel. So it was an amazing experience and networking experience. I highly recommend it to any academics who might be listening and things like that. And NIH has one too. And then that leads you into an SBIR grant, a small business innovation research grant which I got for about $210,000, which was to explore the use of inner world with people with substance use disorders for the opioid crisis specifically. Well, what happened there is that we launched the study and we were trying to target like 40 people with opioid use disorders, substance use disorders coming into the app. And we did, we had those individuals. But we also had 2,000 people who had depression and anxiety come into the app at the same time. And so we quickly realized, hey, there's a need here. So we kind of changed to be focused on depression, anxiety, and other common mental health issues. And the research funding has really allowed us to work on publishing three different papers right now. And it's allowed us to have that kind of academic background and legitimacy to making sure, to knowing if what we're doing is working, which ultimately, we needed to do a randomized control trial. That's the only way to know if something is actually has a causal impact by having a group of people that's randomized to either receive the intervention or get nothing. And it's important to have nothing instead of a placebo. That's my mentor is a specialist in randomized control trials. And you want to compare the thing you think might have an effect to its absence, not to a control condition yet. but actually our randomized control trial, which we're submitting in January, in case I'm not busy enough with the app launch and my PhD. We're sending a $2 million grant to NIMH, National Institute of Mental Health, that will basically be a randomized control trial with three arms. One will be a control condition, so it's just like a wait list, basically. Second one is 2D access to inner world because our app is cross-platform, it works on iPhone, Mac, PC, and virtual reality. So randomized people, it's a wait list, 2D access, and immersive access to inner world so that we can actually measure, is there actually a significant difference between accessing inner world on a 2D device like any kind of game versus being in inner world and experiencing that. And then it's going to be like an eight-session intervention with structured things as well. So yeah, the research has been great. And it helps us know if what we're doing is effective. And yeah, we just have an informed consent approach about we want people to know that we're collecting data and doing research. And yeah, so the data is not just for moderation. It's also for learning how to build something scalable and that's effective.

[00:27:12.178] Kent Bye: So you've been on the App Lab for the MetaQuest Store, and you're going to be moving on to the main Quest Store, which for any app, I think there's only like 440 or 450-odd apps that are on the Quest Store. So that's a pretty unique opportunity to have more exposure. But maybe talk a bit about this experience that you had on the App Lab. What your conversations were with Meta to be able to be promoted onto the main store, because they've been focusing so much on games and it's really great to see an app like this. Like what metrics they were seeing in terms of what made them flip the switch and to give more exposure to what you're doing here.

[00:27:49.197] Noah Robinson: Yeah. So it's kind of crazy. One, it's funny because when I tell people that we're launching on the main Quest store, there's two responses. One is like, Oh, cool. Like they think I'm on, you know, it's like putting an app on the iOS app store, but then people who are in VR, it's like, Oh my God. Wow. That's amazing. because they know how hard it is to get on the store. So there's these two different types of reactions, which is funny if people know about the store and how curated it is and stuff. But basically, we were building for the Quest before the Quest was released, when it was just rumored and confirmed at that point. A standalone headset is obviously going to be the biggest headset if you need a computer. And I've been talking to Meta and trying to talk to Meta. I was trying to talk to Meta from like Oculus Connect three or four, and basically trying to talk to them about, hey, this is a huge thing. We're working on this. I think that it could be, one, it could be an amazing thing to change millions of people's lives. And then two, it's a great use case for VR. And it was very hard to reach them. It was a lot of persistence, a lot of networking, a lot of back-channeling, just being at the conferences, meeting the right people. I also know Graham really well from VRChat. I know Nick from Rec Room, and Sean Whiting as well as at Rec Room. So I've been in this world for a long time and had some connections. And that's just really from being at a conference. And if you're standing around the right people and someone else comes up and you meet someone from Meta or Oculus or Facebook at the time, there's too many names. Yeah. So basically, it was networking. And then we got on App Lab. We were one of the first people to apply to App Lab. I was waiting for it to come out. I knew about App Lab, that they were working on App Lab early before it was released, just because I was like, how can I get on the store? And we were sideloading. And then they're like, oh, we're going to have this other thing. Anyway, so I was very persistent, and we got an App Lab. And then I think the key thing is that Meta saw the metrics. People were spending an hour a week on average in our app. We had thousands of downloads. Our frame rate was really good, 70 FPS average from the beginning. Well, maybe a few months in. But we have a really good development team, so it's really smooth. And I think that's what led them. They have all the metrics. So I think, I don't know this for sure, but I'm assuming that they can just look at their apps and engagement rates. see from App Lab what's doing well, and then we were just approached. I can't really talk about too much beyond that because we signed NDA and stuff like that, but Meta has been incredibly supportive. They are very bullish on this and they're willing to help people to get onto the store if they like the app. It is very curated, it's very difficult. A big thing is that I had to convince them that it wasn't therapy. I had to show them and explain to them and do education around the fact that it's not healthcare, it's not therapy. Yeah, so that's how we got there. That's also one thing to mention. This is kind of an aside on digital therapeutics, but I just really want to make sure I get this out there because That's how a lot of people think about mental health and VR. There's this whole group of people that are trying to have, quote, digital therapeutics with virtual reality for mental health interventions, where you have to go to a doctor and get a prescription. And then you get to download the app and use it in a headset. And I think it's the most backwards way to deliver evidence-based mental health interventions. What we're doing is scaling mental health intervention, allowing anybody to train elite groups. Not anybody, necessarily. We interview them. We train them. We evaluate them. But creating something scalable. But a lot of people out there advocating for, oh, you need to get a prescription from your psychiatrist or general practitioner to use virtual reality app, and it costs $4,000 a month. So yeah, we're not doing that route. We're going the wellness, scalable, accessible, anybody can use it. People are learning the same skills. So yeah, I'm excited about that. I just want to throw that out there that we had to explain to them that we're not a digital therapeutic. We're not health care. We are a social experience that's going to transform people's lives.

[00:31:15.637] Kent Bye: Yeah, I think that, you know, after I did one of the conferences that was talking about non-invasive neural interfaces, and there was a lot of talk about BCIs, and Rafael Usta, one of the founders of NeuroRights, was saying that these devices should be just considered medical devices. After that, you know, meta had killed off their BCI research that was invasive BCI research, because it was getting into this realm where we'd look at what they were doing as a medical device. I think they want to generally avoid anything that is considered a medical context in their app store or anything they're doing. But this line what you're doing between medical defined therapy versus peer counseling. There's a lot of emphasis of what you're doing is not therapy and that there's all these things that you're not doing in terms of intensive mental health crisis intervention. You have a whole list of different resources that you're pointing people to because what you're doing, your app is not crisis intervention, but it's peer counseling. So maybe you could talk about what is that line? The thing that you were talking about very early in terms of like, this is therapy and this is peer counseling. And what is the definition between those two things?

[00:32:23.568] Noah Robinson: Yeah, so there's a couple things here. So one, my mentor, Steve Holland, is working with folks and doing this in India, where they're training high school graduates in rural India to deliver treatment for depression, behavioral activation, and they're just as effective as therapists, and they've done randomized control trials on that. So, this is happening and it's working. Another thing my mentor likes to say is all professions are assaults on the laity. So, any kind of professional guild generally has rules and they advocate for rules and things to create barriers to non-professionals with less training to do similar things. But at the same time, we're not doing therapy. We're not claiming that. So what is the line? I think the line, when I've learned this from, I'm trained in the American Psychological Association, ethical guidelines through my PhD and stuff. And I've learned that this line really is what the person perceives the service to be. That's the thing that determines whether it's therapy or not. So, if someone is told that what they're experiencing is therapy and the person delivering the services says, hey, this is going to treat your depression or anxiety, that's basically that person thinks it's therapy and that's considered therapy. It's a broad word, it doesn't necessarily mean it's like licensed therapy but anyone can call something therapy and the person receiving it thinks that it's therapy, that's that line, the person thinks it's therapy. But if the person knows that it's not therapy and that it's not a trained person and we're not making those claims and it's a pure support and they're just a guide guiding them in an experience, then they know that it's not therapy. But you can read a book on cognitive behavioral therapy and learn the same concepts that you would from talking to someone. Or you could go through an app that's automated and things like that, that some people say should be digital therapeutic, but there's other chatbot apps out there that you chat with and they're doing basically what's there, but they're just not claiming it is. So yeah, that line is where a person perceives it to be, basically what the claims are being made by the people delivering the services.

[00:34:17.508] Kent Bye: You said that you've done a number of different initial research and you're in the process of, you said you're working on three different studies. And what are the early outcomes that have convinced you to continue to pursue this in the context of you're still getting your PhD in clinical psychology and you're in the process of getting these NSF grants and you had to show them at least some of the preliminary evidence. And so what can you say right now in terms of what VR is able to do? relative to other modalities, like maybe the 2D app is just as effective. Maybe you'll end up finding that out. But what's your sense of what is the efficacy of these immersive environments for this type of intervention?

[00:34:58.430] Noah Robinson: Yeah, I mean, so the most data that we have right now is qualitative data. We have quantitative data of changes in symptoms of depression and anxiety that shows a 30% decrease in symptoms of depression and anxiety. But from a scientific perspective, we can't know if that's a causal relationship or just that our sample happens to be people who are motivated to help themselves. I know we're seeing symptom improvement until we do a randomized control trial. But at least it's, hey, there's some change happening here. It's exciting. But the qualitative data is incredible. We have one person who she had agoraphobia. She hadn't left her house in four years, even though she was in therapy every week. And she went into interrog, and within four months, she was leaving her house and going outside and doing things. And now she's become a guide. She's trained in helping others and leading groups. And now we've hired her to be doing even more. And it's like this huge transformation. We have another person who had depression and couldn't get out of bed. And he was in the Netherlands, and he said that he couldn't go to work for two weeks. He was laying in bed, I don't know, for longer than two weeks, for like a month. And then for two weeks, he found out a world on his headset, was using it from his bed, went to meetings every single day. And he said after that, he was able to go to work for the first time and came home with tears in his eyes because he was like, oh, my God, I finally went to work. Again, that behavior observation, doing the thing, getting out of depression, and that helps people lift out of that. People who talk about our users, some of them say, like, this is so much more helpful to me than therapy. And I want to mention, why is it more helpful to people than therapy? But these experiences from people, these real experiences, just like what I observed in the rehab center, Those are the things that are really encouraging us to see. We are changing people's lives and we're excited about that. The other thing I want to touch on in terms of why it's working, it's surprising to people, but the thing that accounts for the most outcome in therapy is called nonspecific effects. So these are just like generally having someone to talk to and who's warm and empathetic and open and listening. That accounts for the outcome, like 60 to 70% of outcomes in therapy are accounted for by these nonspecific effects. not by the modality, the type, the theory, the tools. It's just by having an open, warm person who's trained to be non-judgmental and is listening. And so in inner world, where you're with a group and it's like 15 or 20 other people who are sending out hearts when you're talking about something and things like that, it's really, really powerful and you're amplifying that nonspecific effect. And so I think when someone like one person who was able to come in and talk about her fear of leaving home and like three other people talked about that they couldn't leave their homes at first but they were able to do it and she learned a tool as well. One of our tools is called worst case best case most likely and it's a fear form basically to help people not catastrophize and learn like what's the most likely outcome even though I'm thinking about the worst case. And she uses that tool all the time, and it unlocked her ability to go outside. So these tools aren't rocket science. Social support and nonspecific effects are possible to experience by non-trained professionals. And lastly, we can create something that's incredibly affordable. That's something really important about our app is that it's basically the cost of one out-of-pocket therapy session gets you a year of unlimited access to Interworld. And that's been a huge goal that I've had with the company is building something that we pay our guides. We want people to be able to like, you know, people quitting their jobs to come become guides for us and things like that, which is really cool. So there's a cost to it. Obviously, it's a live service, but we want it to be so affordable that like, You're like, OK, why not? I'll give it a shot. And we also have scholarships as well. So if someone can't afford it, if they need it, we have an application process as well for that. So yeah, we're really excited about it. And we're already changing lives from App Lab. I think Meta saw that. And now we're launching and scaling. And yeah, it's literally a week from today. So it's exciting.

[00:38:32.582] Kent Bye: So you have different types of support groups. There's like things like meditation to like AA groups for addiction. There's session on procrastination and maybe you could talk about the different types of things that you're approaching, whether it's depression, anxiety, and what kind of specific groups that you already have in terms of a regular meetings for people to be able to go to.

[00:38:54.866] Noah Robinson: Sure. So when we started Interworld, it was just check-ins. So it was just kind of people coming and talking about their week. It was just one meeting a week. And we had four people there. And it's hard to imagine, will we ever get to the point of it being, you know, hundreds of events and things. And so it's exciting that we're there. But basically, we have all sorts of different types of events. So we have, yeah, like meditation, we have creative events, where you can just draw casual hangouts, we have specific events like reframing our negative thoughts, compassion fatigue, healthy relationships, newcomer events, social anxiety, fitness, maintaining self-care, all these things. I'm actually just reading a list from, if you go to app.inner.world, you can just see a list of all of our events for people to get an idea and things like that. And basically, we have our guides who come to us and ask about certain events that they're interested in hosting. And then we also have an event request form that people can fill out to say, hey, I'm interested in this event. Imposter syndrome is another really good one. So basically, the events happen through suggestions from the community. And most of the events also have tools that are involved with them. So people can actually learn the tools. And I don't know if you got a chance to check this out too, but we've built an entire prerecorded avatar system in the offline home and other places. So basically I can record a lesson or an intro to something and someone else can pop it out and play it. And so that's another way that we can have events that teach a tool where I introduce the model, for example, the cognitive immersion model. And anybody in a meeting can just pop out and play it at the beginning of the meeting to scale. Again, it's all about scalability, learning these concepts. So yeah, the meetings are tool focused, and then people also have a chance to check in and talk and engage with one another as well.

[00:40:29.143] Kent Bye: Yeah, in the lobby area that you can enter into before you go into the hub with other people, there's an opportunity to play these pre-recorded lessons and I watched a number of them and yeah, just hear a lesson about cognitive behavioral immersion or any of the other tools that are there and that you have this tool set. So it sounds like that people in these sessions can pull up any number of these different tools. So does that mean that there's like specific tools that if it's happening in context, someone might pull it up and then give a ad hoc lesson right there to give people an idea of some of these theoretical approaches for understanding what's happening in that moment. So maybe you talk about that tool set, because it's basically pulling out an object out of your menu system, but that object is a graphic or tool to describe one of these many different types of psychological theories.

[00:41:18.695] Noah Robinson: Yeah, so the idea is that these tools are principles, basically. And during a meeting, yes, someone can pull it out and it appears in front of you and it's 3D. You can draw on it. We have the drawing system as well in the app. So that is very helpful to people because I bet even when you were just describing the Cognitive Model, and your experience, I bet you can imagine the setting that you were in when you were watching that lesson. You were there. There's a place that you were at. So by doing that in these meetings, people think back to their experience, whether it's in the onsen or the theater world or the campfire, and they're able to remember that tool in the context of when they learned it. And so, yeah, it's a 3D experience, and each person can pop out their own tool and work with it as well. So that's the really cool thing about it.

[00:42:01.328] Kent Bye: Yeah. The other thing that was striking was that you said that there's going to be a person that is in your world 24 seven. There's always going to be someone there. And I was like, wow, that is really quite ambitious for this kind of upstart social peer counseling group. But, you know, when I went in there, there was somebody in the hub that greeted me and was able to talk to me. So yeah, maybe talk about how do you pull off having someone there 24 seven or are all those people being paid or are there. ways that people are volunteering to participate in this experience?

[00:42:32.085] Noah Robinson: Yeah, so the people there 24-7 are all being paid. What's really exciting is that we just had a job application out that we closed for now, but we were hiring guides. And in just a couple of weeks, we got 300 applications for people to become guides. It's a part-time job, it's flexible, all that kind of stuff. So it's really exciting because there's a huge workforce out there of people who are interested and excited to do this kind of thing. And we want to pay them, which is why our app has a cost, a subscription cost to it. But yeah, they're all paid. I will say... What's my biggest fear about launching? I will say we don't know what the demand is going to be yet. So having the right number of guides available and ready is very difficult, and load balancing and things like that. So we can't guarantee that there'll be a live person for people to talk to 24-7, because if we're completely inundated, there will be a lot of public worlds people can explore. There'll be events that they can go to. But yes, we are working towards that, so that there's always people online that you can talk to whenever you're feeling stressed or down, basically.

[00:43:32.200] Kent Bye: Yeah, going in and actually having someone to talk to was helpful even when I was going in and just getting at the lay of the land. And yeah, it seems like you've been able to cultivate quite a community. Are you at liberty to say how many people are actively using it or what scale are you already at?

[00:43:48.677] Noah Robinson: Yeah, we have about 2,000 monthly active users right now and like 60 trained guides. Yeah, so I mean, it's exciting. You know, one thing I hope is that I do think Meta has made a big mistake with promoting Horizons so much as the Metaverse, because now the public gestalt, the zeitgeist, the public zeitgeist is basically that the Metaverse isn't working. You know, Meta had to cut its projections from 380,000 users to 300,000. Instead, Meta, who's investing a lot of billions of dollars in this, it's working. They have this Quest ecosystem, but the Metaverse is VRChat and RecRoom and these other apps where people are actually spending time. So I think Meta needs to, instead of promoting their own kind of mediocre right now Metaverse app, I know they're working on it, but they should be talking about the wins that their technology has enabled. So we're excited to hopefully be an example of that. But also, I think they really need to shift their strategy and be talking about Be Archified and Rec Room and these other platforms, because those are the experiences that people are engaged in and spending lots of time and all that kind of stuff. So the Metaverse is alive and thriving, and there are people who will never give it up. There are people who are going into these apps, and they're always going to buy the new headset. They're never going to give it up. It's not going anywhere. But it's just that Meta's version that they built isn't necessarily taking off as they want. So we're excited. We're excited to be another kind of use case of something that is working and changing lives in the Metaverse.

[00:45:11.020] Kent Bye: Yeah, I think that I see that there was a memo that Mark Zuckerberg had written back in 2015, where he was saying that their strategy was going to be opposite than Apple, where Apple put their number one thing as the hardware that they're selling. And Meta said that there's also platform services, but also first party apps that they're building. And that their strategy all along has been to build their own first party apps and to then second priority be to support the ecosystem. And then the third priority is to sell the hardware. So they've obviously been selling the hardware as a loss leader. They're actually losing money on that. But there is this tension, this existential tension that I see where there's a bit of a conflict of interest that Meta has, where they want to be developing their own first party apps, but they also are supporting the larger ecosystem. And they have always to this point, put that as number one, the thing that they are building and the stuff that they've been building is not as compelling as what is already existing in the ecosystem. So that to me is a bit of a dilemma that you're elaborating.

[00:46:08.652] Noah Robinson: I think they could do a lot. They could really show the world that people are using these other apps. They are using the metaverse. So hopefully their strategy will shift over time and they'll stop emphasizing their own first party app as much while they're working on it and really promote these other apps and show that this is working.

[00:46:25.456] Kent Bye: Yeah, because there's a part of the grassroots community development that you've been doing that I think is, you know, you go in there and you can see there's actually a cohesive group of people that are going in there regularly and getting these benefits. And so, yeah, in terms of developing community, the numbers relative to their scale is probably a lot less than what is even going on horizons. But the meaningful interactions and the time of engagement, I think, is probably other metrics that, you know, they show this kind of grassroots from the ground up community cultivation, which I think has happened both in the other successful Metaverse apps of Rec Room and VRChat. And so there seems to be something that you're doing that is the key essence of community building and leading into the gifts. So people are giving their gifts, but receiving gifts. And so there's something there about that exchange of people providing their time, but it receiving something in return. That's also a key part that I think is kind missing from when I go into Horizon Worlds, there doesn't seem that same type of community cultivation. It seems like this kind of top-down, brand-driven worlds are being created, but also even the worlds that are being created by the community from the ground up are not being promoted and emphasized. So anyway, in terms of community cultivation, I think you've been able to do an amazing job.

[00:47:32.531] Noah Robinson: Thanks. Yeah, we're really excited. And this has been, it's so crazy that it's a week away. Like, it's been a vision that I've had for so long that I can't believe it's happening. I'm very grateful to Meta because they have supported this, they built the ecosystem, the Quest ecosystem, and this is going to be a transformative thing that would not be possible without Meta. And Yeah, we're excited. One last thing to mention that is important from the privacy perspective, I'm very proud to say that when Meta's servers, there was like a crash of all of their services and servers, I think like a year ago, like two summers ago, and our app kept working completely smoothly with no hitch. We don't use any meta data collection, or we're not touching their servers or anything. We built our own avatars. We're using a different lip sync SDK. So we've really focused on data privacy and security as something that's really important. So even though that has helped us a lot, I do want to say, we don't sell data if we don't have an advertising company in or affecting what we're doing.

[00:48:29.618] Kent Bye: Awesome. And finally, what do you think the ultimate potential of virtual reality might be? And what am I able to enable?

[00:48:38.498] Noah Robinson: So I think the biggest use case for virtual reality is probably going to be climate change, I think. I think as the climate gets worse over our lifetimes, it's going to be harder to go outside and enjoy the weather. And I think virtual reality is going to help people with their mental health and being able to go outside and have experiences and connect with each other, even when the climate is harsh, more harsh, I would say. I know that's kind of a dystopian view or something, but I think that AR is going to proliferate. People are going to really use that a lot when they're out with each other. But yeah, I think that as the climate gets worse, as we have more hundred degree days and these other kinds of things, I think people are going to use VR a lot more to get exercise, go out, feel like they're connecting with other people. And yeah, that's kind of one of the biggest use cases. I think that's going to happen.

[00:49:21.118] Kent Bye: And what do you think some of the applications of mental health VR, where do you think that's going to go?

[00:49:28.373] Noah Robinson: Our goal is to build something that is so easy to access and so effective that people are like, OK, why not? I'll give it a shot. And we are excited within a world to transform the thinking about what it means to get mental health support, how hard it is to get mental health support into something that's like, oh, yeah, I'm just going to go just like, you know, exercising or other kinds of things or downloading. a meditation app, oh yeah, I can go talk to someone actually, learn about my problems, learn tools, and transform my life in the real world. And I think virtual reality will always remain a very powerful, the most powerful way to deliver psychological intervention because of the cognitive behavioral immersion principle where you're completely changing someone's environment and immersing them in this other world versus augmented reality that changes something in your environment. I think plucking someone out and putting them in this other world and teaching them skills, our goal is to have people come back to reality more empowered than they left it. And that's very different from a lot of other apps that are sucking people in and trying to get them to play like I did with RuneScape. So I think that where I see inter-world and VR mental health support going is that it's going to proliferate and become this incredible tool to change people's lives and help them live in the real world in a better way.

[00:50:37.490] Kent Bye: Awesome. Is there anything else that's left unsaid that you'd like to say to the broader Immersive community?

[00:50:42.131] Noah Robinson: I just want to say, hang in there. I know there's a lot of skepticism about the metaverse right now and doubters and things, but I think we've gotten to the point where, again, there's people with the technology who are not giving it up. There's people who aren't going to stop using VR, and that community is only going to grow. So I'm very excited, and I think this is a very exciting time to be in VR. And yeah, I'm just grateful for this interview. And Ken, all the work that you do as well, because this podcast is amazing. I've been following it for years. I think this community is only going to grow, even though there's a lot of skeptics out there, especially right now.

[00:51:14.135] Kent Bye: When I got the inner world from App Lab, at what point do people have to pay? Can they download and get some initial experiences? At what point are you asking people to pay? Is that even implemented yet? Or what does that come on the onboarding process?

[00:51:26.907] Noah Robinson: Yeah, so basically when people download the app, they will be able to start a 14 day free trial, two week free trial. So they'll be prompted to start their subscription when they make their account. And the cost with launch that we're going to have is going to be about if you pay annually, it's going to be about $16 a month. So it's like $200 a year. $1.99, I should say. And then if you pay monthly, it's going to be like $30 a month. And this gets you unlimited access. We explored several different models that we were thinking about, but we didn't want to charge per session or be a microtransaction-fueled free app that's manipulating people psychologically to get them to spend more and more money or something. We just wanted people to pay and get unlimited access and use it as much as they want. hopefully at a very affordable price, basically for the cost of $199 is basically the cost of like a therapy session, or it might be the cost of 10 copays of health insurance covered therapy session, but you know, unlimited access as much as people want.

[00:52:23.763] Kent Bye: Awesome. It sounds like this is also an opportunity for people to work within Metaverse or have a job. And so as you potentially grow, there may be more demand for people to come and be one of these guides or a member that is part of the team. So yeah, it seems like that you're building out a workforce as well, which is also really exciting.

[00:52:42.528] Noah Robinson: Yes. And if people are interested, you can email us, you know, hello at inner dot world. If you're interested in learning how to become a guide and yeah, there's so many people out there who are the warm, empathetic listeners who like to help people, nurturing others, gives them a sense of meaning and purpose. And with just a little bit of training, they can help to transform people's lives. So.

[00:53:02.353] Kent Bye: Well, no, I'm really excited to see this get out onto the Quest store. Again, congratulations, because that is a big accomplishment relative to all the other people that, you know, the thousands of other apps. And yeah, I think the community that you've been able to cultivate and engagement, I think is a testament towards this is something that is really on the optimistic positive side of to provide evidence against some of the metaverse skeptics in terms of that there's nobody in the metaverse that wants to do any of this. So clearly there are, and there's people that are receiving benefits and It's exciting to see the translation for what the different types of immersion that can happen and how that can be an impact psychologically. And then a lot of your work is also going to be potentially proving that out in terms of the double blind controlled studies that you're doing here at some point to be able to publish more research. That's still ongoing, but there's enough qualitative aspects to say that it's working and it's exciting to see where it goes. So thanks again for joining me here today to help unpack it all.

[00:53:54.095] Noah Robinson: Thanks. And yeah, one last thing I'll say, my last last thing, people say that it looks like the metaverse is a tool in search of a problem. But I'll say that innerworld came from a problem and we found the tool that is very effective to solve it. So yeah, thanks a lot, Kent, for the time and really excited to see where it all goes.

[00:54:10.942] Kent Bye: So that was Noah Robinson. He's the founder and CEO of inner world, and he's launching on the Oculus quest main store on November 10th, 2022. So I have a number of different takeaways about this interview is that first of all, well, I'm just a real fan of this experience and what Noah has been able to cultivate with. This has really been a passion project for many, many years. I know he's been working on it and slowly building up this community and coming up with a scalable mental health intervention platform. To have someone available 24-7, I think, is extremely ambitious for anybody that's running any type of job. in a virtual environment and not knowing what the load balancing is going to be. This is going to be a real week or two or a month of learning in terms of what the demand of this is and how they're able to actually scale out their existing support groups and opening it up to the millions of different Quest users. I mean, it's already been available to the users, but the App Lab is sort of like you don't get exposure to promotion on the main store for the Quest. You kind of have to advertise it for yourself and do a lot of grassroots marketing. And I think the metrics that Noah's saying is that they have these 2,000 monthly users. But I think the real thing was that they have the engagement time of about an hour for each of the sessions, which was a signal to Meta, at least, that there was some real deep and meaningful engagement that's happening here. This is not therapy. It's not crisis intervention. It's not a medical application. This peer counseling is what he said he had to do a lot of education. I think, generally, meta is pretty resistant to having things that are considered medical treatments. The whole virtual therapeutics that Noah is going into, where you get a subscription from your doctor to get prescribed an experiential application that you go get, He's resistant to that because that's just the existing model. It ends up being these huge prices of $4,000 to get even access to this. Then you need insurance. It then becomes not really accessible for people just to have access to it. He wanted to do a completely different model than that, that he was in some ways finding a workaround for what he was and was not able to do in terms of providing therapy in the context of still getting his Ph.D. in clinical psychology. And so doing these type of peer counseling support groups was a way to get around that and that you're still able to get a lot of those nonspecific effects of having people listen, be nonjudgmental and offer empathetic listening. I'd also provide guidance on these many different frameworks. You have these built-in menu systems in that you can pull up these different objects that have these psychological theories that are on there. Just frameworks to help navigate all these different dimensions of mental health. In the context of these different support groups, they can start to pull it up. You can draw on them. I just had a memory of the cognitive behavioral model adaptation from Greenberger and Padesky's five-part model to understand life experiences of the physical reactions, the thoughts, the moods, and behaviors, all within the context of the environment. For me, I see this matching into my experiential design framework of the embodied presence from the physical reactions, the mental presence from the thoughts, the emotional presence from the moods, and the active presence of the behaviors. And that's all within the environmental context. So there's a sense of environmental presence, but also the environmental context that you're changing your context. And so the whole idea of cognitive behavioral immersion is that you're changing the context of someone's environment. And then from that, they're able to change your thoughts, behaviors, and physiology. And as a result, kind of like this similar way in which that you don't have agency over your feelings. necessarily, but you can control these other vectors of your thoughts and behaviors and your physiology and your context. And that as a result, all those other things will help to shape and shift your mood or your feelings. And that's the entry point for delivering these types of mental health interventions. So yeah, there's a way in which that cognitive behavioral immersion is what Noah's talking about, but it's an expansion of this cognitive behavioral therapy. I wanted to just flag that I had this really intense and in-depth conversation with Grant Maxwell, with these 13 different thinkers, thinking about all these different ways of dealing with the opposites. And Spinoza was talking about how the will from Spinoza's definition is the emotions and that you don't have free will in the sense that you can't control your emotions. And so there's a similar type of deterministic nature of feelings and that it's difficult to directly change your emotions. But you can change all these other factors that may be able to get you into these different modes of emotional center of gravity, like depression as an example, he kept on referring to this technique of behavioral activation. And so you're actually going out and doing activities and changing your environment. And from that, being able to maybe change your thought streams, and that that was able to at the end of the day, maybe help to shift your mood. And also Noah was comparing this cognitive behavioral immersion to different types of psychedelic interventions for therapy that is changing your perceptual experience. And from the changing of your physiological and perceptual experiences, then that may be able to lead to different thoughts and behaviors, and as a result, also be able to shift your mood as well. So there's ways of recording. And so you can go in and just watch a lot of these short little five to 10 minute lectures or to have a little meditation just within the context of your home world that is different than going into the hub world. So before you log in, there's a whole onboarding experience that really is trying to get all these different layers of consent. And then you can go into the hub world where there will be people who are live there 24-7. And there's a lot of different support group things there as well. There is a lot of recording of everything, and so that's probably the one thing that I have a bit of a pause. But in terms of this being a research project, this is trying to understand more of the dynamics of this type of peer counseling and looking at the comparison to therapy and all the different therapeutic interventions that are well-known and well-studied. This is a way of being able to use the virtual technologies to see what is working, what's not, and to try to get a better sense of the dynamics of this type of peer-to-peer counseling. So there's a research component that is recording all these different things. So there's a encouragement for you as you go into these environments to pick a new identity that you're not having your existing identity. And so you have a different username and whatnot. But there could still be personal identifiable information just for people recognizing different aspects of what you're sharing, or if there's ways that people recognize your voice or whatnot. So it's not a perfect system to not have any identifiable information, but generally it tries to keep it non identifiable. And there's a whole other research component to what they're doing here. And I'm just really glad to see that it's getting promoted from the App Lab. You know, it's another instance there of the curation strategy of meta has been extremely strict and, in my opinion, sometimes too strict, but they're trying to really grow an environment and ecosystem where the stuff that is on the store has a certain level of quality. And if you want those other things that are more experimental, then you can go out and searching. There's other databases that are aggregating all these different experiences on the App Lab. And yeah, at the end of the day, according to what I was talking to with Ryan Engel, just the placement on the store and being in the top ten list and the top end reviews, that was a way of really driving attention and awareness for these apps that are already on the Quest store. There's only like 450-odd apps or so. The ones that are successful are the ones that are using the internal methods of getting promoted in different ways. So anyway, as it goes over into this Quest store, it's going to open up the floodgates of all these people coming in, and hopefully the end result is that they're going to be able to actually scale up this, have enough people that are subscribing, and to have people who are able to serve the needs in this peer-to-peer counseling mental health context. So, that's all that I have for today, and I just wanted to thank you for listening to the Voices of VR podcast. And if you enjoy the podcast, then please do spread the word, tell your friends, and consider becoming a member of the Patreon. This is a less-than-supported podcast, and so I do rely upon donations from people like yourself in order to continue to bring you this coverage. So you could become a member and donate today at patreon.com slash voicesofvr. Thanks for listening.

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