Gary Galambos Talks Technology and Psychiatry at The RANZCP 2024 Congress

Associate Professor Gary Galambos spoke at The Royal Australian & New Zealand College of Psychiatrists (RANZCP) conference in Canberra in June, about how the clinical care of people with mental ill health can be enhanced.

The topics that received the most excitement were about innovative technologies that Gary has been researching and developing, which promise to bring more efficiency, effectiveness, and teamwork to private practice. What also captured his colleagues' attention, is that these translational interventions are currently being implemented in the clinical care of young adults being treated in an early intervention mental health service in Sydney.

MindSkiller Exposure Therapy 2D

Gary was inspired to develop a digital exposure therapy intervention out of frustration that no commercial products had yet been developed for people with Obsessive Compulsive Disorder (OCD). Exposure therapy is the gold standard treatment for OCD, and being a visual medium, a digital interface makes intuitive sense to be utilised for this purpose.

Exposure therapy refers to Exposure and Response Prevention (ERP) for Obsessive Compulsive Disorder (OCD) and other disorders, where the patient needs to be exposed step by step to the subject of their anxiety.

MindSkiller Exposure Therapy 2D is being accessed by his patients via MindSkiller, a specialist-grade digital mental health platform that was founded by Gary. The 2D therapy allows patients to undertake exposure tasks using their own device (PC, tablet, or mobile), and tailor the exposure therapy plan to their particular obsessions or compulsions, such as fear of contaminants, uncertainty, hazards, asymmetry, or superstitions, before moving on to the next step.

Gary's colleagues were impressed that the 2D Exposure Therapy intervention has been interconnected with a VR headset so that patients can transfer the data captured in the 2D program onto the VR version.

Exposure Therapy VR

Gary also spoke about Virtual Reality Exposure Therapy (VRET) at the conference. The VR Headset prototype has been developed in partnership with DP Immersive, which takes Exposure Therapy a big step forward. It enables the user to undertake their exposure to anxiety-provoking obsessions and compulsions in an hyper-realistic immersive VR environment. Being more immersed induces a stronger emotional reaction, which enables effective re-learning of underlying brain circuitry causing any irrational fears.

A cutting edge addition to the VR bundle is a programmable scent device introducing olfactory stimulation, which amplifes the immersive experience further for the user.

This VRET intervention can be used as a standalone method of Exposure Therapy, which is how it is being introduced into the Uspace OCD Program, where inpatients have exclusive access to this emerging technology. It can also be used in concert with Transcranial Magnetic Stimulation (TMS) TMS treatment for OCD.

This ground-breaking intervention is about to be piloted in Uspace, the Young Adult Mental Health unit at St Vincent's Private Hospital (SVPH) in Sydney, where Gary is Medical Director.

MRI-Guided Transcranial Magnetic Stimulation for OCD

This is another cutting-edge technology that attracted a lot of interest at the conference. In 2023, A/Professor Galambos developed a partnership between VisionTMS and Uspace to create an MRI-guided TMS statewide service for young adults with treatment-resistant depression.

It was a first for NSW to be able to offer a decentralised outpatient MRI-guided TMS to young adults with community radiology clinics rather than TMS psychiatric practices. This was so well received that in 2024, Gary and his team introduced an MRI-guided TMS service for OCD using 2D Exposure Therapy with a view to add a VRET option.

AI-assisted Psychometric Testing

The next exciting innovation Gary spoke about was AI-assisted psychometric assessment for OCD, that his Uspace research team are in the process of seeking ethics approval.

Gary’s vision is to enhance early intervention by connecting mental health education, help-providers, services and technology, such as the above, through a patient-centred ecosystem at the heart of which is MindSkiller. Launched in September 2023, MindSkiller facilitates shared care by giving clinicians the ability to access clinical care pathways, management plans and outcome measures in private practice.

• Contamination - with urges to clean and avoid germs, diseases, bodily fluids, and perceived harmful substances like toxins.

• Order and symmetry - leading to organising, repeating, and hoarding.
• Doubt - leading to constant checking and reassurance-seeking.
• Superstition - giving rise to urges to count, tap and touch.
• Fear of danger and aggression - leading to mental rituals, constant safety-checking, and even self-harm.
• Morality and doing the right thing - causing strict rule-following, urges to confess, extreme fear of making mistakes, and reassurance-seeking.

"They [the conference attendees] were really delighted that someone was working on all of this to try to improve efficiency and effectiveness and teamwork in the private sector,” says Gary, summing up the excitement his lecture generated at the conference.