Virtual reality therapy an emerging weapon in war on PTSD
By Hugh Lessig | Daily Press (Newport News, Va.) | Published: October 7, 2012
NEWPORT NEWS, Va. — The world of virtual reality, dramatized in films like "The Matrix" and TV's "Star Trek," has become an emerging weapon in the very real war against combat stress for troops and veterans in Hampton Roads.
The Hampton VA Medical Center is one of a few dozen places around the country that offers the chance to re-experience combat trauma in a tightly controlled setting – and slowly overcome long-held anxieties.
Wearing goggles and earphones in a doctor's office, patients revisit a three-dimensional slice of Iraq, Afghanistan or Vietnam, navigating a digital world ridden with incoming mortar rounds, bullet holes in windshields and even the smell of cordite and burning garbage.
As a form of therapy, virtual reality is not new. Patients who suffer fear of flying have used it for years. It helps others conquer their fear of speaking in public
At the Hampton VA, staff psychiatrist Kathleen Decker has used the technique for about four and half years with veterans and active-duty troops who suffer from combat-related post traumatic stress disorder, or PTSD. Decker estimated that between 50 and 80 setups such as hers exist throughout the VA medical system and the Department of Defense. Hampton is believed to be the only medical center to offer the service in the VA's Mid-Atlantic Heathcare Network, which covers portions of Virginia, West Virginia and North Carolina.
After donning the goggles and earphones, the patient uses a joystick controller identical to one used for video games. But forget any comparisons to XBOX or Playstation, according to Decker.
"You're not playing a game," she said. "You're striking chords in their memory. When you're in a war game, you are busy being aggressive. This is much more about seeing things happen around you."
The level of detail isn't as sophisticated as today's video games, but that isn't necessary.
"It just triggers the memory in the person," Decker said. "It doesn't have to be a perfect representation of the environment."
One of Decker's patients agrees.
Sam asked that his real name not be used for this story. He's an active-duty soldier who suffers from PTSD, and his goal is to recover and serve as a squad leader again. He has completed four combat deployments, serving in both Iraq and Afghanistan.
During his final deployment in February 2009, Sam was riding in a convoy of armored Stryker vehicles in northwest Baghdad when an improvised explosive device struck the vehicle in front of him. Sam was stationed in the hatch, and he suffered lung injuries and a traumatic brain injury from the blast that hit the neighboring vehicle.
He doesn't remember the attack, but the resulting trauma is very real.
Sam doesn't drink or do drugs, so he turned to violence to deal with the anxieties welling up inside him. He assaulted his wife. He started getting violent with soldiers.
To compound the agony, Sam's 16-month-old daughter passed away in 2010. He had missed her birth while on deployment..His commanders ordered him into counseling, and at first, he didn't see the need.
"I blew it off," he said. "I didn't believe in PTSD treatment. I thought it was just weak-minded individuals."
The turning point came when doctors hooked him to a machine that showed his brain activity. His aggression, he said, "was off the charts."
Doctors at Fort Meade referred him to the Hampton VA, where he became a candidate for Decker's virtual reality therapy.
"I didn't want to do it," he said. "I was anxious for a week. But for me to continue active duty, this is a necessity."
Sam has undergone one virtual reality session so far. He was transported into a digital world as a .50-caliber gunner on a convoy. It took him back to a previous deployment in Afghanistan, where that was his job. He found himself looking for old dangers.
"It was wild – like seeing the overpasses, that's one of the things we look for," he said. "The tops of buildings, anything on the ground, we're always looking for that stuff, so I thought it was pretty realistic."
Sam hopes to eventually conquer his fears by experiencing them over and over with Decker at the controls, deciding when to fill the screen with an IED blast, or send a sniper's bullet through a windshield, or induce a variety of odors from a collection she keeps in a file drawer.
The smells can be as effective as visual cues – and truly foul-smelling. One depicts the odor of blood.
Decker said she proceeds very slowly, allowing patients like Sam to gradually experience a traumatic event without getting overly stressed. For example, Sam's first session involved moving through the virtual world with no trouble.
The "cardinal symptom" of PTSD is avoidance, so she doesn't want a patient to say, "I'm not trying that again. It was too stressful." She keeps up a constant dialogue with patients as they look through the goggles, asking about their anxiety level.
"The therapist has a tricky job of not fostering avoidance," she said.
Sam admits that he's not one to express his feelings in public, especially when they relate to difficult periods of his life. But he wanted to tell his in hopes that others would seek help.
"I never cared about soldiers' aches and pains," he said. "That's the guilt I have today. If I go back to being a squad leader, I will definitely check my soldiers a lot more, physically and mentally. I wouldn't give them a choice to seek help if I saw them acting out of character."
Many of today's younger soldiers joined the military after the terrorist attacks on 9/11. Sam, who is 36 and has 14 years of Army service, was inspired by the earlier generation of Vietnam soldiers. It is worth noting that Decker has two Vietnam-inspired virtual reality worlds in her toolbox. One puts the patient in a helicopter, the other slogging through a rice paddy as a foot soldier.
Sam hopes that Vietnam veterans find their way to offices like hers.
"Hopefully, those guys can get some treatment and relief," he said. "That's what I'm looking for – the relief."
Capt. Heather Bautista, standing, a social worker at the David Grant USAF Medical Center at Travis AFB, Calif., turns to see the virtual fireball of an exploded IED as she checks the operation of virtual reality-based software in April, 2009. At the controls of the system is Lt. Cmdr. William Satterfield of the U.S. Public Health Service.