ICT creates new PTSD treatment

A mounted display, directional 3-D audio, and vibrations act in concert to immerse a man clutching a game controller through a virtual Middle East. His avatar is riding a Humvee, part of a convoy, when an IED suddenly and abruptly explodes up ahead. His virtual comrades erupt into commotion.

This isn’t a video game setup showcasing the newest installment in the Call of Duty series. It’s a therapy for post-traumatic stress disorder being developed by researchers at the USC Institute for Creative Technologies.

The treatment, known as Virtual Reality Exposure Therapy, allows veterans with PTSD to confront traumatic war memories. In ICT’s Virtual Iraq/Afghanistan program, patients can explore various scenarios in settings reminiscent of Middle Eastern cities and deserts.

A trained therapist who can manipulate the environment to each patient’s needs guides them through the virtual world. Therapists can adjust weather, add villagers and trigger events with the touch of a button in the game.

As each patient explores the virtual world, he or she communicates with the therapist in order to work through the emotions and physiological effects being experienced.

Exposure therapy is a common form of behavior treatment used to treat many anxiety disorders. In this type of therapy, the patient learns to gradually confront the fears, anxieties and situations at the root of his or her disorder.

Though exposure therapy can be used to treat certain disorders by directly exposing the patient to the actual trigger or feared situation, this isn’t possible with PTSD for war veterans where the underlying trigger is a painful memory from the war.

Historically, exposure therapy for these cases is conducted through guided visualization, which relies on the patient imagining and recreating memories and feelings. With virtual reality, however, therapists can directly place patients in immersive environments that elicit a physiological response as if they were actually in the environment.

“We can go back and look at log files and know exactly what the patient saw in the simulation,” said Albert “Skip” Rizzo, the associate director and research lead for Medical Virtual Reality at ICT.

Exposure therapy is not a new science, but technological innovations have allowed for significant advances in the treatment.

“The use of technology by this generation is not a luxury, it’s a given. As long as you’re delivering evidence-based treatment, then the technology can make it more effective, more efficient, more trackable,” Rizzo said.

The technology is also becoming cheaper as advanced gaming hardware becomes more widespread. Rizzo said the hardware for the program costs less than $5,000.

Aside from using virtual reality to treat veterans with PTSD through exposure therapy, Rizzo is also working on using virtual reality to prepare servicemen and women who have yet to be deployed.

“We put ourselves out of that job by doing a better job on the front end so that we can reduce the ultimate incidence of PTSD,” Rizzo said. “Now, I don’t think we can eliminate it completely, but if we can cut it in half that would be a great thing.”

Technology and virtual reality is an emerging aspect of USC School of Social Work’s military social work subconcentration, which is using other virtual reality technologies in partnership with ICT to train future clinicians who have to interact with veterans.

One example of this is the “Virtual Patient” — a simulation program designed to replicate the behavior of war veterans that were exposed to combat stress. In this application of virtual reality in the clinical setting, students role-play with the “patient,” Staff Sergeant Alamar Castilla, an avatar programmed to emulate the symptoms of a number of conditions, including depression and post-traumatic stress.

“It’s great for veterans and civilians. From the veteran perspective, it teaches me how to handle countertransference and set clinical boundaries,” said Marc Rentaria, a graduate student in his concentration year of the Master of Social Work program.

Rentaria himself is a veteran of the U.S. Army who has been deployed three times.

Some students worried, though, that the program could over generalize the conditions of patients.

“Nothing compares to a living, breathing veteran in front of you because there is no one, single veteran,” said Tien Quach, an Army Reserve and a student in the master of social work program. “There is that particular veteran. But I do like the fact that there is a lot of research into it because you have to start somewhere.”


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