Virtual Reality To Treat Ptsd In War Veterans
Post-traumatic stress disorder is a mental health condition that is triggered when someone experiences or witnesses a distressing event. It can also develop after a prolonged traumatic experience. It is commonly found in soldiers who have experienced military combat.
Matt Neve joined the RAF in 2001 at the age of 16. Two years later, he was deployed to Iraq. His role in the war was as a driver, which left him responsible for helping to pick up wounded soldiers. In a recent interview with the BBC, he said: When youre put into an environment like that when youre seeing guys that have been catastrophically injured, some have been killed, its quite difficult to describe.
You have all these emotions flowing through you fear, upset, anxiety and it all hits you in one wave and it took its toll on me constantly seeing that on a daily basis.
After finishing his service, Matt started experiencing flashbacks and night terrors, while also starting to drink heavily. It wasnt until 12 years later, after speaking to other veterans who suffered from PTSD, that Matt realised the cause of his issues.
He started receiving counselling and cognitive behavioural therapy, which did not make an impact on his condition, known as treatment-resistant PTSD.
Two-thirds of those who took part in the trial saw an average improvement in their symptoms of 37%. There are now plans in place to widen the treatment to other non-military PTSD sufferers.
Research on US veterans
Using Virtual Reality For Exposure
In VRET, an individual is immersed in a computer-generated virtual environment, either through the use of a head-mounted display device or entry into a computer-automated room where images are present all around. This environment can be programmed to help the person directly confront feared situations or locations that may not be safe to encounter in real life.
There is some evidence which shows that VRET may be useful for treating several different anxiety disorders and anxiety-related problems.
Some examples include claustrophobia, fear of driving, acrophobia , fear of flying, arachnophobia , and social anxiety. In addition, a couple of studies have been done that test how useful VRET may be for PTSD.
VRET for PTSD has primarily been examined in Vietnam War combat veterans. Therefore, the virtual environment in which a person is immersed has included imagery that a soldier may come into contact with during combat, such as helicopters and jungles. These studies found that, following VRET, soldiers experienced a reduction in their PTSD symptoms.
Some studies have also examined whether VRET may be effective in reducing PTSD symptoms among soldiers from the Iraq and Afghanistan Wars. Similar to what was found among Vietnam veterans, it appears as though VRET can reduce PTSD symptoms in such vets.
New Technology For Diagnosis And Treatment
Virtual reality, exposure therapy, and biometric sensors can all work together to diagnose and treat PTSD. Several companies and universities have developed tech to improve the effectiveness of treatment.
One example comes from clinical psychologist Skip Rizzo. His VR system allows the patient to talk about their experience as they walk through the trauma, but it also has customization options. These options allow therapists to add secondary elements like clouds, missiles, small-arms fire and helicopters.
Another example is Ellie, a virtual PTSD screening tool launched by USCs Institute for Creative Technologies. Ellie provides patients with an unrecorded, anonymous interview session, which encourages vets to be more open and talk freely a tactic that helps to build rapport. Future developments may enable Ellie to report the veterans susceptibility to PTSD.
A third example of this technology comes from a process called Neuroflow, which monitors PTSD symptoms, such as heart rate-levels and brain-based neurological movements in real time. As the patient talks, the therapist monitors the readings of stress, engagement levels and relaxation to help identify triggers.
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How Does Virtual Reality Therapy Work
The study suggests that realistic motion avatars could be the future of social interactions in virtual reality, which could have clinical implications for therapeutic relationships.
Shane L. Rogers, PhD, researcher and lecturer in the Edith Cowan University psychology department in Australia, and the lead author of the study, said that due to the increasing affordability of motion capture technology, it could start to become widely adopted for a greater variety of purposes such as psychotherapy.
The therapist can drive the movement of a digital avatar in real-time so that the avatar mimics their face and body movements in a smooth and lifelike manner, Rogers told Psych Central.
Virtual Reality And Exposure
According to research published on NCBI, VR can help to modify behaviors, thoughts and emotions through virtual experience designed for and adapted to the persons needs in order to facilitate and enhance the process of change. With VR, the patient is immersed in the environment that triggers memories of the trauma. This immersion is a key part of exposure-based therapy , which involves the patients ability to visualize the trauma and narrate the story to the clinician. This combination of VR and EBT looks potentially promising. Yet according to the NCBI publication, the need for more controlled studies, the need to standardize treatment protocols using VR-EBT, and the need to include assessments of acceptability and related variables are crucial for the development of effective interventions.
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Vr Advantages Over Ive
The preference of virtual reality exposure therapy over in-vivo exposure therapy is often debated, but there are many obvious advantages of virtual reality exposure therapy that make it more desirable. For example, the proximity between the client and therapist can cause problems when in-vivo therapy is used and transportation is not reliable for the client or it is impractical for them to travel as far as needed. However, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. Going along with the idea of unavailable transportation and proximity, there are many individuals who require therapy but due to various forms of immobilizations they can not physically be moved to where the therapy is conducted. Again, because virtual reality exposure therapy can be conducted anywhere in the world, those with mobility issues will no longer be discriminated against. Another major advantage is fewer ethical concerns than in-vivo exposure therapy.
Miami Va Using Virtual Reality To Treat Ptsd
The invisible scars of combat can make reintegration to civilian life a challenging transition for some combat Veterans, especially for those with Post Traumatic Stress Disorder. For South Florida Veterans, a new technology combined with traditional treatments may hold the secret for a successful post-military life.
Mental health providers at the Miami VA Healthcare System are now offering a virtual reality treatment option for Veterans with PTSD. Combining VR with traditional treatments, such as prolonged exposure therapy, providers can help Veterans change how they perceive and respond to the symptoms of PTSD, which typically cause depression, isolation and anxiety.
Avoidance, hyper vigilance and re-experiencing are symptoms of PTSD that result from memories of trauma, said Dr. Pamela Slone-Fama, Miami VA posttraumatic stress clinical team staff psychologist. By using a recovery model approach, prolonged exposure therapy and virtual reality, most of our patients who complete this treatment dont experience the same level of stress and intensity when faced with painful memories. Prolonged exposure therapy is what makes this approach to PTSD recovery so effective.
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Is Vr Therapy Effective
Virtual reality is not a new concept, even in therapeutic settings.
Virtual reality exposure therapy that places people in simulated environments related to combat developed by technology companies like Bravemind is being used at over 100 sites across the United States to treat combat-related post-traumatic stress disorder .
Though the process of reliving trauma may sound intense, 2021 research suggests that VRET can have benefits.
Research on the benefits of VR therapy for mental health conditions dates to at least 1995, when a small-scale study showed that virtual reality exposure could help people who have a fear of heights.
But the idea that a therapist-client relationship could occur in a virtual world is relatively new.
Communicating in VR transports you into another world, Rogers said. When you step outside the real world for a moment into the virtual one, for some people, this might feel like a safer space to process the negative feelings around negative experiences.
Rogers added that disclosing negative experiences to another person face-to-face may lead to feelings of shame or embarrassment. Interacting in VR provides an added layer of interpersonal distance, making disclosing feelings easier for some.
He was also surprised by how much participants seemed to enjoy their social interactions in the virtual setting, suggesting increasing acceptance of the technology.
A Look At Vr Exposure Therapy And Phobias
Phobias are regularly treated using exposure therapy. This involves the controlled introduction of a situation or object that the patient fears.
The treatment typically begins with the patient imagining what they are scared of then gradually increasing the physical presence of the phobic stimulus. Over time, as the client perceives more control over the environment, they gain a sense of mastery over their fears .
And it works in VR just as well as it does in the real world.
For example, virtual balconies and rooftops have been used to treat people with acrophobia . But it doesnât end there. VR settings have also been successful in treating other phobias, including :
- Arachnophobia â an intense fear of spiders
- Aviophobia â an extreme fear of flying
- Agoraphobia â the fear of open spaces and situations where escape is not possible
- Claustrophobia â an intense fear of being trapped in small spaces
- Glossophobia â the fear of public speaking
While there is still some uncertainty about whether virtual environments can invoke the same level of stressful responses as their physical counterparts, they continue to prove to be successful treatment tools. And as VR improves, the disparity between digital and real-world experiences reduces further.
For the therapist, VR is a valuable tool to facilitate and control emotional engagement in clients while working through their fears, anxiety, and trauma .
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Chronic And Acute Pain
Virtual reality has been shown to be effective in immediately decreasing procedural or acute pain. To date there have been few studies on its efficacy in chronic pain. Such chronic pain patients can tolerate the VR session without the side effects that sometimes come with VR such as headaches, dizziness or nausea.
Details Of The New Study
The study focused on the interactions between two avatars in a three-dimensional virtual setting.
Fifty-two undergraduate psychology students from 18 to 53 years old rated their experiences communicating with an avatar driven by another person wearing motion capture technology.
They engaged in casual getting-to-know-you conversations and were interviewed about positive and negative experiences.
The researchers compared the avatar conversations to face-to-face conversations and found that about 30% of participants felt more comfortable disclosing negative experiences in virtual reality compared to face-to-face.
This indicates that for a substantial proportion of people, this mode of communication might be quite useful for psychological therapy, Rogers said. We are currently doing more research to further investigate that.
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Inclusion Criteria And Search Strategy
A search of MEDLINE, PSYNDEX, Scopus and Web of Science was conducted using the keywords PTSD OR trauma AND VR, VR OR Virtual Reality AND PTSD, VRET OR Virtual Reality Exposure Therapy AND PTSD from the beginning of database records until December 2018. Studies were included in the meta-analysis if controlled trials evaluated the efficacy of VR-based treatment in samples with PTSD according to the DSM-IV, DSM-5, or the International Statistical Classification of Diseases and Related Health Problems ICD-10. The primary outcome was PTSD symptom severity. Secondary outcomes included symptoms of depression and anxiety. All control group interventions were included in the present meta-analysis, and multi-group comparisons were coded separately. No further restrictions on age of participants, type of trauma, comorbidity, medication, and language or publication status were applied. In addition, Google Scholar alerts were enabled to ensure the inclusion of accepted articles and articles in preprint, and authors with a research focus on this specific field were contacted to ensure the inclusion of unpublished studies. The title, abstract, and main text of each study were examined independently by two authors , and exclusions of studies occurred at each stage of the process .
PRISMA flowchart of screening, exclusion, and inclusion criteria.
Cognitive And Behavioral Interventions For Post
Ehlers et al. note that several versions of cognitive behavioral treatment for post-traumatic stress disorder have been described in the literature with most showing positive effect . Currently there are three main Trauma Focused CBT models Resick et al., cognitive processing Therapy , Foa et al.‘s prolonged exposure model and, Ehlers and Clark’s cognitive model of PTSD. All have shown positive outcomes when used to treat PTSD and are recommended in clinical guidelines developed by American Psychological Association .
To date, Foa et al. PE model has remained one of the most extensively researched treatments for PTSD and has generally shown positive outcomes . Largely influenced by Emotional Processing Theory the model suggests that a fear structure is a program for escaping or avoiding danger that includes representations of feared stimuli, responses, and the meaning of stimuli and responses . As such, when one is exposed to their fears in a safe and controlled manner they are able to emotionally process the information more accurately. Within PTSD treatment the traumatic memory is conceived as a specific pathological fear structure. PE acknowledges that clients have erroneous negative beliefs regarding the traumatic event, and this has led to a lack of cognitive processing of the trauma .
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How Effective Is Vret
Medical treatments need to be scrutinized and put through rigorous tests before approval. The treatment is approved if it outperforms the control group or a placebo. VRET has already entered clinical trials.
The UCF Trial: Researchers from the University of Central Florida are presently testing their proprietary VRET software: Traumatic Event Scene Creation System. The state-of-the-art system enables therapists to intuitively create any scene within minutes by entering the details of the trigger.
UCF’s VR software will uniquely immerse participants in the sights, smells, and sounds of their trauma. The trial will continue into the second quarter of 2022. You can participate or learn more about the ongoing trials on UCFâs information portal.
The Oxford Trial: A trial conducted by Oxford University in 2016 was met with positive results. Although the sample size was limited to 30 patients, the results were promising. Participants reported significant reductions in anxiety and paranoia after undergoing as little as 30 minutes of VRET.
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What Is Virtual Reality Exposure Therapy Like
Youll spend time getting to know your therapist and discussing what caused your trauma. Then your therapist will create the environment for your VRET. You might use a virtual reality headset or enter a dark room with many screens that create an immersive environment mimicking what your trauma was like. There can be sights, sounds, smells, and vibrations to further recreate the traumatic experience and emotional response. There can be sights, sounds, smells, and vibrations to further enhance the experience. The setup is designed to help you confront the situations that cause you fear and anxiety, but in a safe and controlled environment. Youll discuss these immersive experiences with your therapist. Medication and training in coping skills may also be used in conjunction with therapy.
Please Note: VRET can cause dizziness or headaches, which may be more noticeable for those with brain injury.
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What Is Virtual Reality Therapy The Future Of Psychology
Imagine treating soldiers with post-traumatic stress disorder in a combat situation rather than an office.
In 2012, the U.S. Naval Medical Center in San Diego, California, did just that â albeit virtually .
Soldiers were immersed in digital simulations of combat the experience brought back to life through 3D images, sounds, vibrations, and even smells.
Virtual reality has proven to be a powerful tool to help people overcome PTSD and many other mental health issues including phobias, anxiety, and depression. This article explores the science behind the therapy, the treatments, and some of the software available.
Before you continue, we thought you might like to . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
Vret Can Be Better Than Conventional Therapy
There are several reasons why VRET stacks higher than conventional exposure therapy. Conventional ET can only target specific social triggers and fears. That limits the effectiveness and scope of exposure therapy.
Consider the example of sexual assault-induced PTSD. In real life, exposing a PTSD patient to a similar trigger is difficult. Similarly, confrontation with combat exposure, fire hazards, and so on, cannot be safely replicated. Hence, VR is the most efficient and cost-effective method of exposure therapy.
VRET removes all imaginable limitations. For instance, a person with extreme social anxiety can learn to cope in social situations without having a public breakdown.
Until now, such a type of exposure has never been possible. Similarly, VR can treat phobias such as arachnophobia, hydrophobia, and claustrophobia. Essentially, any mental disorder that requires confrontation can benefit from VRET.
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Does Vr Therapy Work
Virtual reality treatments arent necessarily more effective than traditional prolonged exposure therapy, said Dr. Sherrill. But for some patients, V.R. offers convenience and can immerse a patient in scenes that would be hard to replicate in real life. For some people, the treatment can mimic video game systems theyre already familiar with. Theres also a dual awareness in patients who use virtual reality the images on the screen are almost lifelike, but the headset itself functions as proof that theyre not real.
Months after the Sept. 11 terrorist attacks, Dr. Difede and Dr. Hunter Hoffman, who is the director of the Virtual Reality Research Center at the University of Washington, tested virtual reality treatments in one survivor with acute PTSD, one of the first reported applications of the therapy. Dr. Difede said that the first time the patient put on the headset, she started crying. I never thought Id see the World Trade Center again, she told Dr. Difede. After six hourlong sessions, the patient experienced a 90 percent decrease in PTSD symptoms.Dr. Difede later tested V.R. exposure therapy in Iraq War veterans 16 out of the first 20 patients no longer met the diagnostic criteria for PTSD after completing treatment.
Dr. Deborah Beidel, a professor of psychology and executive director of U.C.F. Restores, has broadened the treatments beyond visuals, customizing sounds and even smells to create an augmented reality for patients.