The numbers are staggering. By some estimates, a full one-third of veterans who served in Iraq and Afghanistan over the past decade have come home as the “walking wounded.” With the invisible scars of posttraumatic stress disorder (PTSD) or a traumatic brain injury, these men and women are not easily identified nor, because of the stigma of mental health care within the military, do they always seek treatment.
The good news is that, while previous war veterans may have similar concerns, there is far more attention being paid to the problem today.
One of the more innovative and promising treatments is the use of virtual reality technology to work with soldiers and marines dealing with PTSD. The Virtual Iraq program, developed by the University of Southern California’s Institute for Creative Technologies, with funding from the Navy, Army and the Telemedicine and Advanced Technology Research Center, offers clinicians an additional tool to use in providing exposure therapy.
In some ways, the technology is like a very cool, high end video game. But as its creators will attest, it is not a game. The interaction is not as layered as in a game and the goal is vastly different.
Wearing video headset goggles, carrying a controller that feels and has the heft of a military-grade weapon, standing or sitting, the patient is put as close to the feel of the real thing as possible while in the safe environment of a therapeutic setting.
He will see scenes and smell the scents of the war – the stalls and spices of a marketplace, the inside of a Humvee along with the diesel and cordite of the vehicles or explosions. The sitting position can be augmented with a vibration to imitate the feel of a rumbling vehicle. With the experience monitored and controlled by the therapist, the patient can explore the area, talk about what he saw and explain what happened.
“Prolonged exposure is based on the concept that we develop a fear structure around things related to the trauma,” says Margaret Harvey, Psy.D., associate clinical director of the Veterans’ Program at the Red Sox Foundation and Massachusetts General Hospital Home Base Program, a clinic for veterans and their families that started using the equipment this spring. “Virtual reality helps the vet remember the event.”
The goal, she says, is to enhance and bring back the feelings and memories associated with the trauma, to allow the patient and therapists to continue the treatment one-on-one.
“It helps them to experience the emotions that had to be cut off because there was no room for it in combat,” she says. “They can go back and explore it and put it to rest.”
For some veterans, she explained, this experience can help them see that they “did the best they could” in the situation. When looking back, many will question their responses during the trauma and wonder if they could have helped the situation turn out differently. By putting them into a similar scenario, they can start to forgive themselves for not being able to stop the event.
“It helps to get them to a place of acceptance.”
After studies on Virtual Iraq showed that soldiers reported reductions in symptoms after seven sessions, the U.S. Air Force purchased 10 sets of the equipment for sites around the country. Its use has spread slowly across Veterans Administration, military and private clinical sites.
“The big picture is that it is not proving more effective than exposure therapy but it is as effective,” says Josh Spitalnick, Ph.D., adjunct assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and vice president of research for Virtually Better, Inc., which provides and services the technology. “This represents an alternative option for service members seeking treatment for PTSD.”
For some, the technology does not seem worth the price if results are similar to prolonged exposure therapy, regarded as the “gold standard” of PTSD treatment.
“It is still rather costly,” says Terrence Keane, Ph.D., director for the behavioral science division of the National Center for PTSD at the VA Boston and professor of psychiatry and assistant dean for research at Boston University. “As the prices come down, we could add it but right now we have had a lot of success using imagery-based treatment.”
Still, as an alternative therapy, virtual reality may claim its place in the tool belt. With the stigma associated with mental illness especially prevalent in the military, playing a “video game” may be the way in for younger people.
“We hope this technology will spur more people into giving themselves the opportunity to engage in treatment,” says Harvey. “It is tough work, but you have to do tough work as soldiers and marines and this is another piece of tough work to heal for that.”
By Catherine Robertson Souter