By Rachel Stern
Being trapped amidst chaotic crowds in a crumbling building, stuck in an escalating war zone or facing your most daunting fear—for $160 an hour—may not seem like the most exciting, or sane, prospect to many people.
But for those with post-traumatic stress and other anxiety disorders, being placed in a virtual war or stress zone may represent the most realistic cure.
In contrast to the conventional therapy of visualization and talking about trauma—in which a patient must search within themselves for the root of their problems—scenes of “Virtual 9/11,” “Virtual Iraq” and “Virtual Vietnam” bring the trauma back to the patient.
Developed by the Georgia-based Virtually Better in 1996, virtual exposure therapy has been used to treat patients in the areas of speech pathology, attention deficit disorders, pain distraction, motor-rehabilitation and anxiety disorders, including most recently, Post-Traumatic Stress Disorder (PTSD).
“You can raise the level,” said Dr. Albert “Skip” Rizzo, who presented his research on “Virtual Iraq” on Feb. 18 at the American Association for the Advancement of Science (AAAS) meeting in San Francisco, of what many would consider his unorthodox therapy.
“[Exposure therapy] allows people to face their fears and feel more in control,” Rizzo, who works at the Institute for Creative Technologies at USC, said.
Virtual Exposure Therapy and PTSD
Post-Traumatic Stress Syndrome describes the psychological after-effects of traumatic events. Victims often suffer from nightmares or flashbacks, increased irritability, a lack of emotions and isolation.
A 2004 study by the Walter Reed Army Institute discovered that almost one in eight soldiers returning from Iraq and Afghanistan experienced some syndromes of PTSD.
In the immersion system of “Virtual Iraq,” realistic street scenes, sounds, and smells encourage PTSD sufferers to “re-live” Iraq in a controlled environment. In “exposure therapy,” the clinician determines the environment the patient is ready to see—ranging from simply driving a Humvee down a desert road to being immersed in a zone of rapid gunfire and explosions.
For an extra dose of realism, participants can stand on a platform that recreates the vibration of a military vehicle or a concussion from a bomb blast.
Being able to walk a patient through the senses and sounds of their trauma is what distinguishes virtual exposure from conventional forms of therapy, according to Jane Bogart, UC Santa Cruz’s Student Health Outreach and Promotion coordinator.
“Sometimes fears come from not knowing what is happening,” said Bogart, who helped counsel PTSD sufferers after the 9/11 attacks as the health promotion director at New York University.
Virtual Iraq has been utilized in clinical trials in 10 locations around the United States, and has been installed at 15 Army and Marine Corps sites.
The “Virtual Iraq” participant wears a headset that can show virtual images of either a street scene or a desert. The system, which costs almost $10,000, includes a “smell machine,” a box that delivers eight different smells—cordite, diesel fuel, burning rubber, body odor, middle-eastern spices, and cooked lamb—by means of an aerosol spray.
Four soldiers have discontinued the treatment, but the dropout rate, according to Dr. Rizzo, is no greater than that of any other form of counseling.
In an era of video games, Rizzo believes that traumatized soldiers are less likely to feel less stigmatized seeking virtual treatment than they would with conventional therapy.
The only negative effects of the therapy, he said, occur when patients experience too much, too fast. Rizzo recalled that one Vietnam veteran suffered a panic attack when virtually placed into a war zone he had not experienced in 25 years.
In a scene from “Virtual Vietnam,” one sits in the cargo compartment of a helicopter, which is replicated in real life by a bass woofer system beneath the seat to duplicate helicopter vibrations. Patients glide over a green-tinted jungle river and seemingly endless fields of rice patties.
In another scene, they hear the sounds of helicopters, explosions and troops calling for help.
Both scenes, Dr. Rizzo said, help stimulate real memories. The eight veterans treated in “Virtual Vietnam” have seen reduction in PTSD symptoms ranging from 15 percent to 67 percent.
The programmers at Cornell University who designed “Virtual 9/11” listened in fine detail to thousands of eyewitness accounts of the event to recreate the day in extraordinary detail. Once patients put on their helmets, they see and hear the first signs of panic from the offices of the Twin Towers. They follow the panicked crowds frantically searching for an exit, push themselves down stairs and finally reach the ground level chaos.
Dr. Rizzo feels that most PTSD sufferers have trouble visualizing such traumatic scenes on their own, as patients tend to block out such traumatizing events from their memories.
While the patient recounts their memories out loud, the clinician manipulates the program to add in sights and sounds to better duplicate what the patient is feeling.
“The therapist has to be in close contact,” Rizzo said. “We’re not trying to eliminate the clinician; we’re just giving the clinician a tool.”
The typical PTSD treatment takes place in two one-hour sessions over the course of five weeks.
Dr. Elana Zimand is the director of clinical services for Virtually Better, the company that designed the 3D imaging software for “Virtual 9/11.” Zimand feels that virtual exposure therapy can be a safer method for easing patients into difficult situations than real-life immersion.
“Real life scenarios are really good ways of conquering fears, but sometimes they’re too scary,” Zimand said. “This is a good first step.”
Gary Shoemaker, interim director of UCSC Counseling and Psychological Services, feels that both conventional and virtual reality therapies can be effective with the aid of the counselor. When using visualization techniques with patients suffering from PTSD and other anxiety disorders, he is careful not to “flood them” too quickly with the past event.
“We don’t want to re-traumatize people,” Shoemaker said. “We work with people to decide when the timing is right to revisit the event.”
According to Shoemaker, conventional forms of therapy for PTSD include cognitive-behavioral therapy, group therapy, and psychotropic drug therapy, and Eye Movement Desensitization and Reprocessing (EMDR)—which works by processing the way the body reacts to distressing memories.
Other Anxiety Disorders
Ruthie Surojon could feel her hands shaking and her breath growing thicker as she stepped in front of the glaring crowd. She raised her voice to speak, and did not stop for 15 solid minutes. Then she took off her headset.
“Without the experience, it wouldn’t be so effective,” Surojon said. “Because part of the experience was coming up with things that might help and seeing if they work. They helped me test my [fears].”
Surojon, for 15 minutes out of a 50-minute session, was virtually placed behind a podium where she was to speak in front of a large crowd.
“It was not the real thing, but I was really anxious,” Surojon said. “My hands were shaking and everything. I was there, you know?”
Next month, Surojon will speak publicly for her engineering firm—in reality—for the first time in her life.
Anxiety disorders affect 40 million Americans, or about 18 percent of the population. Fear of public speaking, fear of heights and fear of social situations account for the most common phobias.
According Dr. Helene Wallach, a virtual reality researcher and conventional therapist at Safed Regional College in Israel, virtual reality therapy fills in the holes in conquering their phobias that the imagination cannot.
“Some people have difficulty imagining things,” Wallach said. “[With virtual reality therapy] they don’t have to imagine. They can actual see it.”
Virtual emersion therapy can also be used to help stroke victims regain motor skills like walking, climbing stairs or standing upright. Another use of virtual simulation is its potential for diagnosing, and ultimately treating, Attention Deficit Hyperactivity Disorder (ADHD) patients, a condition afflicting one in 20 children in the United States.
“Virtual Classroom,” a program Rizzo developed in 1999, simulates the nuances of a real-life classroom, down to the paper airplanes and background chatter. Since “Virtual Classroom” mimics the real-life distractions facing children normally, councilors can actually diagnose a child for ADHD in about 20 minutes, where usually that process would take hours with a therapist.
Real Virtuosity: Philosophically Inspired Technology
The French philosopher and culture critic Jean Baudrillard, who died last week, famously proclaimed “The gulf war did not take place.”
Baudrillard postulated that we live in a “hyperreality,” a superficial copy of a more meaningful world people have not yet learned to see due to the mass-produced images that surround them. The Gulf War, he argued, existed as images on radar and TV screens more so than it did as actual combat.
The ideas of Baudrillard—as famous for his eccentricity as his cultural observations—were one of the chief inspirations for the 1999 film The Matrix, in which the protagonists “discover” that their perceived real-life experiences have simply been the creation of a computer program.
Rizzo’s Institute of Creative Technologies’ graphic lab, which produced the computer graphics for The Matrix and Spiderman II, attempts to make virtual reality therapy as “real” as possible for patients by focusing on luminosity.
They capture the light on real objects from panoramic images, which they apply to similar, computer-generated objects. Those objects then contain the same illumination from the real world—whether they be translucent, shiny or shadowy.
Dr. Jane McGonigal—utilizing a Matrix-esque twist, believes that computer immersive worlds should be called “real virtuality” instead of virtual reality.
McGonigal, a game designer specializing in alternate reality games, feels that computer games as a whole spur participants to “create their own environment.”
“There’s less inhibition for participants,” McGonigal said of educational computer games such as Immune Attack and Virtual Babylon. “They’re not looking around to see if the smart kids have their hands up.”
Rizzo believes that computer technology and virtual simulations—whether used to treat anxiety and cognitive disorders, or just for recreation—will continue to be at the forefront of educational innovation.
He said, “We need more intuitive ways to interact with computers.”