Is VR Bad for Your Brain? A Neurosurgeon's Expert Opinion
This is an interview by our founder, Kristen Jenson, with Dr. Donald Hilton. Dr. Hilton is a neurosurgeon and a member of our Defend Young Minds Advisory Council (see end of article for full bio). This interview was recorded September 9, 2022. Transcript has been edited for clarity. Watch or read below.
KRISTEN: Hey everyone! I am Kristen Jenson, the founder of Defend Young Minds. Today I am really excited to have Dr. Donald L. Hilton, Jr. with us. He’s going to answer questions about Virtual Reality and how it affects the growing brain of children and how it can be such a strong influence [on them]. We need to be cautious as we have this new technology at our disposal, so I know this is going to be really interesting for parents out there.
This technology is here and it’s not going away anytime soon, so it’s really good for us to learn all we can about it.
First, let me introduce Dr. Hilton. He is a board-certified neurosurgeon in San Antonio, Texas. He has previously served as adjunct associate professor of neurosurgery at the University of Texas Health Science Center in San Antonio and as a Director of the Spine Fellowship and the Director of Neurosurgical Training at the Methodist Hospital. He’s currently serving as Vice Chief of Staff at Stone Oak Methodist Hospital. He has almost three decades of neurosurgery experience.
He’s done so much work outside of neurosurgery as well. He’s authored peer-reviewed articles and book chapters on addiction. He’s well-known throughout the world on the topic of addiction.
He also serves on the board of the National Center on Sexual Exploitation and he’s served on the board of the Society for the Advancement of Sexual Health. He’s spoken at numerous symposiums and forums showing how pornography is a public health issue in the United States and internationally. He’s testified in Congressional Hearings at the U.S. Capitol Building and spoken at the Polish Parliament building in Warsaw and the Vatican Conference in 2017.
He has so much experience and we are so privileged to have him here with us today to talk with us about Virtual Reality and its effects on the brain.
Welcome, Dr. Hilton, and thank you so much.
DR. HILTON: It’s good to be with you Kristen.
How does VR affect the brains of children and teens?
KRISTEN: What does the research say about kids–teenagers and younger–using VR headsets? Are there any concerns at all that anyone has raised out there in the academic world or in the medical world?
DR. HILTON: To my knowledge–and I’ve just done a cursory search of the literature–there's not a lot of research on children using VR sets. In fact, there’s a lot of caution. Some of the VR makers are even recommending that young children not use the sets at this point. There’s warnings for under 13, given the whole issue of even the internet and what that does with social media, for instance, to children with a developing brain.
Even with adults, there’s not a lot of research on VR and what that does. There is an interesting article that came out recently, though, published in a journal called Computers In Human Behavior. The title of it, interestingly, is Virtual reality induces depersonalization and derealization: A longitudinal randomised controlled trial. This was not a VR pornography study. This was looking at mainly VR gaming.
KRISTEN: What is depersonalization and derealization? Could you explain those terms?
DR. HILTON: The acronym for it is DP or DR or they are combined as DPDR. DPDR is essentially defined as being in a matrix-type world that’s not real. To the point where the person actually feels like they’re part of that medium and they are separated in a sense from the real world. The virtual world kind of becomes their real world. And there’s a blurring of what is real. The brain is tricked into thinking they do live in this second life, virtual, matrix-like world.
The virtual world kind of becomes their real world. And there’s a blurring of what is real.
It’s an interesting article. This was actually published in June 2022, it just came out a few months ago.
Basically, the summary was that based on just this study, they can’t conclude that it induces long-term deficits at this point (because VR is so new), but what they are saying is that there are certainly people subjectively saying that they feel [disconnected from reality]. There is a call for more study, but they say, “Trusting reports on internet forums, a substantial number of people have developed unpleasant symptoms of depersonalization (DP) and derealization (DR) after virtual reality (VR) consumption.”
The initial study says, “While we can’t show objectively that there’s long-term harm [because this is all new], there is a concern.”
I think this is an interesting study, not necessarily in it giving us long-term results, but just saying that it’s enough of a question in enough people that they did a study about people complaining of depersonalization/derealization from just gaming. [There was] enough of an alarm bell that they did this study.
KRISTEN: Let’s talk a little bit about just a game. A game that has violence in it. Is that going to traumatize a child more if it’s VR or if it’s just a game on a [flat] screen?
DR. HILTON: I don’t think there’s any question about it. But as we’ve said, I’ve read a few studies that don’t really tell us much yet, but they just show that the questions are being asked.
Now, having said that, my wife and I have had one experience with virtual reality. We were at a conference addressing the pornography problem.
They had someone there doing a VR demonstration where you put a headset on. There was a girl who had been trafficked and she had been interviewed. She told what happened–not in graphic detail, but she just explained how she had been stolen from her family, I think in South America. So you put this headset on and she told you her experience.
[You feel like] you’re standing in this room with her as she’s telling this story. It was surreal. She was 3D, it felt like you could reach out and shake her hand. Then you looked to your left and there was a window. You looked out and in the street you could see things going on out in the street. And you look to your right, you could turn around and look at the wall behind you. It was absolutely amazing.
I remember, Jan [my wife] and I both did it and it was so real. It almost brought you to tears when she told this terrible story of what happened to her. The only thing was, when I looked down I didn’t have any feet. I didn’t exist–my body wasn’t there. So that was where there was a big difference with the real world and the VR world. But it was pretty dramatic. It was pretty remarkable actually.
KRISTEN: I don’t want to say that all VR is bad. VR is technology and we can use it for good and I know there are going to be many good uses for VR. But we have to also be cautious.
I think that answers the question. Because it is such an impactful experience that anything that’s happening there is going to trick the brain even more. It’s going to make the brain feel more. As it is, when you’re watching a movie and you get to a really suspenseful part–scary or whatever–you can feel your heart rate going up, so your brain thinks it’s in a dangerous situation just with a flat screen. Imagine how much more it’s going to react when it’s got the whole VR headset and feels like it’s right there.
I don’t want to say that all VR is bad. VR is technology and we can use it for good and I know there are going to be many good uses for VR. But we have to also be cautious.
So again, I would just caution parents. And I think you probably would, for being careful with using this technology on young children.
DR. HILTON: There are several other studies–and these are mainly in the journal Computers In Human Behavior–and one of them is The impact of immersion on the perception of pornography: A virtual reality study.
In their summary, they say “It thus appears that experiencing pornographic video stimuli in high-immersive virtual environments increases the experience of presence as well as sexual-related perception.”
Not surprisingly, common sense would say that it should be a more immersive experience sexually to be in a VR world, than to be on just a computer screen. It makes sense and that’s what they confirmed in their study.
Another study states, “Clearly the immersive capabilities of technology are not the only and likely not the strongest predictors of sexual arousal, but there are concerns that it could exacerbate compulsive pornography consumption.” They say maybe it’s tempered by the fact that it doesn’t really immerse completely, but there’s the concern again.
These are early studies. We don’t have a lot in terms of telling us this is dangerous.
This other [study], though, is a study on the global market of VR porn and how it’s essentially going to become a major market force in the technology world and that up to 60% of all VR programs now are pornographic. If you think about gaming and other things being 40% or less, and porn is already 60% of what’s being developed for VR.
Up to 60% of all VR programs are now pornographic.
Which goes back to when Oculus was purchased by Meta–which is Facebook’s parent company–the owner of Oculus said that really everyone felt that VR pornography would drive the Oculus headset. But when you ask people in the forums in the mainstream business world, they’ll say ‘VR porn, what’s that?’ And then he said, sarcastically, that behind the scenes, they were depending on VR porn to drive VR technology, such as Oculus.
It’s definitely–as you mentioned in your opening, Kristen–going to increase. So I think the question we all have to ask ourselves is–clearly it’s more immersive, it’s clearly a different world where there’s early studies–people are starting to look at virtual reality gaming and pornography and ask questions about depersonalization/derealization–
So what does that mean for us? What do we do with our children? Do we all go out and buy VR headsets and let them sit around?
That’s a rhetorical question. I have some thoughts on that.
KRISTEN: Yes, and we’re going to get to that.
You already mentioned that VR definitely enhances the experience. It’s more immersive. We feel like we’re in that world to a greater degree, that it’s actually causing people to feel that blurring–wondering “Was I doing this in VR? Was I doing this in real life?” And having that blurring. So I would think that is troubling, and that could be a problem especially with children. Especially younger children who already [get confused] with fantasy and reality.
Again, we’re just trying to keep up with what’s happening and what we know now. There’s going to be a lot happening in the next few years and we just want to be on top of it.
KRISTEN: In terms of using VR with pornography–you mentioned that 60% of VR material out there is pornography right now. So we can see that the industry is taking advantage of this new technology and driving it. And I think you seem to believe that–although we need more studies–it could be even more addicting than pornography on a flat screen, because it is so much more immersive. That makes sense, but we’ll have to wait for the science to get there, right?
DR. HILTON: Let me answer that this way–and my reference for this is an article from a couple of years ago from Insider Magazine from 2019: Why People Use Virtual Reality Porn and What Psychologists Think. That’s where they say an estimated 60% of the top virtual reality websites are porn sites. Which means, VR adult entertainment is big business, and that’s expected to increase.
There are two other articles–the LA Times had an article where they estimated that 50% of everyone with headsets uses it for porn and another one said that 78% of men who had headsets will use it for porn. Again, they really couldn’t show a reference, but most people are saying that VR headsets are going to be used for porn in many cases.
We personally know a man who’s in his forties who purchased a VR headset and his 15/16 year old son accessed [porn] at least once and perhaps twice and he had no idea and later the young man came out [and told his dad]. And of course, teenagers are [tech] savvy, so he had already accessed it.
The thing to remember is the way that VR is filmed–it’s filmed with multiple cameras and it’s filmed from a point-of-view perspective and typically a male point of view perspective, although I’m sure to meet the increased demand for female-centered pornography that will also be varied to catch that viewership as well.
But [right now] with this point of view really focusing on males right now, essentially when they film it’s from the vantage point of the male pornography performer and so the person literally has the impression that they’re having actual sexual relations with this female performer. So they become almost an Avatar in this virtual world.
So to say that it’s going to be more immersive and wait for science, I personally don’t need to wait for that. To me, just what I know about the brain and human physiology, and everyone that’s used it–people on forums who are trying to quit pornography say that this is way harder for them. One of them said he wished he had never seen VR. Compared to conventional pornography it’s just much more difficult for him to think about stopping in terms of the impact on his reward system.
He wished he had never seen VR.
A cautionary tale from history
DR. HILTON: Just for perspective, I like to think of it this way: William Halstead is the father of American surgery. He trained Harvey Cushing who is the father of my field–neurosurgery–back 120 years ago. First at Johns Hopkins, then Cushing went on to Harvard. But Halstead, where he essentially pioneered modern surgery at Johns Hopkins, his residents that he trained essentially established different fields of medicine. So he’s a real pioneer.
While he was pioneering medicine, he found that you could put a solution in the eye to operate on someone’s eye that would anesthetize it and allow you to do surgery, which before you can imagine how painful it was to operate on someone’s eye without anesthesia. This was a -caine solution, like lidocaine. But this was CO-caine. It was a cocaine solution they would put in your eye and it didn’t make you high, it just numbed your eye. And cocaine solutions are still used today.
This was brand new. It was new technology. And they found that when you’re off and you’re not doing surgery, you can take a whiff of this stuff and it gives you a real buzz. And it’s harmless. It’s just a nice buzz. So William Halstead became addicted to cocaine before they even knew that it was addictive. Then they treated his addiction to cocaine with morphine. So he had a double addiction and there’s a fascinating book about it–he still developed surgery even though he struggled with his addictions throughout his career.
And I think this VR technology is similar. Cocaine and other drugs have uses that are wonderful in medicine and applications that bless our lives. VR headsets are used in simulations and flight training and surgical simulations–VR is going to be fantastic.
But it’s powerful.
It’s powerful technology and it’s new. To think that we can create this reward system trap that will be designed to be maximally captivating to our eyes and our brains, and think we can just walk away from that, is naive.
KRISTEN: It is. We really have to respect the power of virtual reality. As parents, as grandparents, it’s important for us to be cautious when we are introducing this to our children.
Dr. Hilton’s recommendation on VR for kids
KRISTEN: Let’s just wrap this up. You said you had some of your own thoughts about kids and VR. So spill it! Let’s hear your own opinion.
DR. HILTON: I think we need to be very cautious with children and VR. Just as we are cautious with gaming and emerging adults and children, teenagers. They don’t have a stop button. Like “Do you want broccoli or do you want high sugar?” They’re going to choose the high sugar. And this is really high sugar for their brain, in a sense, and I think we need to be very, very cautious about VR with children–particularly VR headsets.
For instance, even an adult man who has struggled with pornography, then it’s going to be very tempting for this person to use it for VR applications, and when they do it’s a pleasure reward that they won’t easily forget. The curiosity will definitely cause that cat to go back for more, so to speak, and can kill the cat.
So I just think that it needs to be understood that this is really powerful technology. There’s going to be obviously some great ways to use it, but it needs to be respected.
Just as we don’t leave loaded guns lying around. VR headsets and VR technology needs to be given the respect that it’s due given the dangers inherent.
KRISTEN: And I think some kids are going to be more susceptible. Parents can see [if their child] already has a problem with screen time, they already have a problem disengaging just from a flat screen, then you may want to hold off on VR until they’re much more mature and have that thinking brain developed quite a bit more.
Dr. Hilton, thank you so much for being with us and for explaining some of the research and bringing up some of these points about VR and expressing how powerful it really is and how powerful it can be.
Of course, we’re not here to tell any parent what to do, but we are here to provide some educated opinions and some good information.
Thank you so much and we look forward to talking with you again on other topics.
DR. HILTON: Thank you, have a great day.
Donald Hilton, M.D. is a board-certified neurosurgeon specializing in minimally invasive spine surgery. Dr. Hilton graduated cum laude with his medical degree from the University of Texas-Galveston in 1988. He continued towards a surgery internship and later residency training in neurosurgery at the University of Tennessee.
Dr. Hilton is nationally recognized for developing the first tubular dilating system, designed to be used collaboratively with a three-dimensional microscope. This system has widely impacted surgical treatment for herniated discs, degenerative joints, and spinal stenosis. In addition, Dr. Hilton is recognized as one of the Best Doctor’s in America for the past 8 years, as well as a Texas Super Doctor. He is a published author of several book chapters, peer-reviewed journals, and his book He Restoreth My Soul.
Dr. Donald Hilton has spoken nationally and internationally concerning minimally invasive surgery and is a member of several medical associations including the American Medical Association, Texas Medical Association, Texas Association of Neurological Surgeons, AANS Joint Section on Neurotrauma and Critical Care, and the Congress of Neurological Surgeons. Additionally, Dr. Hilton is venerated for his work presenting the neurological impact of pornography addiction on the brain, receiving the Guardian of the Light award from Lighted Candle Society alongside his wife in 2008. He is a highly respected and acclaimed team member of Neurological Associates of San Antonio.
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"I really like the no-shame approach the author takes. It's so much more than just 'don't watch or look at porn.' It gave my children a real understanding about the brain and its natural response to pornography, how it can affect you if you look at it, and how to be prepared when you do come across it (since, let's face it... it's gonna happen at some point)." -Amazon Review by D.O.