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.