Virtual Reality Could Help Patients with Combat-Related PTSD

Army Col. Michael J. Roy, who oversees the "Virtual Iraq" exposure therapy at Walter
Reed Army Medical Center, conducts a demonstration of a life-like simulator that
represents a new form of PTSD treatment with Army Sgt. Lenearo Ashford.
ORLANDO — The military already uses video games and simulations to train its soldiers, sailors, airmen and Marines, but in the future, doctors might incorporate virtual reality into treatment for combat-related post traumatic stress disorder.
Deborah Beidel, a psychology professor at the University of Central Florida, is studying the use of virtual reality to help people who were deployed in Iraq or Afghanistan deal with fear and anxiety. The five-year program just began its third year, but preliminary indications are that simulations can be a useful tool for treatment, Beidel said.
The study uses virtual reality as part of exposure therapy, which puts the patient in repeated contact with the events or objects that cause fear and anxiety.
"The usual example I give is, how do you get over your fear of a dog? I ask someone that and they say, 'Well, I've got to be around a dog,'" Beidel said during an April speech at the Defense GameTech Users' Conference in Orlando. "The issue is, though, you have to be around the kind of dog that's associated with the trauma in the first place. So if you were bitten by a German Shepherd and I bring in a chihuahua for treatment, that's not going to work."
For people with combat-related PTSD, replicating a situation such as an IED blast is impossible, so a virtual simulation is used to get as close as possible to the sights and sounds of the actual event.
Beidel and her associates use a simulation system calledVirtual Iraq, developed by Skip Rizzo, a research scientist at University of Southern California's Institute for Creative Technologies. A clinician can use an ordinary computer to build the scenarios, such as an IED blast or an attack sustained while walking around a marketplace, patrolling a city roof, or riding in a Humvee. They can change the time of day or details such as whether the patient is driving the vehicle or was a passenger.
The patient wears headphones and a head-mounted display with 360-degree vision that changes as he moves his head. He is seated on a platform with large speakers under it, so as explosions occur, he can feel the vibrations.
Besides the sights and sounds of the simulation, Beidel and her team also use smell as a way to bring back memories of the event. As the patient walks past garbage in the virtual reality, for example, the clinician can release a garbage odor. Scents of the desert, spices or explosives are also powerful triggers, Beidel said.
The program is open to anyone who has served in Iraq and Afghanistan and is suffering from PSTD, including active duty, veterans, National Guard, reserves or civilian contractors, and is funded by the U.S. Army Operational Medical Research Program. By the study's end, 180 people will have participated in the program, Beidel said.
During the first phase of the study, the patient undergoes 15 sessions of exposure therapy. Each session entails repeating the incident for 90 minutes using some combination of sights, sounds and smells, she said.
Exposure therapy is effective in treating the stress, fearfulness and anxiety of PTSD, but it doesn't help with anger management or relearning social skills. So after the first phase is complete, the patient undergoes group therapy for social and emotional rehabilitation, Beidel said.
“What we find is that at the end of treatment, about 70 percent of the people we've treated so far no longer meet the diagnostic criteria for post traumatic stress disorder,” she said. “The others are better. They're not without symptoms, but they're better [than they were].”
Normally, when a patient cannot be put into direct contact with the event or object causing the disorder, he is asked to use his imagination.
"People will often say, 'I've been trying not to think about these things. It's totally irrational for you to tell me that now I've really got to focus on this, I've really got to think about this particular situation,'” Beidel said. "Using a head mounted display, it's much harder for people to not get immersed in a particular situation."
Another advantage of using virtual reality is that younger patients are more likely to try it because it doesn't look like any therapy they have heard of, Beidel said.
“They're not going to come in and lie on someone's couch and you know, talk about about their mother,” she said. “It's a much more active, much more engaged situation, and people are more likely to want to at least give it a try and become interested in the treatment sessions that we have."
Photo Credit: Defense Dept.

Topics: Bomb and Warhead, Improvised Explosive Devices, Health Affairs, Simulation Modeling Wargaming and Training, ComputerBased Training