Tech: 'Virtual Iraq' May Reduce PTSD

Earlier this week, a reporter was escorted down an Iraqi street during the morning call to prayer. There was a marketplace to the right, nondescript buildings down the road and a few pedestrians milling about. Then a helicopter flew overhead, accompanied by the bone-rattling sound of gunfire. The ground shook as a parked car suddenly exploded, apparently blown up by an insurgent's improvised explosive device. Sniper fire popped from the rooftops. Dazed civilians wandered into the reporter's path—though it was unclear whether they were friendlies, or insurgents in disguise poised for an ambush.

All of this took place over the course of a few minutes on New York's Upper East Side, in the one-window office of a Cornell University Weill Medical College psychologist. The Iraq in question was a simulated one, experienced from inside a virtual-reality helmet, complete with goggles and powerful headphones. Don the helmet, and you are instantly immersed in a disturbingly realistic videogame version of an urban Iraqi battleground. The platform underfoot houses a motor that shakes the ground whenever simulated rockets hit or bombs blast. JoAnn Difede, director of Weill's program for anxiety and traumatic-stress studies, plans to put the virtual-reality helmet to use as part of a counterintuitive therapy aimed at studying, and ultimately healing, soldiers who suffer from posttraumatic stress disorder (PTSD).

"If all of this works, it will change the way we treat PTSD patients," explains Difede. "I'm enthusiastic, or I wouldn't be doing this." She is working under the widely (though not universally) held theory that PTSD stems from a patient's inability to put a traumatic event behind him. "It's as if it's happening over and over again," she says—the incident manifesting itself in flashbacks and through nightmares. The patient as a result can become numb and withdrawn, refusing to discuss anything having to do with the circumstances that traumatized him. "This allows us to help a person engage," Difede says. She hopes the technique will also shed more light on the disorder itself, its causes and what personality types might be most susceptible to developing it.

Virtual reality is the next step along a continuum known as "exposure therapy"—the method generally used to treat PTSD patients today. A typical exposure-therapy patient is asked to tell and retell the story of what triggered his trauma; by talking it out, the theory goes, he is able to process it, and put it behind him. "Exposure therapy is considered to be the best empirically supported treatment for PTSD," says Albert (Skip) Rizzo, the cognitive psychologist who developed the virtual-reality software at the University of Southern California's Institute for Creative Technologies. But there are limits to its effectiveness; patients often go to great lengths to avoid reliving the trauma, or alter key aspects of it in their memory. "The problem with imagination is that one of the facets of the disorder is avoidance," says Rizzo. With virual reality, he says, "we can consistently expose the patient as opposed to rely on their imagination." Rizzo is careful to point out that the technology is not a substitute for talk therapy but rather a tool to improve it.

Rizzo acknowledges that, to the layperson, it may sound like a bad idea to expose a trauma patient to the very thing that traumatized him. But according to Spencer Eth, a member of the task force that wrote the American Psychiatric Association's guidelines for the treatment of PTSD, this is, in fact, a standard practice. "These treatments have been around for a very long time—20 plus years—and they work," he says. "There's no question that they work. The use of virtual imagery is a refinement of technology, but it's the same technique." Eth, a professor at New York Medical College, stresses that exposure therapy is just one of a large number of treatment options available to PTSD patients. "The fact [that] there are so many different kinds of treatments for PTSD shows that none of the treatments are where we want them to be."

One 45-year-old retired Army staff seargant, who spoke with NEWSWEEK under condition of anonymity, is a bit more equivocal in his assessment of the program. Despite initial jitters at the prospect of reliving the source of his anxiety, he has completed nine weeks of virtual-reality therapy at Emory University's School of Medicine. "It has helped to a point," he says. In his third and final tour of Iraq, he was on a recovery mission interrupted by an rocket-propelled grenade; one of the soldiers under his command lost a leg. He enrolled in the study because, he says, he needed something to help him "relax and get back to my life." The scenario they created for him, he says, didn't quite look like the real thing, although the sounds were certainly real enough to jog some buried memories. "I'm still not outgoing like I used to be. I'm sleeping a little better. My wife says I'm still jumping in my sleep and moaning, but I can't remember what my nightmares are. It's not as bad as it was when I first got back." Now retired, he says he would recommend the treatment to his fellow soldiers.

Here's how it works: after repeatedly retelling a therapist about a specific traumatic experience, a patient puts on the helmet and sits in the chair. The therapist works from her own computer, using a touch-sensitive screen to shape the virtual-reality experience. (There is an impressive array of variables at the therapist's disposal: the sound of wind, an overcast sky, night-vision goggles, aerial views for pilots, the distant crackle of gunfire.) Say a soldier was in a convoy that was hit by a rocket, killing everyone else on board—a common PTSD-triggering combat event. Difede's team will recreate the event in as much detail as possible using the virtual-reality software. Then, in the course of 10 sessions spanning five weeks, the soldier will relive it again and again, until he is habituated to it. The patient's heart rate and perspiration levels are closely monitored—so even if he doesn't verbalize any distress, the clinician has other ways of determining if the experience is getting too intense. The goal is to make the trauma "become a memory, rather than a flashback or nightmare that controls them," says Difede.

Testing of the system—which costs just under $10,000 and includes two computers, a mock rifle that doubles as a navigational tool, the helmet and the base-shaking platform—is already underway. Six patients have completed 10 sessions of the therapy in a preliminary, scaled-down study. Rizzo, the cognitive psychologist who developed the software, was in Washington this week to present the findings at the Cybertherapy conference. Of the six, five showed remission of PTSD, based on the military's standard definition; one completed the program with no gain. "One woman is actually going back" into combat, says Rizzo. "I worry about this a little because we know that repeat deployments increases the risk of PTSD. But she made the choice, and she wanted a career in the military." Difede's department is one of 12 sites in the country that have either received funding for the study from the Office of Naval Research or have just begun running it, Rizzo says.

This is not the first time virtual reality has been used to help patients cope with PTSD. Difede used the same technique on World Trade Center first responders who survived 9/11. Using software designed by Rizzo, Difede immersed traumatized respondents inside virtual renderings of the towers as they filled with smoke and eventually came crashing down. Stephen King, an FDNY fire chief who was in the North Tower when the South Tower collapsed, told New York magazine that he was a "shambles" before his virtual-reality sessions with Difede; he had recurring nightmares, feared bridges, high-rises and tunnels, and was generally reluctant to travel into Manhattan from his Long Island home. "Now I've got my life back," he said after his 11 sessions under the helmet.

The big challenge is to convince Iraq War soldiers and veterans to overcome the stigma some feel is attached to PTSD and seek the help they need, says Rizzo. "People at risk for developing PTSD wouldn't go to therapy, thinking it made them look weak or it could mess their career up," he says. "In the beginning it was hard to recruit people, but VR is a really good draw." The videogame aspect of the therapy will certainly have its appeal to a generation of soldiers raised on Nintendo and PlayStation. But the chance to chase away the ghosts of war will be the most compelling draw of all.