When Planned Parenthood first invited me to see its virtual reality film Across The Line, I thought the focus would be on the many hurdles women face seeking reproductive health care in Mexico — that line could be the border, over which are some of the strictest abortion laws in the world. But then, physical walls aren’t all that bar women from reproductive health care, and that’s what the film hopes to make clear.

At showtime I don goggles and find myself with a 360-degree view of a clinic where Dr. Raegan McDonald-Mosley, chief medical officer of the Planned Parenthood Federation of America, is comforting a visibly shaken patient named Christina who has just been driven through an anti-abortion protest. These are real women, not actors, reenacting something the organization’s employees and patients routinely experience: a gauntlet of verbal harassment they must cross to make it to a clinic’s front door.

Next we’re riding in the backseat of a car as Christina’s friend tries to find the entrance to the center. The driver slows as she sees lines of protesters, many with detailed pleas on cardboard signs — the only word I can make out is “rape,” with a question mark. When Christina cracks her window to ask for directions to the health care clinic, a man tells her it’s an abortion clinic and that they’ll perform the procedure up to 30 times that day. He softens his tone, inches closer into the window, and says, “Look, there’s a place that’s very safe down the street … let me take you there, please. Please.”

It’s creepy, but this isn’t the worst that the 2.5 million men and women who annually visit Planned Parenthood hear, as I see next in an animated scene where I’ve stepped into Christina’s shoes. On the sidewalk in front of an unnamed women’s health center, men and women close in on me, unleashing a stream of moral accusations and curses — to the left, a man calls me a wicked woman, then a tearful woman asks how I can demand my rights if I’m not willing to protect those of a child. The most brazen is a young man to my right, who says, “Just walk in here with a smile, right? Right into a murder clinic… God’s going to destroy you in a pit of fire and you won’t be smiling then,” before he calls me a “wicked jezebel feminist” who “shouldn’t have been a whore … sleeping with every guy at the club.”

He spits his words with a ferocity that causes me to sit straight back in my chair, tense as if ready to run or fight. He doesn’t know anything about me, just like the man pleading with Christina knew nothing about her — or the services performed at Planned Parenthood for that matter. Abortions accounted for a mere 3 percent of the nearly 11 million total services its clinics provided in 2013, and McDonald-Mosley told Medical Daily that most of the women seeking these procedures are already mothers.

But regardless of what is and isn’t available at Planned Parenthood, this is just not how to treat people, McDonald-Mosley said, which is why her organization has made the film: to drive home what it feels like today in front of clinics across the country.

“Imagine how you would be if you were in a vulnerable situation just going to see your health care provider,” she said. ”Imagine the care that you would want. The experience you would want.”

Activists participate in the 2016 March for Life January 22, 2016 in Washington, D.C. Alex Wong/Getty Images

Playing on an audience’s emotions to inspire a new perspective is something people have done for more than 2,000 years, but the medium is new. We’re still learning how virtual reality can shape our emotions, but early research suggests that it’s a more powerful storytelling tool than any we’ve had before for inspiring empathy and reshaping how we relate to others and to ourselves.

‘Storytelling is where it’s at’

Up until recently, immersive virtual reality (VR) has almost exclusively been talked about in the context of video games. Some research suggests that the technology makes violent video games damagingly realistic; that the intense death and violence increases a player’s risk of becoming antisocial, aggressive, and less empathetic. But a 2015 study on nonviolent video games found that being immersed in a virtual world is not unlike diving into a great story — players transported to other times and spaces feel as if they’re going on a real journey, making it easier to relate to the protagonist's fate. The more players engaged with the narration in nonviolent games, the more meaningful choices and relationships they made. This suggests that in the right context, immersive VR can affect theory of mind, the cognitive ability to take on different perspectives and assess other people's emotions, beliefs, hopes, and intentions. 

Theory of mind helps foster empathy, which some people lack, however, an impairment is thought to play a role in clinical disorders such as autism and schizophrenia. Researchers are excited about VR’s potential as a tool to build empathy and help with clinical diagnostics and treatments.

Jeremy Bailenson, founder of Stanford University’s Virtual Human Interaction Lab, sees virtual environments as psychological states in which individuals can perceive themselves in new ways. Along with perfecting the technology, he wants to get a greater handle on its psychological effects. His is the first lab to study the effects of VR over the long-term, with approximately 1,000 participants participating in a wide range of empathy scenarios that deal with prejudice, bullying, and other social ills. At his lab, researchers create and manipulate VR representations of users in an attempt to fool their brains into changing their behaviors.

In one experiment, researchers altered college students’ avatars to look like their 65-year-old future selves and found they were willing to put away twice as much money in savings than those whose avatars were unchanged. Bailenson said the visceral experience of seeing yourself older as opposed to just thinking how one day that will be true creates a “deeper connection to your deeper self.”

If VR can build that kind of connection in other cases, it could be a powerful tool. “What we need to think about are the wonderful things we can do in virtual worlds that can make the world a better place,” Bailenson told PBS Newshour.

This work may not have inspired Across The Line outright, but it gives executive producer Molly Eagan heart. Eagan, who also serves as Planned Parenthood’s vice president of patient and employee experience, told Medical Daily that she’s “not a film or a technology person, but I am an empathy person.” When she connected with the film’s creative team, they were interested in using both virtual reality and computer-generated graphics to relay this issue of bullying outside health centers in a “stickier way.”

“That’s what’s compelling to us about this,” she said. “Could we help somebody understand how important health center safety is and raise the issue of how ugly the bullying has gotten?”

ATL poster The poster for "Across The Line." Planned Parenthood

Planned Parenthood is currently analyzing a survey they gave to audience members to measure the impact of the film and how it may have affected viewers’ understanding of stigma and their opinions about bullying. Based on the work Bailenson has done, Eagan already suspects it’s had a meaningful impact. Planned Parenthood executive vice president Dawn Laguens agrees.

“Storytelling is where it’s at,” she said. “It brings life and new technology to the issue.”

Embracing emotion

Technically, social psychologists have been creating virtual environments for decades using hard scenery, props, and real people. This work can be laborious, and it’s limited by real-world constraints and ethical considerations for actors. Today, computers have cleared away many of these obstacles. “Digital object models need only be created once, a fact now well known among digital effects creators in the movie business,” according to one of Bailenson’s studies. But this technology is more than convenient — it has a stronger effect than traditional and 3-D movies. And because digital representations can be tracked and manipulated during the experience there are unique possibilities for social interaction.

Immersive VR helps people become more aware, Jonathan Gratch told Medical Daily. He is the director for virtual human research at the University of California’s Institute for Creative Technologies, and while his work focuses more on human-computer interaction, it’s similar to Bailenson’s in that emotion is a crucial component. Participants’ experiences are so much more vivid that they can really feel the consequences of their actions, he said.

We tend to think that emotions complicate conflicts and we try to suppress them to find rational solutions — a practice that traces back to the Greek Stoics, who held that wise men and women should be rule-based, abstract thinkers. But in his experiments, Gratch has found that’s not always the case. Sometimes emotions need to be addressed directly before a problem can be resolved. He’s interested in learning the circumstances under which people feel certain emotions, and how those influence their judgement.

“We’re not really good at predicting our emotions,” he said. Instead, we do something called affective forecasting: “When we think abstractly, we don’t think of the consequences vividly.”

Immersive VR can take such abstract thoughts and make them immediate, inspiring concrete thinking. One study found that these thinkers were better protected from symptoms of post-traumatic stress disorder. This change in perspective happens because the viewer is “focusing on how a situation is unfolding, what is being experienced, and what the next steps are,” clinical psychologist Dr. Rachel White, the author of the study, said in an accompanying statement. “It differs from abstract processing, which is concerned with analyzing why something is happening, its implications, and asking ‘what if’ questions with no obvious answer.”

Better than 2-D

VR has a very real effect on our cognitive processes and perspectives, but so far there are no strong studies that look at its long-term effects. Gratch says that Bailenson does have a short-term measure for users on their way out of the lab: After scenarios designed to increase sympathy for environmental protection, he will knock over a glass of water and take note of how many paper towels participants use to clean up the spill. But once they’re out in the real world, it’s anyone’s guess how well they sustain what they’ve learned through their avatars.

Eagan argues that a single VR experience is already more impactful than traditional 2-D films because “it’s more like theater.” A 2012 study from Harvard Medical School found that, after new information shocks, refreshes, or teaches the brain something new, a person’s behavior changes. William Shakespeare’s plays in particular have been shown to create functional shifts in the brain, opening room to learn a word’s meaning before the brain understands its function. Basically, reading Romeo and Juliet can throw the brain off guard — assuming you’re reading the real thing and not SparkNotes — in a way that produces positive mental activity, the authors wrote.

The first folio of William Shakespeare's work that contains the play 'Romeo and Juliet' during an unveiling for auction at Christie's King Street on April 19, 2016 in London, England Chris Ratcliffe/Getty Images

It’s not Shakespeare, but Eagan finds immersive VR is helping Planned Parenthood tell the story of what it’s like for women and their physicians to walk through angry protests; to jolt viewers’ systems with how bad it’s gotten, something she knows personally.

In one uncomfortable experience, protesters recognized the tools she was packing in her trunk. “We have an instrument called a colposcopy that I was putting in the back of my car, and a protester came and blocked me in from the alley,” McDonald-Mosley said. It was a frightening moment, one that carried a real sense of threat: “I was like great, now they have my license plate number. It’s very nerve-wracking.”

Sadly, it’s also a common occurrence. In 2015, a first-of-its-kind survey from the Feminist Majority Foundation revealed that since 2010, the percentage of clinics facing harassment increased from 27 to 52 percent. Confrontational posters that read things like “Killers Among Us” have also proliferated. And last November, Robert Lewis Dear opened fire on Planned Parenthood’s Colorado Springs clinic, killing a police officer and two civilians, and injuring four others.

While many protesters focus only on abortion, Planned Parenthood also administers STD testing and treatments; cancer screening and prevention services, like pap tests and HPV vaccinations; and pregnancy and prenatal services. More importantly, for some women, and especially in low-income populations, these centers are the only source of family planning services and education.

“I think what’s important to know is that one in three women in this country will have an abortion, and those women are more likely to be women of color and low-income,” McDonald-Mosley said. “And what I’m hoping people do when they see this film is realize this is not how we want to treat people in this society, especially more marginalized members. People deserve to be treated with dignity and respect... I can do that in the context of the four walls that I control, but unfortunately I can’t do that outside the health center.”

McDonald-Mosley recalls a protester who once followed her for a couple of blocks when she left on her lunch break. But she often has the luxury of avoiding such harassment by walking around to the back of the building. That her patients can’t escape threatening, verbally abusive run-ins in the same way, she said, “really breaks my heart.”

Virtual reality, real change

A future in which machines augment our emotions much like they boost our physical abilities is looking increasingly likely. Already in Gratch’s lab, participants have shown an increased willingness to disclose their mental health problems to virtual humans than therapists in real life. The reduced sense of judgement they felt from the computer pushed them to open up and display their sadness more freely.

In 2014, a pilot study found that, when compared to a regular computer screen, VR allows for an unprecedented sense of immersion and arousal in response to certain images. A virtual spider looks much more real than a photo, and a viewer’s response tends to be more realistic as well. This could be a positive result, the researchers said, because it suggests VR can increase emotional responses. More research is needed, but already Bailenson, Gratch, and the producers of Across The Line can say for sure that VR offers a telling look into human behavior. That’s a bet other filmmakers are making as well, in the hope of increasing empathy for life in a refugee camp and life with autism.

For Eagan and Planned Parenthood, a positive response to Across The Line will put more projects in motion. “We want to see, when we get out in much more diverse communities, if we [can have] a similar impact,” she said. “I feel like the flower has only started to open.”