Researchers tout virtual reality for PTSD treatment

PHILADELPHIA — Virtual reality has shown to be an effective treatment option for soldiers with posttraumatic stress disorder, military and civilian scientists said here at the 2012 American Psychiatric Association Annual Meeting. They showcased two exposure-therapy programs called “Virtual Iraq” and “Virtual Afghanistan,” in which patients are encouraged to work through their combat trauma in computer-simulated war zones.

Researcher Albert “Skip” Rizzo, PhD, of the University of Southern California Institute for Creative Technologies, said virtual reality (VR) programs designed to treat patients with posttraumatic stress disorder (PTSD) have spawned numerous clinical trials to prove their efficacy and clinical utility.

“VR outperforms imaginal exposure in head-to-head trials,” he said. “And I don’t care if it’s outperforming imaginal exposure. Even if VR was just as good — that would be fine with me because there are other assets VR brings to the table. … You can engage the patient in a more intense way.”

Based on the video game “Full-spectrum Warrior,” which was originally released for the Xbox console gaming system, “Virtual Iraq” and “Virtual Afghanistan” were field tested by soldiers serving in combat zones. The virtual environment is complete with sights, sounds and even smells, according to researchers, who featured a storyboard in which a squad of American infantrymen patrolled the streets of an unidentified city in Iraq. While the squad members interviewed an elderly shopkeeper about enemy locations, a young boy in the background chased a soccer ball into an alleyway, where he triggered a hidden explosive device, killing him. Throughout the virtual experience, a “mentor” appeared, prompting responses from the patient and offering coping-skill strategies.

According to Rizzo, the clinician is in control of the user’s experience, capable of manipulating weather conditions, time of day and ambient sounds in real time.

Robert McLay, MD, MPH, research director of the Mental Health Directorate at the Naval Medical Center in San Diego, discussed two methods for delivering VR exposure-based therapy.

“You can do it very aggressively, where you can re-enact their actual trauma narrative, or you can teach them relaxation first and prepare them before they really go into it,” McLay said, adding that both methods have shown impressive results in terms of overall PTSD scores.

Besides treating returning service members diagnosed with PTSD, VR therapy can also be used to prepare soldiers before deployment or to screen for pre-existing conditions, according to researchers. The technology has also been used to help patients whose trauma are linked to a variety of events, including the attacks on the World Trade Center, bus bombings in Jerusalem and motor vehicle accidents.

“In spite of the cartoonish nature of some of the older animations, and even to some degree in the newer stuff, the brain is easy to fool,” Rizzo said. “In these environments, people with anxiety disorders are primed to react to stimuli. … People engage with it.”

According to the researchers, there are major disagreements between organizations such as the US Department of Defense, the American Psychiatric Association and the International Society for Traumatic Stress Studies about guidelines for effective PTSD treatment.

“Finding treatments that apply to active duty service members in particular is difficult,” McLay said. “Most of us agree that treatments for PTSD in general have not been having a huge effect in our active duty population.”

Consequently, McLay said he was approached by the Office of Naval Research about developing new technologies to manage the increasing number of returning service members diagnosed with PTSD. VR, he added, constituted a viable treatment option.

According to Rizzo, VR exposure therapy is moving toward mainstream use and offers alternatives for clinicians seeking effective treatments for all types of patients with PTSD.

“We want to provide options,” he said. “We want to break down barriers of care. We want to appeal to people who might not like one treatment and prefer to seek another. And that’s where I see the value of these programs.”

To read more about VR in clinical settings, visit http://medvr.ict.usc.edu/.

For More Information:
Rizzo S. Symposium S103.1. Presented at: the 2012 American Psychiatric Association Annual Meeting; May 5-9, 2012; Philadelphia.

Disclosure: The researchers report no relevant financial disclosures.