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All content in this area was uploaded by Nicholas Salamon on Oct 19, 2017
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68th International Astronautical Congress (IAC), Adelaide, Australia, 25-29 September 2017.
Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
1
IAC-17-A1.IP.10
Application of Virtual Reality for Crew Mental Health in Extended-Duration Space Missions
Nick Salamon1,2, Jonathan M. Grimm1,2, John M. Horack1,2, Elizabeth K. Newton2
1 Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, 201 W
19th Ave., Columbus, OH 43210
2 Battelle Center for Science and Technology Policy, John Glenn College of Public Affairs, The Ohio State
University, 1810 College Rd. N, Columbus, OH 43210
Abstract
Human exploration of the solar system brings a host of environmental and engineering challenges. Among the
most important factors in crew health and human performance is the sustainment of mental health. The mental well
being of astronaut crews is a significant issue affecting the success of long-duration space missions, such as spending
a long period of time on the Moon, Mars exploration, and/or eventual colonization of the solar system. If mental
health is not properly addressed, these missions will be at risk. Upkeep of mental health will be especially difficult
on long duration missions because many of the support systems available to crews on shorter missions will not be
available. In this paper, we examine the uses of immersive virtual reality (VR) simulations in order to maintain
healthy mental states in astronaut crews who are removed from the essential comforts typically associated with
terrestrial life. Various methods of simulations and their administration are analyzed in the context of current
research and knowledge in the fields of psychology, medicine, and space sciences, with a specific focus on the
environment faced by astronauts on long-term missions. The results of this investigation show that virtual reality
should be considered a plausible measure in preventing mental state deterioration in astronauts, though more work is
needed to provide a comprehensive view of the effectiveness and administration of VR methods.
1. Introduction
1.1 Background
In the early days of US manned spaceflight,
relatively little attention was paid to questions of mental
fortitude among astronaut corps. Instead, astronauts
relied on the discipline required of them during previous
careers as military fighter pilots to endure the
difficulties of operating in small volume spacecraft.
Additionally, mission lengths were on the order of days,
not months. These factors of short mission length and a
well-disciplined crew helped to facilitate the successes
of programs such as Mercury, Gemini, and Apollo in
the era of astronaut selection typified by the idea of “the
right stuff” [1].
As national interests evolved to include longer
stays in more permanent “space stations,” a greater
emphasis was placed on the human factors involved in
spaceflight. The shift from short missions focused on
proving technical capabilities gave way to longer
missions of human habitation for the purpose of
experimentation. The missions that took place on
stations Salyut, Skylab, and Mir brought attention to the
need for psychological support and coping methods for
station personnel. The often cited Skylab “mutiny”,
during which the crew of Skylab 4 ended
communications for a day in order to rest, led to
procedural changes like better accommodations for crew
stress and workload flexibility [1,2]. In the larger
context of extended human spaceflight, however, the
incident serves to highlight the central importance of
crew mental health in the successful completion of
missions. As in any effective strike, it became clear that
without the crew, nothing would be accomplished. [3,4]
1.2 Motivation
Today, the crafts used in these early space
exploration programs would be classified as isolated,
confined, and extreme (ICE) environments [5]:
inhabitants are physically separated from other people
and conventional support systems, they are confined to
a small capsule, and the extreme environment around
them means that a mistake can be catastrophic. While
the sample size of people who have flown in space is
small, there is a larger and more accessible population
that has experienced similar environments:
Submariners, inhabitants of Antarctic bases, and
participants in dedicated ICE simulation studies have
been seen as populations analogous to those in long-
duration space missions [6,7,8,9].
The psychological effects of living and working in
such environments have been documented by studies of
these ICE analogues and evidence from past
spaceflights. Psycho-environmental factors of ICE
habitats include crowding, lack of privacy, social
isolation, and sensory restriction [8,9]. Observed
behavioural problems include anger, anxiety,
interpersonal conflict, social withdrawal, sleep
deprivation, decrease in group cohesion, and decrease in
motivation [10]. Also documented primarily in Russian
crews is “asthenia”, which is a disorder often defined by
68th International Astronautical Congress (IAC), Adelaide, Australia, 25-29 September 2017.
Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
2
the symptoms of fatigue, concentration and performance
decrements, irritability, and sleep disturbances [11].
Though asthenia is not universally classified as a
disorder [12], the fact that it is frequently reported in
cosmonauts suggests that astronauts’ cultural
background may impact coping in an ICE environment
[11]. The negative effects listed above could have a
serious detrimental impact on a mission if left
unmitigated. Furthermore, crew selection procedures do
not entirely prevent the occurrence of negative
behavioural events [10], so it is important to have
countermeasures in place to predict, prevent, and
manage events that could occur.
There are several countermeasures currently in
place to help mitigate the risk of behavioural problems
on the International Space Station (ISS). NASA
astronauts undergo extensive training on behavioural
health before missions, including training on how to
recognize and deal with psychological problems and
interpersonal conflicts [13,4,2]. While on-orbit,
astronauts have access to confidential meetings with a
flight surgeon, who is trained to recognize signs of
behavioural abnormalities [4]. Astronauts also receive
“care packages” to boost morale, which contain
favourite foods and other personal items sent by friends
and family [4,2]. There are plentiful opportunities for
communication with people on earth. Email is available
as a means of keeping correspondence with friends and
family, and phone calls can also be made from the ISS.
Astronauts may receive surprise calls from favourite
public figures [2]. The station also has an internet
connection that, while slow, is readily available for
personal use [14]. Free time can be used to watch
movies, look out the window, take pictures, and to
pursue other leisure activities at the astronaut’s
discretion. Looking out the ISS windows at earth has
been cited as a highly rewarding, psychologically
enriching, and even a transcendent activity, with
crewmembers tending to voluntarily take hundreds of
pictures of earth [15]. Other available activities include
playing music, games, and reading [16]. In addition to
these activities and countermeasures, days in space have
generally been filled with work activity ranging from
science experiments to station maintenance. Notably,
there have been no major behavioural incidents reported
on the ISS.
While inhabitants of the ISS enjoy relative
comfort and communication with earth thanks to their
position in low earth orbit, future space missions will
explore environments far more isolated. Plans to further
explore the solar system through human trips to the
moon and Mars are beginning to take shape. While the
engineering problems are daunting enough, the human
element of these missions makes them all the more
challenging. For example, a one-way voyage to Mars
could last upwards of nine months from departure to
arrival, followed by a habitation period of a similar
length or longer. During this time, earth will shrink into
the background of space as a point of light (dubbed the
“Earth out of view phenomenon” [2]), and the
communication lag due to distance between the craft
and Earth will become as long as twenty minutes on
average [17]. Both of these factors will serve to further
isolate voyagers. Crew will also have to live in close
quarters for the entirety of the mission, leading to a
necessary emphasis on group living skills to combat
potential interpersonal problems [18]. Emergency
resupply and rescue missions from earth will be
impossible. A Martian mission will therefore depend
less on the resources of Earth and will instead be more
autonomous [2]. An increased level of autonomy could
lead to large swathes of unscheduled time for
crewmembers, which could increase the probability of
psychological issues. At the end of the two week
Gemini 7 mission, during which the only objective left
was to remain in space, the novelty of orbiting Earth
had ended and Frank Borman and James Lovell read
novels to fill the time. Of this period, Borman said,
simply, “the last three days were bad” [19].
1.3 Virtual Reality in Space: A Novel Approach
Borman only had to withstand three days of
monotony inside the capsule habitat of Gemini 7.
Imagine yourself in a similar capsule environment
except with the time scale multiplied by one hundred
and you will arrive at a better understanding of the
psychological challenge of long-duration spaceflight.
Namely, how will it be possible to keep a crew from
mentally unravelling as they inhabit a stress-inducing
environment for months or years on end? Novel
approaches will need to be developed, tested, and
implemented to help ensure the safety of crews and
missions. The purpose of this paper is to introduce the
probable use of virtual reality (VR) technology as a
mental health safeguard and to expand the conversation
with possible topics for future research.
In this context, virtual reality is understood as
technology that can visually immerse the user in a
simulated environment. This typically involves the use
of a headset, or head mounted display (HMD) that
occupies the user’s entire visual field. While VR is
commonly understood as a visual medium, it can also be
used to engage the other senses, for a truly “immersive”
experience [20]. What sets VR apart from other media
consumption platforms is the possibility of highly
convincing simulated environments. This feeling of
“presence” (realness) experienced when in a simulated
environment effectively means that VR may be used to
store many different locations and experiences for the
user to explore and enjoy at will [21].
The main advantages of VR as a means to
facilitate coping (and salutogenesis) are its potential for
68th International Astronautical Congress (IAC), Adelaide, Australia, 25-29 September 2017.
Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
3
flexibility, breadth, and effectiveness. VR is flexible in
that simulations are limited only by processing power
and creativity. Furthermore, VR could be used in
conjunction with monitoring technologies to become a
responsive system that adapts to the needs of individual
crewmembers. The possibility for infinite variations
means there is wide breadth of applications. To this
point, VR has been used in applications as disparate as
surgery, military training, the treatment of mental
disorders, and many more. As the technology improves
and becomes more accessible, this field will expand
further. Finally, the immersive nature of VR gives it the
ability to create a strong and convincing feeling of
presence. Improving visual realism and enhancing
audio-visual VR with touch, smell, and taste will likely
improve the presence of simulations.
2. Related Work
The development of VR technology has given rise
to multiple disparate applications and fields of research.
The uses of VR have a range that extends to immersive
gaming, astronaut training, pain management therapy,
and the treatment of psychological disorders. Research
has even been done on how VR can be applied to
increase empathy or to get people to use less paper
[22,23]. A full review of VR research literature is not
within the scope of this paper, but the above examples
briefly show how VR has become a useful tool in many
different fields.
The specific example of the use of VR in health is
of particular importance. A number of research efforts
have investigated the potential for the use of VR in the
medical field. A subset of these has investigated the use
of VR for mental health, and a yet smaller subset has
identified VR as a possible solution to the problem of
sustaining crew mental health on long-duration space
missions. This section will explore some of the progress
that has been made by research on how VR can be used
in mental health and psychosocial applications.
2.1 VR for Health Applications
In recent years, the cost of VR technology has
gone down, while its quality has increased. As a result,
more researchers have been able to run experiments
examining the possible uses of VR in medicine. Notable
examples include the use of VR for physical and mental
rehabilitation, and the treatment of mental disorders.
This is relevant to the need for mental health support on
long-duration space missions.
VR simulations have been shown to effectively
distract burn victims and cancer patients from pain,
resulting in decreased ratings of pain among inpatient
study participants [24]. VR has also been used to treat
eating disorders. Studies on obese patients have found
VR therapy to be effective in improving body image,
reducing emotional eating, and reducing depressive
symptoms [24,25]. Phobias have also been effectively
treated using VR. People suffering from fear of heights,
agoraphobia, public speaking anxiety, fear of flying, and
arachnophobia have been effectively treated using
exposure therapy delivered through VR simulations
[25,26]. In cases of comparison with standard accepted
treatments like in vivo exposure and cognitive
behavioural therapy (CBT), VR has been similarly
effective [26]. Symptoms of post-traumatic stress
disorder (PTSD) have also been significantly reduced
after VR therapy, with improvement remaining on
follow up (six months, in one study) [26,27].
Additionally, patients report high levels of acceptability
of the treatment [27]. VR therapy has even improved
cognitive function and reduced negative symptoms in
patients with Schizophrenia [25]. As a final example,
VR training has been shown to increase the chance of
receiving a job offer among schizophrenic and autistic
people [25].
These initial successes in the realm of VR applied
to mental health are promising signs. Widely accepted
VR treatment methods could mean accessible and
inexpensive treatments for many people. However, there
is a lack of high quality studies in this area, and many
gaps in research. More work must be done to show the
efficacy of these methods [24,26,28]. Widespread self-
treatment of psychological disorders is probably years
away. Even so, the potential for VR to emerge as a
serious option is significant enough to warrant further
investigations. In light of these results from health
researchers, VR for astronaut mental health becomes a
field of research with great potential.
While much of the research on VR for health has
concentrated on its use as a treatment for ailments such
as pain or psychological disorders like PTSD, less
attention has been paid to how it could be used for
maintenance of healthy mental states and prevention of
disorder. Prevention will be especially important in
long-duration space missions, as a serious behavioural
incident could have a large negative impact due to small
crew sizes and the general hazards of a space
environment. To stop a problem before it can occur or
move beyond initial stages is the ideal scenario.
2.2 VR in Space
VR has seen some use in space applications.
NASA has extensive VR capabilities that have been
honed for years. These capabilities are mainly used for
training astronauts. Immersive environments can be
much more effective for relaying certain types of
training information, which aligns with the principle of
“show, don’t tell”. Before going to space, astronauts can
strap into a harness attached to a crane system that
simulates microgravity while wearing a VR HMD in
order to learn how to perform a spacewalk or use a
specialized tool in space [29]. Augmented reality (AR)
68th International Astronautical Congress (IAC), Adelaide, Australia, 25-29 September 2017.
Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
4
technology has also been used on the ISS as a possible
replacement for a hardcopy instruction manual
[30,31,32]. So VR is not completely foreign to space,
but immersive technology has not yet been used to
improve mental health outcomes among astronauts on-
orbit.
2.3 VR for Mental Health in Space
Many research efforts have focused on the effects
of VR, but few have specifically investigated its use in
the maintenance of psychosocial health on long-duration
space missions. NASA has extensive VR capabilities,
but most of these have been used for training. There has
been interest in using VR for mental health in space,
though this has yet to emerge as a large field of study.
At least two research efforts are investigating the
potential of VR as a restorative/preventative mental
health measure with a specific focus on space
applications. Anderson et al. have found that exposure
to simulated natural scenes can reduce stress levels. The
researchers also point out that VR has advantages for
use in ICE environments due to its ability to relax users
in a private and confidential setting, and as a means of
escape from daily sources of stress [33]. Another effort
is called “A Network of Social Interactions for Bilateral
Life Enhancement” (ANSIBLE), which is a simulated
virtual world that includes interpersonal communication
designed to help preserve ties with family members
back on earth. Other features of ANSIBLE are virtual
games, artwork, simple AIs, environments, and other
activities that can be interacted with in a virtual
environment [34]. One notable detail is that ANSIBLE
is being developed specifically for astronauts on long-
duration missions. The progress toward VR for space
mental health applications that has been made in these
studies is ongoing.
3. Recommendations for Future Research and
Implementation
As VR technology improves, it will be easier to
create more realistic virtual spaces, and the ability to
design a convincing virtual environment opens the door
to novel methods of implementation. Further analysis is
required to better understand both the challenges and
benefits of various techniques. Below is a list of a few
topics of interest that may warrant further investigation
or validation.
3.1 Virtual Nature
The restorative and peaceful qualities of natural
settings have been known for generations and across
cultures. Today, this sentiment is supported by
Attention Restoration Theory (ART), which postulates
that exposure to natural setting can help reduce stress
response and increase focus by providing a stimulating
yet peaceful space on which concentration can focus
passively, allowing active concentration to “refresh”
[33,35,36]. These cognitive benefits have been
demonstrated through studies exposing participants to
real natural environments, simulated environments (VR)
and even still pictures of nature [33,35,36,37,38].
How beneficial can exposure to VR nature be?
Early results are promising, showing that a short amount
of time spent exposed to a natural VR environment can
reduce levels of stress, with additional subjective ratings
being largely positive [33]. A possible application of
VR+ART would be to use simulated natural
environments to reduce stress and improve
concentration and cognitive function on long space
missions. For astronauts who will not have the option to
step outside their capsule for a relaxing walk in the
park, virtual nature could be the next best thing.
3.2 Exercise and Virtual Environments
Crewmembers on the ISS are required to exercise
for at least two hours every day in order to combat the
physically degrading effects of space. If this trend
continues in future long-duration missions, the total
time spent exercising per year would be about a month.
Instead of spending this time staring at the interior of a
spaceship, astronauts could choose to use VR to run or
ride a bike in the environment of their choice. These
environments could range from calming and natural to
highly exciting and stimulating, or any other type of
setting/stimulus level. While natural scenes with water
and animals have been effective, some participants in
simulated ICE studies have responded positively to the
idea of urban scenes. These may create a sense of
normalcy among viewers in space, even though urban
environments have not been restorative for average
populations on earth [33,35].
One challenge in implementing VR for exercise,
especially running, is the potential for discomfort while
wearing a HMD. Today, most headsets available for
commercial use are bulky. Future developments may
need to reduce HMD size for this method to be effective
and acceptable to users. An additional challenge is the
problem of monotony in a simulated environment. Too
much repetition could defeat the purpose of immersion
in a stimulating environment. Implementing an
algorithm that automatically generates new areas of
environment as the user travels along could address this
problem. Developers could look to the example of the
immensely popular video game, Minecraft, in
attempting to construct such an algorithm.
Studies have noted the importance of perceived
control over personal environment and actions [9].
Additionally, it is likely that preference in VR
simulations will not be uniform across astronauts. For
these reasons, having a large range of choices available
for users may result in the maximum positive outcome
for a group.
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Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
5
3.3 Virtual Windows, Augmented Reality for Team
Cohesion
So far, immersive VR has been the only method
discussed. Another technology that may find use on
long-duration missions is Augmented Reality (AR), in
which a headset or glasses enable the user to see his/her
real surroundings while supplementing them with
simulated overlays [39]. While losing some of the
advantages of immersion, the ability to experience
augmented reality without completely blocking the
visual field could be useful in a different range of
activities, and has already been investigated as an
effective means of relaying procedural information in
space, as opposed to reading a manual [31,32].
A future use for this technology may be the
addition of a virtual view out an existing real window,
or a simulated virtual window. Kearney points out that
virtual windows are desirable by crew and can reduce
stress, in the same vein as the ideas of ART mentioned
above [20]. An AR setup could be used to project a
view of Earth or an Earth environment onto an existing
window, supplanting the consistent blackness of space.
This could provide a much greater feeling of presence
and depth when compared to 2D display virtual
windows that have been proposed.
Such a view could be constructed in an immersive
VR setting, but AR would allow crewmembers to share
the view of their real surroundings, as well as a view
through a virtual window. Sharing in positive
experiences could benefit team cohesion. The
importance of windows has been noted among astronaut
populations and others [2,15,40]. Among ISS
astronauts, one of the most frequently cited rewarding
experiences is the view of Earth from space [15,40],
which takes up a large portion of the visual field when
viewed from windows on the ISS. This transcendent
view could be recreated using VR or AR, which could
be one solution to the problems that may be caused by
the “earth out of view” phenomenon.
The view of earth has been met with universal
acclaim among astronauts, but a virtual window would
be capable of simulating any view. This could be used
to create scenery that might not be advisable for fully
immersive VR simulations. Dangerous wildlife,
underwater locations and the like could be viewed
through a virtual window that acts as a protective barrier
separating the outside environment from the safety of
the inner environment.
3.4 Simulated Social Interaction
As artificial intelligence (AI) develops alongside
VR, there is a chance that the two may be combined to
allow for simulated social interactions within a virtual
world populated by virtual agents. This could allow
crew to feel as though their “social sphere” is larger
than the few crewmembers they are able to interact with
directly, and could counteract the negative aspects of
social isolation. Further research on producing
convincing AI and human-AI interaction is necessary.
Another possibility to consider is the ability to interact
with other VR users in real time. Simulations do not
have to be “single player” but can include other crew
who can participate in a collective experience. In this
light, VR can be used as a multi-user method for
increasing team cohesion.
3.5 Entertainment: Games, Media
A platform such as VR naturally lends itself to
entertainment media applications. Most mass-market
VR applications are games or programs for
entertainment value. This may translate well to the
problem of filling large amounts of free time on long-
duration space mission. Video games have proven
themselves to be highly entertaining and captivating
activities. The maximal level of immersion offered by
VR as an entertainment platform means that VR games
have the potential to surpass traditional (2D) games in
overall entertainment quality.
Games can even become problematically
engrossing, a fact that most parents could probably
attest to. Even so, the positive effects of games have not
gone unnoticed. Using games to promote mental health
has become a research topic of interest [41,42,43].
Casey indicates that the positive effects of games can
include the promotion of autonomy and competence
through emotional engagement while reducing negative
behavioural issues like anxiety, insomnia, social
dysfunction, and stress [41]. So it seems that, when
done right, games can be not only entertaining, but also
health promoting. In space, VR video games could go a
long way toward maintaining the health of astronauts.
Other forms of entertainment could also be
explored. VR can be used as a platform to take in more
conventional forms of media like books, movies, videos
from home, and the like. As previously stated, variation
and choice in experiences can be an important factor in
mitigating boredom in space, so a large variety may be
the best approach.
3.6 Simulate Larger Volume, Mutable Habitat
The habitable volume for astronauts on a long
duration mission will likely be less than what they are
used to on earth, with the added hindrance of extended
confinement. Crowding in a capsule environment could
be a serious problem that impacts team cohesion and
stress. A possible solution to the problem of crowding is
the construction of a virtual private room that would
effectively increase the perceived habitable volume.
Because of the value of a sense of control over one’s
environment, the features of this space should be under
the control of the user. A virtual private area may be
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Copyright ©2017 by The Ohio State University College of Engineering. Published b ythe IAF, with permission and released to the IAF to publish
in all forms.
6
used as a “hub” of sorts, or a station in which the user
avatar begins the virtual experience, which could lead to
different activities such as viewing nature, playing
games, or watching videos from earth. A similar
approach has been taken through the design of
ANSIBLE, as mentioned previously [34].
3.7 Practical Constraints and Hardware Considerations
3.7.1 Effects of Microgravity
How will astronauts navigate their virtual
environments? Nausea, vertigo and balance problems
may result if visual cues do not match the signals of the
inner ear [44], so outside the influence of gravity,
ambulation within a virtual environment may be
rendered obsolete. Will VR users in space simply be
able to float around in simulated environments? If so,
how would this impact the presence (realism) of the
simulation and its effectiveness?
3.7.2 The Social Impact of VR
Difficult to predict is the impact the use of VR
technology would have on team dynamics. It could be
that attitudes toward VR among crewmembers are
positive due to the effectiveness of the simulations in
providing a convincing environment for relaxation or
entertainment. On the other hand, it is possible that VR
may not be well received and instead viewed as a
novelty without many benefits. At least some of the
attitude towards VR may be enforced by norms within a
group that evolve over time [10]. Further work is
required to determine how the use of VR will affect and
be affected by group dynamics.
3.7.3 Hardware and Implementation
What are the spatial costs associated with VR on
long-duration missions, in which crew are already
limited to a small environment? What compromises will
have to be made for flight readiness criteria? What will
be the energy costs associated with detailed
simulations? How will answers to all of these questions
change in the years between now and when a long-
duration mission is ready to launch? Kearney brings up
these and other important practical concerns in
considering immersive virtual environments as a
countermeasure in space [20].
4. Conclusions
There will be a great need for preventative
measures on long duration missions to colonize the solar
system. Crews must be able to perform at peak levels
throughout the duration of the mission in order to
complete objectives and address potentially life-
threatening problems that could arise. The possibility of
using immersive virtual reality to help mitigate the
psychological problems crews will face has received
limited attention to date. Since VR simulations could
serve as effective countermeasures for astronaut mental
health due to the flexibility and realism of VR
technology, these novel approaches to the problem of
space mental health warrant further investigation.
Acknowledgements
Our thanks are due to Dr. Jay Buckey for the
critical insights and advice he provided, and to Adam
Sauer for demonstrating to us the power and flexibility
of VR.
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