Virtual Reality Therapy Shows New BenefitsOctober 28, 2014
For some veterans of war, recovering from trauma means going back to the battlefield.
The battlefield isn’t real, however, nor are the gunfire and soldiers. But the scene is as a veteran like Chris Merkle remembers it. Behind a pair of virtual reality goggles, Mr. Merkle is once again invading Iraq on one of his longest days. Gunfire erupts, and he sees Iraqi men go down, not knowing whether he shot them or someone else did. He has no time to question, he is on the move. In his mind, he is back at war.
When Mr. Merkle removes his goggles, he is back at the Veterans Affairs Healthcare System in Long Beach, Calif. The clinic is one of dozens of centers in the U.S. using virtual-reality exposure therapy, an increasingly popular treatment method for mental-health conditions such as post-traumatic stress disorder, phobias and anxiety.
Mr. Merkle, 41, began using the therapy in the winter of 2013 after multiple tours in Iraq and Afghanistan left him numb and angry, suffering from what the doctors told him was PTSD. He has completed treatment and exhibits few symptoms, but returns periodically for follow-up sessions.
“I was angry, I was stressed. I tried a lot of things, but when I tried virtual reality it was like a toxic release,” said Mr. Merkle, who now works for the Long Beach VA facility in veteran outreach. “You’re not just talking to a therapist on a couch,” he said. “You’re in that event, you’re reliving those moments.”
The technique also has been used on patients suffering from PTSD as a result of sexual assault, motor-vehicle accidents and the Sept. 11, 2001 terrorist attacks. Researchers say it has shown to be successful in treating eating disorders, alcoholism and phobias, like a fear of flying or of public speaking. The idea is that when patients are immersed in a virtual, three-dimensional environment in a safe and controlled place, they can better confront the people and places that trigger anxiety.
“When you talk about war or sexual assault or anything like this, these are experiences that will change someone for life,” said Skip Rizzo, the director of medical virtual-reality research at the University of Southern California’s Institute for Creative Technologies. “We’re not creating digital rapes here. Our goal is to get a person closer to confronting hard emotions.”
Virtual reality exposure therapy is meant to take patients into a virtual world via a headset or three-dimensional studio. There, they interact within a videogame-like environment, equipped with visual, auditory and sensory cues. When Mr. Merkle moves his head, his virtual world moves with him. When a bomb explodes, the ground below him shakes. He says he even hears crying in the distance.
Critics warn the therapy might be too intense for patients who are still sensitive after a traumatic event. Others have criticized the technology, which can cause motion sickness in some people, and complained the graphics more closely resemble a videogame than a realistic scenario.
“Some people are too fragile to add the stimulation of the environment that’s going to remind them and bring them back to their trauma” said Tracie Shea, a professor of psychiatry and human behavior at Brown University, in Providence, R.I. “It might be an advantage for some patients, but it also might be too much.”
Virtual technology constructs a personalized environment based on what a patient remembers, adding specific sounds or visuals from the patient’s memory for realistic effect. For patients afraid of flying, that might be the sound of an airplane engine; for victims of sexual assault, it might be watching a man approach in an empty bus station.
The more patients interact with the virtual environment, the more they typically are able to recall, until the scene becomes familiar. Healing begins when eventually the familiarity of the scene suppresses fear neurons in the amygdala—the part of the brain that processes fear and emotion—and new information about the event is learned, researchers say.
Virtual-reality exposure therapy was pioneered in the early 1990s by a team led by Barbara Rothbaum, now director of the trauma and anxiety recovery program at Emory University School of Medicine in Atlanta. After first testing its effectiveness on fear of heights, Dr. Rothbaum conducted a study on 10 Vietnam War veterans, exposing them to two virtual-reality scenes: a helicopter and a clearing surrounded by a jungle. The patients interacted with the two scenarios while wearing a headset and headphones throughout 90-minute sessions for eight to 16 sessions. By the end, all participants reported a reduction in PTSD symptoms ranging from 15% to 67%.
“The goal is to never freak patients out. As a therapist, with the sounds, you’re nudging them along, pushing them in a therapeutic way,” said Marya Schulte, a clinical psychologist who worked on a U.S. Department of Defense-funded study using virtual reality to treat veterans of Afghanistan and Iraq at the VA Hospital at Long Beach.
At NewYork-Presbyterian/Weill Cornell Medical Center in New York, JoAnn Difede, director of the program for anxiety and traumatic stress studies, said she has seen remarkable recoveries in patients after virtual-reality exposure therapy. While researching its effectiveness for Sept. 11 victims, Dr. Difede said she offered the technology to a woman who was irritable and numb and who was unresponsive to traditional treatment.
“She looked at me and said, ‘This looks like a cartoon.’ But when she put the headset on, she started to cry, and she started to tell me her story with a degree of emotion that I had not seen in eight weeks of treatment with her,” Dr. Difede said.
“All we’re really doing here is taking an evidence-based treatment and delivering it with new technology,” USC’s Dr. Rizzo said. “People will never forget the horrible things they’ve gone through. But that doesn’t mean they’ve earned a life sentence of pain.”