Case Study on VR Treatment for PTSD

Researchers at Emory University published an article on virtual reality exposure therapy for Iraq war veterans with PTSD in the most recent issue of the Journal of Traumatic Stress (view abstract here). Due to the extreme number of soldiers who experience events that put them at an increased risk for PTSD (92% of soldiers and Marines who served in Iraq report being attacked or ambushed; 70% report having seen dead or seriously wounded Americans) clinicians are trying to develop new technology to meet the mental health needs of returning veterans.

In this case study, a 29-year-old male veteran underwent four exposure therapy sessions using a VR headset system. The veteran is a combat engineer who served one year in Iraq and met the diagnostic criteria for PTSD. He reported having trouble focusing at work, driving, and sleeping. He also experienced hypervigilance - constantly being on alert - as well as mood swings and irritability.

The rationale behind exposure therapy (VR and non-VR) is based on Foa and Kozek's model of emotional processing, which posits that in order to overcome a fear, it must be activated and one must learn how to get used to it without an emotional response. Eventually, the fear can be extinguished as the patient learns to remember the traumatic incident in a non-threatening way.

During the four exposure therapy sessions, the therapist paired traditional therapeutic techniques such as breathing and treatment information with exposure in the VR environment. The system allowed the therapist to manipulate different variables that included visual, auditory, and olfactory components. As the sessions went on, the therapist increased the intensity of the stimuli to add stress. The patient completed pre-therapy and post-therapy assessments.

Although the sessions had increasing intensity, the patient's ratings on a PTSD symptoms inventory decreased as the sessions continued. By the end of the treatment, the subject's overall ratings had decreased by 56%. He initially fit the definition of "extreme" symptoms, but by the end of treatment, fell into the "mild/moderate" range of PTSD. The patient reported that he could concentrate more at work, had improved communication with his wife, and socialized more often. While this is an extremely new therapy with little empirical data, this study offers a promising vision for virtual reality researchers as well as a technical system and protocol for therapy.

• Gerardi, M., Rothbaum, B.O., Ressler, K., Heekin, M., Rizzo, A. (2008). Virtual Reality Exposure Therapy Using a Virtual Iraq: Case Report. Journal of Traumatic Stress, 21, 209-213.
  

Virtual Reality News April 2008

• Hunter Hoffman and David Patterson's SnowWorld, which I've written about before, is currently being used at Loyola University Hospital in Maywood, IL for burn victims. More than just a distracting media presentation, SnowWorld is an immersive VR video game that relies on the user to complete problem-solving tasks in the game, reducing their pain levels as evidenced by self-reports and MRI scans

• In stroke rehabilitation, researchers in Israel are using VR to enhance both diagnosis and therapeutic treatment selection for patients. Currently, the team of computer scientists and health professionals have designed a system that can differentiate between types of injuries - traumatic brain injuries vs. cerebrovascular accidents. Next, they will program the computers to generate models of patient recovery in order to select the best treatment for each specific patient. While diagnosis is an area that doctors can already do without the help of technology, projecting treatment outcomes with consistent accuracy is not something doctors can currently do with high consistency and accuracy. The VR is also used in patient therapy to demonstrate healthy movements of limbs without physical movement. The patient sees their limbs on a screen performing movements without pain, which can activate mirror neurons, which are frontal lobe neurons that fire when performing a task or seeing it performed. By seeing a natural movement, not experiencing pain, and having the typical motion pathway activated in your brain, pain is reduced and the patient's motility increased.

• London researchers recently used a VR headset to study paranoia in the general population, as subjects were transported via a virtual London Underground on a 4-minute ride. About 1 in 3 participants experienced paranoid thoughts about one or more of the neutral passengers populating the subway. People who experienced day-to-day thoughts of paranoia were more likely to experience it in the virtual underground. The next steps are to design a protocol that allows diagnosis and therapeutic sessions utilizing the technology. Read more here.
  

Citation:

Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D and Garety P (2008) Virtual reality study of paranoid thinking in the general population.
British Journal of Psychiatry, 192, 258-263.