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Cedars-Sinai Creates an Avatar for Mental Health Treatment

Analysis  |  By Eric Wicklund  
   February 05, 2024

The Los Angeles health system has launched XAIA, an AI-enhanced VR app designed for use with the new Apple Vision Pro headset

A health system pioneer in the use of AR and VR technology is launching a new VR app for mental health—to be used with the new Apple Vision Pro headset.

Cedars-Sinai, which has been using AR and VR for several years for a variety of treatments, last week unveiled the XAIA (eXtended-reality Artificially Intelligent Ally) app, giving users what the Los Angeles-based health system calls an “immersive therapy session led by a trained digital avatar, programmed to simulate a human therapist.”

Healthcare organizations have long experimented with AR and VR in areas like labor and delivery, pain management, pediatric care, neurological care (including concussion diagnosis and treatment), and behavioral health. The form factor holds promise for both inpatient and home use, and as an educational tool as well as a clinical tool.

“Apple Vision Pro offers a gateway into Xaia’s world of immersive, interactive behavioral health support—making strides that I can only describe as a quantum leap beyond previous technologies,” XAIA co-founder Brennan Spiegel, MD, MSHS, a professor of medicine, director of health services research at Cedars-Sinai and a pioneer in researching and using the technology, said in a press release. “With XAIA and the stunning display in Apple Vision Pro, we are able to leverage every pixel of that remarkable resolution and the full spectrum of vivid colors to craft a form of immersive therapy that’s engaging and deeply personal.”

Cedars-Sinai’s strategy here is to connect its new app with Apple’s latest consumer-facing technology, marrying consumer marketing with clinical use cases. XAIA was created by Spiegel and Omer Liran, MD, a psychiatrist at Cedars-Sinai, and is licensed by the health system for commercial sale through a spinoff company created by Spiegel and Liran called VRx Health.

The app is designed to take the user into a “spatial environment,” such as a beach or meadow, where an AI-enhanced avatar programmed to simulate a human therapist guides the user through a variety of treatments, including meditation and deep breathing exercises.

Last year, Spiegel and his team tested XAIA on 14 patients living with moderate anxiety or depression. The results of the study, published in the online journal Nature, indicated patients “described the digital avatar as empathic, understanding, and conducive to a therapeutic alliance.” Though some still preferred a human therapist.

“Virtual reality (VR) employs spatial computing to create meaningful psychological experiences, promoting a sense of presence,” Spiegel and his team explained in the study’s abstract. “VR’s versatility enables users to experience serene natural settings or meditative landscapes, supporting treatments for conditions like anxiety and depression when integrated with cognitive behavioral therapy (CBT). However, personalizing CBT in VR remains a challenge, historically relying on real-time therapist interaction or pre-scripted content.”

“Advancements in artificial intelligence (AI), particularly Large Language Models (LLMs), provide an opportunity to enhance VR’s therapeutic potential,” they added. “These models can simulate naturalistic conversations, paving the way for AI-driven digital therapists.”

The research is still a work in progress, and the researchers said the app should be used to augment human counselors rather than replace them. The study noted that XAIA sometimes questioned a patient too much, as a less experienced therapist might do, or reverted to explaining coping mechanisms rather than further probing why a patient was struggling. In addition, the app also occasionally recommended a treatment without going into detail on why it would work.

“These results provide initial evidence that VR and AI therapy has the potential to provide automated mental health support within immersive environments,” Spiegel said in a separate press release supporting the study. “By harnessing the potential of technology in an evidence-based and safe manner, we can build a more accessible mental healthcare system.”

“The prevalence of mental health disorders is rising, yet there is a shortage of psychotherapists and a shortage of access for lower income, rural communities,” he said. “While this technology is not intended to replace psychologists—but rather augment them—we created XAIA with access in mind, ensuring the technology can provide meaningful mental health support across communities.”  

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.

Photo credit: Photo courtesy Cedars-Sinai


With the nation in the midst of a mental health crisis and trained therapists in short demand, healthcare organizations are experimenting with AR and VR to improve access to care and bring new treatments into the home.

Cedars-Sinai, a pioneer in the use of AR and VR technology in healthcare, has created an app that, when used with Apple’s new VR headset, takes the user into a calming environment and uses an AI-enhanced avatar to offer treatment and resources.

Researchers say the avatar can guide users through cognitive behavioral therapy (CBT) treatments and recommend resources, and should be used to augment treatment rather than replace therapists.

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