Abstract
Since Yuri Gagarin first escaped Earth’s gravitational pull and Neil Armstrong took his “giant leap” onto the surface of the moon, spaceflight has become an indispensable branch of science. Not only has it expanded our knowledge about Earth and worlds beyond, it has also enlightened us about the universe of the human mind.
While space travel is undoubtedly a demonstration of technical prowess and innovation, it is just as much a cultural exercise in human curiosity. In adapting to the novel—and at times hostile—conditions outside of Earth’s atmosphere, astronauts can face physiological and psychological effects, which, over the past decades, have been shown to disrupt nearly every system in the human body.
For example, in 1982, Cosmonaut Valentin Lebedev was about two-thirds of the way through a 7 month space station stay when he began to notice that his mental health was suffering. He was irritable with fellow cosmonauts and found himself counting the days until the mission would be over. 1 Not only did this lead to interpersonal problems and increase the potential for dangerous mistakes aboard the station, but it was a warning sign that mental health would be an important consideration for future space travelers. After all, Lebedev was struggling after only a few months; a potential long-duration space exploration to Mars could last about 30. 2
As we attempt to prepare future explorers for travel to the depths of our solar system, we will need to rely on our understanding of how the human mind reacts to extreme environments in order to maintain mission safety. We will need to consider both the environmental and social threats to the physical and mental health of crews during long-duration space flight missions and develop ways to prevent and mitigate adverse outcomes. 3
A Continuum of Care
Spaceflight is a feat of engineering. However, when humans are part of the equation, it cannot only be about the physics of flight; scaffolding must be built around protecting astronauts’ mental health as well. One psychiatrist who worked with NASA explains that while the machinery of space travel has been well-explored, the mental and behavioral aspects of long-haul space missions are begging for investigation. 1 Similar to research around other high-stress populations (first responders, military, pilots, etc.), much attention has been paid to protecting physical health with high-tech body armor, but less has been dedicated to developing the mental armor necessary for true resilience.4,5
Severe working and living conditions, long-term confinement, and isolation may all induce stress in astronauts. Microgravity is extremely hard on the body, and astronauts must learn and use new techniques to complete simple tasks like preparing food and using the restroom. 6 Annoyances that may be less impactful on Earth (e.g., those aboard the International Space Station [ISS] are continuously exposed to an average noise level of 72 dBA, which is equivalent to the sound of highway traffic from a distance of 15 meters) are impossible to escape in space and can lead to poor mental health.
A growing body of research from crews working for extended periods in similar isolated, confined environments reveals poor outcomes that include impairments of individual well-being, degradations of cognitive and psychomotor performance, interpersonal conflicts, withdrawal, anxiety, depression, lack of motivation, and even adjustment and somatoform disorders. 2 Postmission personality changes and marital problems have also affected returning space travelers and their families. Therefore, it is imperative that space programs develop a continuum of care to maintain the mental health of their crewmembers.
This continuum should focus on both the prevention and treatment of stress-related symptoms before, during, and after each mission. Preflight evaluation of each individual’s psychological needs and selecting crewmembers with interpersonal compatibility in mind is the first step in this process. Additional measures may include preflight psychological training, monitoring, and support while in orbit and postmission reintroduction. To be effective, the continuum must incorporate regular psychological assessment of astronauts and provide early, accurate detection of even mild symptoms so that interventions are always deployed rapidly and effectively.
This may seem a tall order, especially in the extreme environment of space, when communication with the ground is delayed or impossible for periods of time. Fortunately, technology has evolved to a point where it can help humans take these “small steps.”
Recently, mixed reality technologies have become mainstream, with more immersive and realistic computer-generated environments, greater ease of use, portability, availability, and increasingly lower costs.
Augmented and virtual reality (VR) technologies are now used extensively in many different industries with promising results. From education to fashion to medicine, technology is helping humans move forward in their fields. In health care, technology has proven its mettle for rehabilitation, surgery, and pain management, and in psychology and psychiatry in particular, multiple clinically validated studies have already demonstrated great benefits when implementing digital health tools in desensitization, prevention, and management of phobias, posttraumatic stress disorder (PTSD), anxiety, depression, body dysmorphias, weight and eating disorders, among many others. The same benefits may extend to helping individuals living in isolation and confined environments like long-term polar expeditions, submarine missions, and yes, even space travel.
Preflight training
Though astronauts all currently undergo detailed psychological assessment and face intense scrutiny in order to qualify for space travel missions, these measures do not necessarily account for later development of psychopathology in initially healthy individuals. Passing a psychological screening examination does not predict the absence of possible future problems.
Nonetheless, technology can play a significant role in training astronauts for what they will encounter while away. VR stress inoculation training has already shown great promise as a method of tension reduction and overall improved productivity when used in groups with high-stress jobs such as the military, firefighters, first responders, and pilots. 6 In this type of training, mixed reality technologies are used to place individuals in virtual worlds as they are taught relaxation and coping techniques. After they master these techniques in a neutral or pleasant environment, they are exposed incrementally to various immersive virtual worlds that mimic the external stressor they may face in the future, environments that might otherwise cause great anxiety.
Just as a vaccination against a particular microorganism helps our bodies respond quickly when it is exposed to that agent in the future, stress inoculation training prepares subjects to quickly defend against similar fear and anxiety when exposed to similar environments or stressful cues in the future. In the context of space travel, technology could be used before launch to create supervised, controlled, graduated exposure scenarios for astronauts, allowing them to incorporate the skills they need to successfully weather the stressful environments they will face on their missions.
Keeping tabs on bodies and minds
This type of training is even more effective when physiological and psychological monitoring are a part of the process. Just as mixed reality technologies have advanced, so too have monitoring devices. Tools for measuring physical reactions (e.g., heart rate, respiratory rate, body temperature, oxygen saturation, heart rate variability, blood pressure) can be durable, comfortable, inexpensive, and noninvasive. The information gathered through physiological monitoring can be helpful at all points in the continuum, from allowing supervisors to evaluate emotional activation during training to remotely screening for stress reactions during missions to helping patients visualize and alter the activity of their nervous systems once back home.
Technology has its place in psychological screening and behavioral monitoring as well. During remote missions, there can be delays in live data transmission and communication.
To combat this, digital screening devices enable self-assessments that are easily repeatable, meaning that an astronaut can get a quick mental health checkup at any time during a mission (and before and after as well). Then, the data from these measures can be stored digitally and compared across space and time, alerting both the ground crew and the astronaut themselves to any potential issues, allowing for timely intervention to keep the crew in top form.
Artificial intelligence (AI), a rapidly growing arm of technology, also shows promise for continuous remote and passive assessment of crew emotion and cohesion. Video analysis of facial emotions has already been tested aboard the ISS. 3 Voice frequency analysis is also a promising tool, having shown value during a long-term isolation study to indicate a speaker’s excitation during phone communication with ground, even in situations when self-ratings had become inaccurate. These kinds of audio and video analyses could not only indicate the emotional state of the speakers, but video monitoring could also be used to tally how much the crew members are interacting, alerting ground staff to crew members who are becoming isolated from their fellow astronauts, a strong indication of psychological disturbance.
In-Flight assistance
Older forms of technology have already proven to be useful during spaceflight, not only for those aboard but for those back on earth as well. For example, crew members aboard the ISS are tasked with photographing earth. 7 These images were originally intended to record how humans and natural events change the planet over time, supporting research projects on the ground. However, observers soon realized that taking these photographs also improves the mental well-being of crew members, perhaps because it allows them to take a break from their enclosed environment and reminds them of why they are on the mission in the first place.
It is not a stretch to imagine that more advanced technology, such as mixed reality, would increase opportunities to offer both crew members and mission control regularly scheduled computer-based programs to refresh the psychosocial and stress relief skills provided during training. As of late 2024, SpaceX is collaborating with NASA to bring VR therapy to astronauts aboard the International Space Station. 8 The system will offer immersive experiences, selected specifically by ISS Commander Andreas Mogensen, to address various mental health needs.
VR helmets aboard the station could also allow crewmembers to return to the virtual worlds in which they were inoculated or even to visit a location they find relaxing. Though astronauts may occasionally have sweeping views of the blue marble of Earth, they will spend most of their time in efficient, if unaesthetic, man-made containers. One potential application for immersive mixed reality is providing exposure to natural settings.
Imagine an astronaut being able to take a stroll on the beach or some deep breaths in a breezy forest on their lunch break. The European Space Agency’s VR Mental Care has tested the idea of using technology to provide virtual mental relaxation environments to astronauts. 7 If this technology proves effective, those findings could also be used to help deal with psychological issues, such as stress, anxiety, and PTSD, back on Earth.
Beyond opportunities for relaxation, if digital screening or AI monitoring does identify a mental health issue, technology could offer quick relief. 3 Throughout the mission, both crew members and mission control could be given the opportunity to speak, even asynchronously, with counselors who share the same cultural background. AI translation could allow crewmembers to communicate comfortably in their native language, even if the available support provider speaks another. And if live support is not an option at any particular moment, interactive, natural language AI-based instruction programs could be developed that could bridge the gap until live help is possible again.
The great beyond
For some, the hardest part of spending an extended period far from home is returning to a world that has continued in their absence. It is well-documented that Buzz Aldrin, famous Apollo 11 astronaut, sank into alcoholism and depression shortly after returning from his 1969 moon landing. 9 Personal problems that one tried to ignore during a mission may become more significant upon return to Earth. Readjusting to a daily routine after having such an expansive and unique experience can be difficult. As a result, psychological care ethically must continue after space travel.
Technology can provide easy access to both individual and family counseling in this situation, especially for astronauts who have concerns that the disclosure of problems would jeopardize future assignments. Telehealth and mixed-reality equipment can provide different types of treatment, including additional immersive exposure therapy at home, meaning that the astronaut can improve their mental health while reintegrating into society, without having to spend more time away from their loved ones.
The field of space travel, along with mixed reality technologies and AI systems, is both nascent and ever evolving. The same could be said of our understanding of the human brain and emotions. As we explore the universe beyond our planet, we hope to gain insights that will not only benefit space science but also society at large. In considering an ideal continuum of care for those in our space programs, may we also consider providing this same continuum of care to all on this planet. Imagine, if traveling beyond our world is what it takes for us to come together as earthlings, if exploring outer space teaches us what it is to be truly human.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.