This article is more than 5 years old. Information may no longer be current.
Experts endorse virtual reality for PTSD treatment
Click Here to Manage Email Alerts
Some leading experts on posttraumatic stress disorder are advocating the use of virtual reality as an effective treatment option for the disorder. Their findings appear in Psychiatric Annals, part three of a 6-month series on complementary and alternative medicine in the treatment of PTSD.
“Virtual reality continues to evolve from the realm of expensive toy into that of functional technology,” study investigator Albert “Skip” Rizzo, PhD, a research scientist at the University of Southern California Institute for Creative Technologies, told Psychiatric Annals. “New clinical [virtual reality] approaches — undreamed of back in the bygone days of the 20th century — are now possible with recent advances in low-cost technologies that often have their origins in the video game and entertainment industries.”
In the article, Rizzo and colleagues detailed a number of viable applications for virtual reality in mental health care, ranging from exposure therapy for service members with PTSD to simulation programs in which clinicians can train with virtual patients.
Two particular programs, named “Virtual Iraq” and “Virtual Afghanistan,” allow patients to work through their combat trauma in computer-simulated warzones. Field tested at Fort Lewis, Washington, and by service members deployed to Iraq, the programs simulate an environment replete with visual, audio, tactile and even olfactory stimuli. The clinician controls the simulated experience through a separate interface and remains in full audio contact with the user.
“As powerful and seductive as these new interactive and immersive technologies appear, one should never believe that technology alone ‘fixes’ anyone,” Rizzo said. “Rather, the thoughtful use of new technologies to deliver clinical care may best be viewed as ‘tools’ that extend the skills of a well-trained clinician.”
Although the researchers are cautious not to make excessive claims about the efficacy of this emerging technology, results from initial tests have been positive. For example, in the first open clinical trial of Virtual Iraq/Afghanistan (Rizzo and colleagues), active duty service members (n=20) showed a significant reduction in mean pre-/post-PTSD military checklist scores (P<.001). Participants’ mean scores on the Beck Anxiety Inventory also decreased (P<.002).
Subsequent case studies and open trials also have indicated positive outcomes. According to the researchers, there are four ongoing randomized controlled trials with Virtual Iraq/Afghanistan. Two of the trials are comparing the treatment efficacy of virtual reality exposure therapy (VRET) vs. prolonged imaginal exposure, whereas another trial is comparing VRET with VRET plus a supplemental care approach. The fourth randomized controlled trial is investigating the treatment outcomes of supplementing VRET and imaginal exposure therapy with D-cycloserine, a cognitive enhancer that has been shown to aid in extinction learning in animal models.
Resilience training is another promising application for virtual reality. According to the researchers, a recent shift in military thinking has placed more emphasis — and with it more funding and resources — on better preparing service members for combat and the horrors of war. This evolution in mental health care in the armed services entails a variety of training programs that promote psychological fitness and aim to reduce PTSD symptoms upon redeployment home.
The Stress Resilience in Virtual Environments (STRIVE) project, developed by a team of USC research scientists, expands on the Virtual Iraq/Afghanistan programs by teaching service members valuable stress reduction tactics and coping skills prior to deployment. Participants engage in combat simulations represented in a 30-episode interactive narrative that spans an entire deployment cycle. The narrative is similar to that of Band of Brothers, a popular 2001 television drama that followed the World War II experiences of members of the 101st Airborne Division.
Each episode in STRIVE culminates with an emotionally challenging event, such as the death of a squad member or the injury of a civilian child, at which point the simulation is paused. A virtual human “mentor” then appears out of the ether and instructs the user on stress reduction and self-management techniques to cope with the emotionally challenging event.
However, patients are not the only potential beneficiaries of virtual reality. According to background information in the article, the use of actors who pretend to be patients has been the gold standard of medical education, but the high costs of hiring, training and maintaining actors for educational purposes, not to mention a high turnover rate, have been prohibitive. Evaluating audio and video recordings of mock sessions can also be time consuming. To address these limitations, USC researchers developed a virtual patient named “Justin,” a male avatar aged 16 years with a conduct disorder.
Justin was eventually followed by “Justina,” a female sexual assault victim. Together, these virtual patients represented a new educational platform whereby the novice clinician can learn critical interviewing skills by training with numerous versions of the characters, each having their own language corpus of potential responses.
The user-virtual human interaction also has been developed to help active service members, veterans and family members who are seeking treatment, according to the researchers. SimCoach is a similar technology in which military members can interact online with a virtual human who discusses issues common to military life, provides resources relevant to the user’s reported symptoms and helps break down barriers to mental health care for those who may not otherwise feel comfortable interacting with a live human.
According to Psychiatric Annals Editor Jan Fawcett, MD, clinicians are responsible to stay informed of the latest approaches to mental health care, particularly those utilizing new technologies.
“Virtual reality therapies raise entirely new issues regarding types of therapies that show promise of increasing the availability of effective treatments, which means that clinicians will have to develop an understanding of the principles underlying these approaches so they can interface with them in a manner that will enhance their effectiveness,” he said.
Rizzo said therapeutic approaches to mental health care must evolve to match society’s growing acceptance of technology as an indispensible part of daily life, especially among younger service members who are familiar with this kind of technology from other media, including video games.
“Whether by clinician design or implementation, these tools are now providing opportunities to deliver evidence-based care in formats that may have a wide appeal to members of a society who are increasingly viewing technology not simply as a luxury, but as a natural part of everyday existence,” Rizzo said. “Clinicians who scorn the use of such technological opportunities as somehow subverting an authentic clinical process are likely to find themselves in the same spot as those who thought ‘talking movies’ were just a fad.”
- John Schoen
For more information:
Rizzo A. Ann N Y Acad Sci. 2010;1208:114-125.
Perspective
Back to Top
Retired Army Col. Elspeth Cameron Ritchie, MD, MPH
“Virtual Reality Applications to Address the Wounds of War” is a nice summary of how virtual reality applications are being designed and implemented across various points in the military deployment cycle to prevent, identify and treat combat-related PTSD in war veterans. Our veterans from the wars in Iraq and Afghanistan have matured in a culture of computer games and virtual worlds. As our society becomes more digital, expanding our techniques to mobile applications expands our potential reach as therapists. Written by the world’s expert in the field, Dr. Albert “Skip” Rizzo, this article will be of great utility to clinicians interested in exploring new frontiers with their patients.
Click Here to Manage Email Alerts