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Virtual reality provides new hope for PTSD patients

Posted on 23rd March 2017 at 16:13pm

Post-traumatic stress disorder (PTSD) is a devastating condition affecting nearly 7.7 million American adults according to the US National Institutes of Health (NIH). Anyone can develop PTSD, but it is more commonly seen in war veterans and those involved in traumatic events, including natural and man-made disasters.

The Virtual Iraq/Afghanistan exposure therapy from the Institute for Creative Technologies at University of Southern California, has been shown to reduce PTSD symptoms including sleep, irritability, aggression and detachment (photo ICT)

Headset view: Inspired by a video game, Full Spectrum Warrior, virtual reality uses the exposure-based therapy to allow patients to confront their trauma using combat tactical simulation scenarios in the safety of a doctor's office (image: ICT)

Since military and disaster response personnel are at elevated risk for developing PTSD, it is imperative that a reliable treatments be established. With an increasing focus on cognitive computing and virtual reality (VR), such therapy may be the key to understanding and better treating PTSD.

Historically, treatment has largely comprised talk-therapy and combinations of cognitive-behavioural therapy (CBT), medication and group therapy (Foa et al, 2009). One form of CBT is prolonged exposure therapy (PE). This psychotherapy aims to relieve PTSD symptoms by gradually confronting trauma-related situations, feelings, and memories by talking about the details of one’s trauma in a safe space. Group talk therapy allows patients to discuss their trauma with others who have had similar experiences.

While these therapies have proved successful in helping diminish symptoms in war veterans and survivors of natural disasters, they are often not enough to eliminate the vast array of PTSD symptoms completely.

Longitudinal research has revealed that in some patients, PTSD may develop into a chronic disorder, sometimes persisting for a lifetime (Berninger, 2010; Marshall, 2002). And PTSD may present symptoms similar to those of traumatic brain injury (TBI) according to the US Department of Veterans Affairs. Although many returning war veterans and those in war torn or disaster areas have some level of TBI in addition to PTSD, the effects of PTSD alone can be detrimental to a person's physical and mental wellbeing. Symptoms that accompany TBI and PTSD include trouble sleeping, detachment, aggression and decrease in physical activity. While the long term effects of TBI have been highly publicised and the focus of many research projects, those of PTSD are not as well understood.

These more severe cases of PTSD may require a cognitive processing approach (CPT). This therapeutic technique helps the patient understand their trauma and reduce avoidance behaviours that impair the individual from overcoming the traumatic event. CPT led researchers and clinicians to consider virtual reality as a possible approach to conceptualise trauma and to treat PTSD more effectively.

Research and development of virtual reality systems for use in PTSD therapy provides new possibilities for treating patients. VR therapy is largely used to implement exposure therapy, which is thought to be one of the most beneficial treatments for those with PTSD and extreme anxiety according to Rauch et al, 2012.

Today, the Virtual Iraq/Afghanistan exposure therapy, created by the Institute for Creative Technologies at University of Southern California, is used in over 60 sites across the United States. This therapy has been shown to reduce PTSD symptoms including sleep, irritability, aggression and detachment.

Inspired by a video game, Full Spectrum Warrior, virtual reality uses exposure-based therapy to allow patients to confront their trauma using combat tactical simulation scenarios in the safety of a doctor's office (USC). Perhaps the most beneficial aspect of Virtual reality therapy is that it has the ability to confront triggers directly. PTSD symptoms are known to worsen when triggered, whether deliberately or accidentally. A trigger can be anything from a person shouting to a car door slamming shut, and are unique to every individual. These triggers lead to flashbacks in which the person may see, feel, hear or smell something from a traumatic event.

Virtual reality has the promising capability to confront these triggers head on. VR goes beyond any form of talk therapy or medication by harnessing all of the patient’s senses into the therapy session. Each virtual reality session can be tailored to the specific patient's fears and points of anxiety, and include relevant context to the traumatic situation they faced. This includes themed city and rural environments, vibrations, and auditory and olfactory cues.

The integration of multiple senses makes this novel therapy a valuable tool in assessing every aspect of one’s trauma. Having the patient facing their trauma in a controlled setting allows for easy monitoring of vitals and emotional response to various cues. This allows physicians to understand aspects of the individual's trauma better and pinpoint areas in need of help via talk or other forms of therapy.

IBM’s Watson is taking VR to a new level. Integrating understanding, reason, interaction and learning, Watson’s virtual reality systems may be the key to perfecting VR therapy. Watson goes beyond the basic computer-generated simulation of images and space that we think of when we hear the term VR. During the recent Imagination Recognition Hackathon, Watson displayed its skills by manifesting objects that participants drew – bringing their ideas to life and allowing them to interact with their own imaginations.

Watson has the ability to simulate human thought processes using self-learning systems, pattern recognition, and language interpretation. The cognitive computing abilities of Watson are said to be mimetic of the way the human brain works.

With the ability to understand and interpret audio and visual stimuli as well as reason through problems based on the users’ tone and emotion Watson presents exciting new avenues for VR systems in the future. Better understanding and being able to interpret how the brain reacts to traumatic events is necessary in establishing VR therapy as a reliable treatment method for those with PTSD.

by Anna Roselle; Carly EstevesIan Portelli

References:

  • Berninger A1, Webber MP, Niles JK, Gustave J, Lee R, Cohen HW, Kelly K, Corrigan M, Prezant DJ (2010): Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster. Am J Ind Med. 53(12), 1177-85.
  • Foa, EB, Keane, TM, Friedman, MJ, & Cohen, JA (Eds) (2009): Effective treatments for PTSD, Second Edition. New York, NY: Guilford.
  • Marshall, G N; Schell, T L (2002): Reappraising the link between peritraumatic dissociation and PTSD symptom severity: Evidence from a longitudinal study of community violence survivors. Journal of Abnormal Psychology, Vol 111(4), 626-636. 
  • Rauch SA, Eftekhari A, Ruzek JI (2012): Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research & Development (JRRD), 49(5), 679 — 688.
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