Combating PTSD through virtual reality.

A NEW therapy for Post Traumatic Stress Disorder--which occurs after an individual is subjected to or witnesses a life-threatening event--is being fine-tuned at Madigan Army Medical Center in Washington.

Inside a virtual-reality helmet, the patient is afforded a 360-degree view of two scenarios, a convoy through the desert or a foot patrol through a city. A video-game style handset controls movement through the scene. Beneath the platform on which the patient sits or stands, speakers provide the rumbling sensation of the convoy and the attack.

The scenario can be altered to fit the Soldier's experience. The scene can even be altered to create green tones reminiscent of an event witnessed through night-vision devices, if that is what triggered the Soldier's PTSD.

There are basically three clusters of symptoms that coincide with PTSD: re-experiencing an event, which could include nightmares or flashbacks; avoidance, in which the patient avoids cues or reminders of the event; and hyper arousal or numbing, which could include hyper vigilance or suspiciousness, said Dr. (Capt.) Greg Reger, a clinical psychologist for the 62nd Medical Brigade.

"These symptoms occur at least one month after the traumatic event and significantly interfere with the Soldiers' work or their relationships," he said.

PTSD causes humans to associate cues in the environment--that were previously normal--with life-threatening events. If a Soldier was in a convoy that was attacked in Iraq, he might associate that event with routine highway driving on his daily commute to work.

The current standard treatments for PTSD are exposure therapies. Dr. Reger uses the analogy of a child who fears dogs after being bitten to explain how the therapy works. The best way to diminish the child's fear is to slowly and progressively habituate the child to being around dogs again. The child might start by thinking about being around a dog and eventually work up to petting one, until he's again comfortable around dogs.

Exposure therapies can be difficult for combat-related PTSD, because Soldiers cannot be re-exposed to combat as a part of their therapy, Dr. Reger said. Previously, Soldiers had to rely on recalling memories of combat, which can be very difficult and painful. That's where the new technology comes in.

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"Virtual reality gives us a means of delivering potentially traumatic experiences to Soldiers in a way that was not possible before," Dr. Reger said.

Eventually, the technology may include a system that delivers scents, such as burning rubber or Iraqi spices, that could trigger memories for the Soldier. It is also designed to be able to monitor physical reactions, such as heart rates, which will help the clinician track the Soldier's reaction to the therapy, he said.

MAMC is the only Army medical center testing this particular virtual-reality technology, Dr. Reger said.

"Here at Fort Lewis, we have the only Army behavioral health technology office, which is intended to explore and develop a range of new technologies for Army behavioral health," said Dr. (Col.) Gregory Gahm, chief of MAMC's Department of Psychology. "Virtual reality is one of those technologies."

Currently at MAMC, the research team, which consists of Dr. Gahm, Dr. Reger and Dr. Robert Swanson, a research and post-doctoral psychologist, is collecting feedback from Soldiers who deployed in the last year and do not exhibit symptoms of PTSD. The goal is to get feedback from 300 Soldiers to make the technology as realistic and functional as possible. The team hopes to have virtual reality available as a treatment option by the end of the year.

The virtual-reality research project has been possible through collaboration among many organizations. The original research for the technology was done by Dr. Albert Rizzo at the Institutes for Creative Technologies at the University of Southern California, and was funded by the Office of Naval Research. The research to fine-tune the technology is being funded by Telemedicine and Advanced Technology Research Center.

Ms. Rachel Young works for the Northwest Guardian newspaper.