Virtual-reality program
re-creates traumatic

Tripler’s project allows psychologists
to refine reprocessing of events

An innovative project at Tripler Army Medical Center aims to use virtual-reality consoles modeled after video games to treat soldiers and Marines suffering from battlefield stress.

Wearing stereo-vision headgear, patients will be taken back to wartime settings such as the streets of Baghdad or the mountains of Afghanistan to revisit experiences that have left them psychologically scarred.

Military personnel and civilians with post-traumatic stress disorder often have nightmares and trouble sleeping, or jump violently at sudden noises like a horn or a car backfiring. Other symptoms include poor concentration, fear, guilt, isolation, agitation, anger or aggressive urges, excessive sweating or difficulty breathing.

The symptoms can become severe enough to disrupt family life and job performance or lead to heavy drinking or drugs.

"This whole area of treating PTSD with virtual-reality exposure is a fairly new area," says Sarah Miyahira, principal researcher with the Veterans Affairs Pacific Islands Health Care System. "Projects have been done with Vietnam veterans, and another public study involved treatment of victims of the World Trade Center disaster. Both showed good results where, with standard therapy, the patients did not respond."

In standard therapy, psychologists ask patients to imagine themselves back on the battlefield or in a terrorist attack so that they can mentally "process" the frightening and disturbing sensations in a way that ultimately allows them to let go of the experience.

Trouble is, the therapist has no control over -- or precise knowledge of -- what the patient is imagining.

With virtual-reality therapy, the attending psychologist has complete control over the sights and sounds experienced by the patient wearing the head-mounted display. If the setting is a street in Baghdad, for instance, it can be quiet and empty, or noisy with traffic and voices, or earsplitting with gunfire.

If necessary the therapist will even be able to order up an explosion from a car bomb or makeshift mine and the anguished cries of the victims.

"Many people feel a sense of guilt for having survived," says Miyahira. "They feel they could have done more or should have done more, when in fact they really didn't have an opportunity to do anything."

Raymond Folen, a clinical psychologist and chief of the Behavioral Medicine Service at Tripler, says the program will allow therapists to make patients come to grips with painful memories that they understandably prefer to avoid.

"We control the environment," he says, "and it may be that they are back in Iraq and they see buildings that they are familiar with, and then we slowly move up the level of intensity. We work with the individual so that they are really able to assimilate those experiences in a more adaptive way, psychologically and physically, with the net result that they won't have the intrusive dreams, the anxiety and the startled response or the negative emotions associated with a traumatic environment."

Miyahira and Folen are working with a $1.3 million grant from the Office of Naval Research to study the effectiveness of the treatment on war-fighters suffering acute stress. Related projects worth another $2.7 million are under way in California, one of which will involve noncombat personnel such as medics and truck drivers.

The Hawaii test model should be ready by this fall, says Miyahira, who is director of intramural research for a Pentagon-Veterans Affairs joint venture called the Pacific Telehealth and Technology Hui.

The virtual-reality software is being written by a programmer in the Seattle area, she said. The headset will work in such a way that when the patient turns his or her head, the scene shifts accordingly.

The patient will be fitted with sensors so the therapist can monitor breathing and heart rate.

The Army-funded Full Spectrum Warrior video game will be used as a springboard for some of the California research.

If approved by a review board at Tripler, the program will accept its first patients this fall, and Miyahira anticipates about 60 at the start. Sessions will be twice a week for five weeks, she says.

Folen adds, "It's particularly relevant to the fact that we have a lot of soldiers coming back from Iraq and Afghanistan, and it is relevant to the civilian sector as well, like the people who survived the subway bombings in London. It really has great potential."

The VA estimates that up to 8 percent of the population will suffer from post-traumatic stress disorder at some point in their lives.

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