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How Virtual Reality Can Combat Veterans' PTSD

Skip Rizzo: One thing we do know about PTSD is that if it’s left alone, don’t count on it just going away like a common cold. The hard legacy of the post-Vietnam era taught us that lesson.

It seems that every day we’re confronted with the tragic reality that many of America’s service members and veterans are facing enormous mental health challenges. The military suicide rate has risen to an alarming level, this year surpassing the number of those who die on the Afghan battlefield. PTSD is at an all-time high. And there’s the heartbreaking fact that one in four homeless in America are Veterans! Add to all that, the range of related mental health issues including depression, broken marriages, substance abuse, and a large list of every kind of physical injury imaginable.

ptsd virtual reality

So what went wrong?

There are those who will casually say, “Well we shouldn’t have gone to war in the first place”. But with hindsight being 20/20 and all, that just rings hollow to me as it doesn’t really provide a solution for the current problem (in spite of the fact that I am indeed no fan of war).

One thing we can all agree on is that war has always been hell, and that PTSD is not just some recent invention by the modern fields of mental health. The brutal human psychological aftereffects of war have always been there, with PTSD-like symptoms being first reported in written history by Herodotus around 500 BC in his description of a Spartan named Aristodemus, who was so shaken by battle that he was nicknamed “The Trembler”. Since those early times, the psychological wounds of war have consistently appeared as the all too often consequences of combat. And although called by many different names (e.g., nostalgia, soldier’s heart, shellshock, battle fatigue), the big difference now is that we strive to recognize and understand it, apply no shame to it, and try like hell to treat it.

Oh yeah, and one thing we do know about PTSD is that if it’s left alone, don’t count on it just going away like a common cold. The hard legacy of the post-Vietnam era taught us that lesson.

So as I see it, the better question we can ask today is “What are we gonna do about it?” What can be done to turn the tide on this wave of pain being suffered by men and women who stepped up and volunteered to serve their country?

That’s a challenge that many clinicians and scientists have taken up in the last decade. And if there is any silver lining to this dark cloud, it is that the urgency of this human crisis has driven advances in the development, evolution and evaluation of a variety of PTSD prevention and treatment approaches –many of which work! The range of treatment options is diverse—from cognitive therapy to canine therapy to yoga, fueled by significant government and private funding for research and treatment programming that is making a difference for those who deserve our best efforts. And there is an aggressive attitude by healthcare providers about the importance of properly dealing with PTSD this time around compared to previous wars.

My work has focused on how we can advance prevention and treatment of PTSD with the use of computer simulation technology, aka, Virtual Reality (VR). Beginning in the 1990’s, our research group began exploring the many ways that VR can be applied to understand and treat clinical conditions like brain injury, stroke, ADHD, autism, Alzheimer’s, anxiety disorders and more. The rationale for our work has always followed the metaphor of aviation simulation: Just as an aircraft simulator serves to test and train piloting ability, VR simulations can be used to test, train or treat human psychological, motor or cognitive functioning.

In 2004, we turned our VR expertise to address what we saw as an impending PTSD crisis coming out of the conflicts in Iraq and Afghanistan. To do this, we focused on a form of cognitive behavioral therapy called Prolonged Exposure where PTSD sufferers are asked to repeatedly narrate and imagine difficult trauma memories with the aim to confront and process them in a safe therapeutic environment with a clinician.

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ptsd virtual reality

This treatment had strong scientific evidence to support its value, but we felt we might make it more effective and appealing to “digital generation” service members if we could use VR to immerse them in digital replicas of Iraq or Afghanistan and help them – with the presence and guidance of a clinician – to gradually confront the memories and events that haunted them, at a measured pace they could handle. The results from the clinical tests from this work have been positive. The VR Exposure Therapy system has now been distributed to over 50 clinics and the technology has advanced since 2004 to the point where we can customize the virtual experience to better match the patients’ needs.

Inspired by the initial success of this research using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we decided to develop a similar VR-based approach to deliver resilience training with military service members prior to their initial deployment. The Stress Resilience In Virtual Environments (STRIVE) project evolved from the Virtual Iraq/Afghanistan system and aims to foster resilience by creating a set of combat simulations that can be used as contexts for the experiential learning of emotional coping strategies prior to deployment. To accomplish this, STRIVE is designed as a multi-episode virtual reality interactive narrative. It is akin to being immersed within a “Band of Brothers” type storyline that spans a typical deployment cycle. During each 10-minute episode, an emotionally challenging event occurs, designed in part from feedback provided by those undergoing PTSD treatment. At that point in the episode, the virtual world “freezes in place” and a virtual human “mentor” emerges from the midst of the chaotic VR scenario to guide the user through stress management tactics, as well as providing cognitive behavioral exercises for understanding and processing their emotions. This approach is now going through initial evaluation trials to study how service members react physiologically to the experience and whether they can learn the skills of psychological resilience from this method.

The goal of both these efforts is to find ways to reduce the numbers of soldiers and veterans who are suffering from invisible wounds of war. Virtual reality may have been inspired by video game technologies but it is now a powerful tool in the fight to prevent and treat PTSD.

So, in the end, a world without war would be the ultimate success for the human race. But, until humanity evolves and that happens, we have a moral and ethical imperative to use any method at our disposal to prevent and treat the tragic impact that war can leave on those who are tasked with the job of combat. To do this should be nothing less than a national priority for any civilized society.

Finally, for anyone who would like to explore virtual reality exposure therapy as a PTSD treatment option or know of someone who might, here is some contact info for some of our current clinical trials:

How to participate: If you are an Iraq or Afghanistan Veteran, you may be eligible to participate in a national IRB-approved study of PTSD, funded by the Department of Defense, which provides virtual reality exposure therapy and traditional exposure therapy. To learn more, Veterans should contact a site near them.

If you’re not near one of those areas, we can try to recommend a center near you. Either way, don’t give up. PTSD is treatable, and there are many folks out there who can help you if you just take the first step!

Skip Rizzo
USC Institute for Creative Technologies

Saturday, 2 February 2013