The Only Way Out is Through: Using Virtual Reality for PTSD in Veterans
My first summer of graduate school, I worked at the VA in New Orleans. This was a bit of an unusual placement for me as I was training in child psychology. However, as professor whose former student ran the program liked me, and I was best friends with another of his students, I was given one of the three slots.
While it was supposed to be just a research placement, my supervisor also headed up the inpatient PTSD unit. I asked him about getting involved with the unit, even if it was just sitting in on some of the groups. He was hesitant, saying the population of the unit was mostly Vietnam vets and that they could be difficult about having new people attend their groups. Evidnetly they had a habit of throwing them out, sometimes physically. Proof of this came that very afternoon when a medical resident was shouted out of the conference room where they met. After a few days though, I wore my supervisor down and he agreed to let me give it a try.
I was nervous, especially since my supervisor thought it best to let me be myself and other than a few guidelines didn’t give me many suggestions for how to be accepted. One of the vets asked me about my background and finding out I had only completed my first year of graduate school with no military background to speak of, asked me irately how I thought I was going to possibly help them. I responded with the only thing that came to mind. I said I was there to learn from them.
After a minute of so of silence, the group continued, with me being largely ignored. While they may not have fully accepted me, at least they appeared willing to give me a chance. Over the course of the months I was so fortunate to spend there, they grew to let me into their groups and their lives, talking to me in session and out about what life was for them before and now. They took me at my word in terms of being there to learn from them and set out to educate me about a war, never formally declared as such, which my own brother had served in though thankfully not in combat.
I heard about the terror they’d experienced directly and indirectly, their survivor guilt, fury at the government who’d sent them there, horror at losing friends and painful and often debilitating injuries they’d sustained. They talked about what it had been like to return home, not to parades but to chants of “baby killers,” to the veiled hostility they saw in the eyes of those they had once thought were friends. They spoke of coming back only to find that girlfriends and sometimes spouses had moved on sometimes with children they hadn’t seen since.
The constant fear and panic they felt led many of them to live out in the woods as they didn’t feel safe enclosed by walls and didn’t trust themselves not to hurt someone during a flashback. One of the things I had been told before going in the first time was to always makes sure they could sit with their backs to the wall and to see that nothing myself included, blocked their path to the door.
All of them had been in jail at least once for violent outbursts usually during a flashback or drugs. The latter was primarily due to the need to self-medicate when they couldn’t take the anxiety, fear, shame, guilt and other terrible emotions they were feeling. Being locked in a jail cell was tantamount to torture for them since it stripped them of their control making their problems worse. Because of this, I often found myself in court that summer in arguing this very point to get them released to the VA’s custody.
The psychological agony they’d been going through for decades I couldn’t even begin to imagine and only knew that as bad as their physical injuries were, these couldn’t hold a candle to what they suffered emotionally. My goal of learning from them was met in so many ways that even years later I remember their names and faces and the stories they told me. I can still feel the bond that developed and I know that summer changed me in so many ways.
As I was preparing, with a heavy heart, to finish the summer there and go back to school, we got our first Desert Storm Vets. While they hadn’t seen combat, they’d been on the graves unit and were responsible for receiving and identifying soldiers killed by friendly fire. Going through and organizing the soldiers’ personal effects to ship home to loved ones, made these vets feel like they had known these people and with each one they felt as if they’d lost a friend. Hearing the horrific stories of being in the actual combat theater from the Vietnam vets it became clear how they had ended up with PTSD. When I met the Desert Storm vets I learned that war related PTSD could result from experiences besides combat and just how significantly these other situations could impact soldiers lives.
One of the most difficult things for these vets, and another reason a number of them lived in the woods, was the number and unpredictability of things that could trigger a panic attack or flashback. As bad as panic attacks were, flashbacks were worse since they made them believe they were back in the middle of the war. The triggers differed for each person. It could be a color that was the same as a nurses clothes during an attack, a smell such as gasoline from a motor pool where someone was picking up a vehicle when a bomb went off, a song that was playing on a radio during downtime when they’d learned members of their unit had been brutally killed or anything else they unconsciously associated with terrible event. Even when they were aware of their triggers, since it was impossible to predict when they might be confronted with one of them, they did whatever they could to avoid just about everything.
Other symptoms that were frequently troubling were the intrusive thoughts, memories and nightmares that they couldn’t prevent from invading their minds. They were constantly re-experiencing the traumatic events they’d lived through. As terrible as these were to go through once, these vets would do almost anything to make the symptoms stop including sleeping as little as possible and self-medicating. These strategies were largely unsuccessful and only added to their problems and suffering.
One of the main strategies used to help these vets was exposure therapy. For example, one of the groups they had was called War Zone group which was the only one in which they were allowed to give detailed accounts of their war experiences. Letting them do this in a safe environment with others who could honestly say they knew what the person had gone through made it possible for them to face these experiences without avoidance. This resulted in the increasing ability to cope with these memories, decreasing occurrences of flashbacks and the re-experienced events no longer leading to overwhelming anxiety and fear. Helping each other deal with flashbacks during which they’d act as if they were all back in the war also worked as a type of exposure therapy as did listening to each others stories.
Exposure Therapy and Virtual Reality Technology
Of those who experience a trauma, a third go on to develop PTSD. The disorder can take years to develop. In 2013 about 69,000 new cases of PTSD were diagnosed in veterans from Afghanistan and Iraq. The same year, 62,000 Vietnam veterans, were newly diagnosed with the condition, more than 30 year after they left the front. Most experts now believe that exposure therapy is one of the more effective methods of treating PTSD. Essentially, the individual confronts the memory of their trauma repeatedly until these thoughts no longer trigger panic and fear.
In 1997, virtual reality, then a newly developed technology, was hypothesized to be an effective method of delivering exposure therapy. In virtual reality exposure therapy, the person is immersed in a computer-created virtual environment. While initially developed for advanced game play, it was quickly realized that the technology could also be used therapeutically.
In the first study in this area, ten veterans diagnosed with PTSD who had failed to respond to multiple treatment options including medication and psychotherapy, were used to test this method. Each vet wore a virtual reality headset used to present one of two scenarios, a jungle clearing or the passenger seat of a Huey helicopter. The therapist then changed the visual and auditory presentation as the vet talked about their traumatic experiences. After a month undergoing this intervention, all ten patients showed significant improvement.
This success was considered so significant that after the September 11 terrorist attacks on New York’s World Trade Center, burn victims suffering from PTSD were treated using virtual reality exposure techniques. These individuals were shown scenarios involving the planes crashing into the buildings and the explosions. The outcomes for this treatment situation was also extremely successful.
Modern Virtual Reality Technology
Since 9/11, newer systems utilizing virtual reality have been developed. These include computer-automated rooms where images are projected all around the individual. Used for PTSD treatment, the setting can be programmed based on the person’s specific experiences and needs to help them directly confront feared situations or places. This is particularly useful for vets since revisiting a war setting would be clearly unsafe in real life. The situation would be also be uncontrollable and unpredictable, with the fear experienced being tied to real threats of death or injury, leading to a worsening of the symptoms.
To date, virtual reality exposure therapy for PTSD has primarily been used with Vietnam War veterans so the virtual setting includes such imagery as helicopters and jungles. Research has shown that this type of therapy helps to reduce PTSD symptoms in these veterans. A few subsequent studies conducted with small numbers of Iraq and Afghanistan War vets found that virtual reality based therapy was also helpful in reducing symptoms in these former soldiers.
Unfortunately, due to the expense of virtual reality therapy and the logistics of setting up rooms with 360° surround imagery, few therapists or programs, use this type of treatment technology. However, more standard methods of exposure therapy are still highly effective as one component in a treatment program for PTSD. Most VA hospitals still provide outpatient group therapy and other types of useful therapies for PTSD. The most important thing that we can do, is to support and encourage any veterans we may know who are suffering after bravely serving their country, to seek treatment. Sometimes the most important message to impart is simply that they deserve to be happy.
Since the summer I worked at the VA in New Orleans they have shut down the inpatient unit. I was extremely upset upon hearing the news, given how much good I could see was being done at the hospital, even just during the few short months I was there. This is an unfortunate occurrence that is happening across the country.
The problems suffered by our service men and women sometimes cannot be effectively treated outpatient and even if they can it can take far longer to do so. This means a lengthened period of emotional pain they must deal with. If we continue to send our men and women off to war, especially wars that are not absolutely necessary for the security of our nation, we have a responsibility to make sure they are taken care of when they return home.
I hope that those I was so fortunate to haven learned from at the VA are no longer in need of help, and that they have gone on to live happy, satisfying and productive lives. Yet PTSD is a long term disorder that cannot be healed overnight. Should any of them still be in need, it is also my hope that they, along with all of our other vets with emotional difficulties, are provided with the opportunity to take advantage of new technology, such as virtual reality, that might help them. They put their lives on the line to protect us. Now it is our turn to care for them. Money and logistics should not get in the way of helping those who were willing to die for our safety and who now are suffering because of it.