Virtual Iraq for traumatized vets

Virtual Iraq is a virtual reality system that enables veterans suffering from posttraumatic stress disorder to revisit their trauma in order to become desensitized to it. The Department of Defense is testing the Iraq simulation on ground troops who have come back from the war with deep psychological trauma. The sim's engine comes from the game Full Spectrum Warrior but it's augmented with a head-mounted display, earphones, and smell-o-vision. This week's New Yorker has an in-depth piece on the Virtual Iraq clinical trials and the technology's inventor Albert Rizzo, a University of Southern California clinical psychologist who has also built VR systems for diagnosing and treating ADD and memory problems. From the New Yorker:

Strictly speaking, using virtual reality to treat combat-related P.T.S.D. is not new. In 1997, more than twenty years after the Vietnam War ended, researchers in Atlanta unveiled Virtual Vietnam. It dropped viewers into one of two scenarios: a jungle clearing with a “hot” landing zone, or a Huey helicopter, its rotors whirring, its body casting a running shadow over rice paddies, a dense tropical forest, and a river. The graphics were fairly crude, and the therapist had a limited number of sights and sounds to manipulate, but Virtual Vietnam had the effect of putting old soldiers back in the thick of war. Ten combat veterans with long-term P.T.S.D. who had not responded to multiple interventions participated in a clinical trial of Virtual Vietnam, typically lasting a month or two. All of them showed significant signs of improvement, both directly after treatment and in a follow-up half a year later. (P.T.S.D. is assessed on a number of scales, some subjective and others based on the observation of the clinician.) As successful as it was, though, Virtual Vietnam didn’t catch on. It was an experiment, and when the experiment was over the researchers moved on.

Like Virtual Vietnam, Virtual Iraq is a tool for doing what’s known as prolonged-exposure therapy, which is sometimes called immersion therapy. It is a kind of cognitive-behavioral therapy, derived from Pavlov’s classic work with dogs. Prolonged-exposure therapy, which falls under the rubric of C.B.T., is at once intuitively obvious and counterintuitive: it requires the patient to revisit and retell the story of the trauma over and over again and, through a psychological process called “habituation,” rid it of its overwhelming power. The idea is to disconnect the memory from the reactions to the memory, so that although the memory of the traumatic event remains, the everyday things that can trigger fear and panic, such as trash blowing across the interstate or a car backfiring–what psychologists refer to as cues–are restored to insignificance. The trauma thus becomes a discrete event, not a constant, self-replicating, encompassing condition.

Link

Previously on BB:
• VR Goggles Heal Scars of War Link
• NPR "Xeni Tech": Virtual reality to treat PTSD for Iraq vets Link

• [buddy66]

  “The point is to get people out of hell.”

  Thank you, Pipenta (#21). I don’t know how you know it, but you sure know the terrain. I hope you’re in one of the ‘helping professions.’

• [Teresa Nielsen Hayden / Moderator]

  The stories of vets coming home to unsupportive communities have been vastly exaggerated for purposes of propaganda.

  NeoPoliticus: you’ve been listening to people who pour poison in your ears.

• [MarlboroTestMonkey7]

  Very nice, you return home to peace and quiet while the Iraquis can’t inmerse in such virtual technicolor dream.

• [Kyle Armbruster]

  I found that being forced to relive my trauma, and tackle it as simply, “this is something that happened, then this other thing happened,” really cured me. I don’t want to go into details about what it was*, but I couldn’t sleep a whole night for a year without waking up, terrified. I couldn’t cope with people… It was awful.

  But for me, anyway, reliving it in my head over and over took it from “THERE WAS THIS TERRIBLE THING!!!” to “yeah, this thing happened, but it’s over and I’m fine.”

  I imagine that if I had war-related PTSD, this would help me a lot. The past can’t hurt you. That’s the thing you have to train yourself to realize.

  * It wasn’t aliens!

• [Antinous]

  I found the PTSD Workbook to be quite helpful. You can pick and choose what exercises seem relevant to you and ignore the other ones. For example, some people have insistent memories, others have repressed ones. The trauma timeline is quite useful for looking at how your whole life got you to where you’re at, and the writing exercises are great for bringing things up, but be prepared for some nightmares.

• [Takuan]

  which is better? to treat or prevent?

• [Tenn]

  It’s better to use an ounce of prevention, but when that time is past the pound must take play.

• [Tenn]

  But for me, anyway, reliving it in my head over and over took it from “THERE WAS THIS TERRIBLE THING!!!” to “yeah, this thing happened, but it’s over and I’m fine.”

  I’m not exactly traumatized from events that have happened in my childhood, but it’s that realization that has made me lose my animosity towards my family and live without regrets.

  My best friend suffers something that I would in my layman’s way diagnose as PTSD. Very awful event was perpetrated on her by her best friend as a way of preventing another awful event, as I said, and her best friend committed suicide. Some days she’s fine. Other days she’s not. Certain things set her off, certain situations. I’d do anything to help her, including weird ass light therapy or something.

• [rosethornn]

  Whatever helps people feel better is a valid solution (provided it doesn’t hurt others, there’s consent, etc).

  Saying “that’s not psychology!” is completely missing the point.

• [Brett Burton]

  I’ve been doing this exact thing except in reverse to get over post-traumatic stress from too much Grand Theft Auto. I borrow a friend’s car, run red lights, drive up onto sidewalks and smash into all kindsa crap. It totally works! I’m almost completely desinsitized to the game now.

• [demidan]

  for #11

  It is no miracle cure it is real and it works, check it out as around. My youngest brother suffered from PTSD and he did the procedure and is now much better. It does sound like it is too good to be true, but it WORKS.
  PTSD is a stress related issue. In aforementioned light therapy light is flashed into your eyes. AT first in a very regular patterns, that slowly become more and more erratic, thus it slowly desensitizes the subject to stress. Talk to your psych, try it what can it hurt?

• [Anonymous]

  Full Spectrum Warrior? Really? If you want as much immersion as possible, try the Project Reality mod for Battlefield 2.

  http://www.realitymod.com/

  Sure the engine may be a little dated, but the mod adds so much more realism (minus smell-o-vision) it’s really something you have to try for yourself to believe. As much realism as is possible with a simulation, that is.

• [Antinous]

  it slowly desensitizes the subject to stress. Talk to your psych, try it what can it hurt?

  Your description of it makes it sound like it may be pushing memories and emotions deeper into the subconscious rather than bringing them out to be integrated consciously. Is this done in conjunction with cognitive therapy or any other modality?

• [Santa’s Knee]

  Antinous, don’t be so hard on the guy.

  As he said – his mother is also his sister-in-law.

  That’s PTSD in the making right there…

• [Antinous]

  I have a friend whose mother married his cousin after she divorced his father. She used to babysit him, but at least she didn’t have to change the monogram on the towels.

• [pfh]

  With Virtual Reality
  we can create the Iraq we dreamed of
  where the people
  greet us as liberators

• [scottfree]

  Back when Bion and his lot were running the Tavistock clinic in London, which specialised in shell shocked soldiers after WWII, what they tended to think was PTSD was a sort of belated symptom, a return of a repressed trauma, and they treated people with some success by having them remember before the war, to whatever it was shocked them the first time round.

  I’m a fan of this people don’t change business, that our psychologies are holistic, in the sense that the roots of present problems are firmly planted in the distant past. I really hope someone’s taking the time to help these people to sort themselves out without thinking that every problem stems from combat. Chances are, at least some of the problem was there before.

• [NeoPoliticus]

  Sldrs rn’t stpd. Thy knw th Lbrls nd th Nws Md hv bn spprtng th trrrsts thrght “th wr” TH LBRTN F RQ – hlpng thm mrdr 3500 r s sldrs. f thy thght th cntry ctlly cmpltly spprtd thm, thr wld b lt fwr css f PTSD.

• [Tenn]

  Neopoliticus,

  You’re neosomething alright.

• [Teresa Nielsen Hayden / Moderator]

  Pipenta, there’s been serious research into the stories about the reception Vietnam vets got at home. Very short version: Snopes.com territory. For instance, last I heard, no one had managed to confirm a single case of a vet getting spit on, which is the most-retold story of the lot.

• [Takuan]

  and as the Hueys swept low and the guns opened up, the running figures in the paddies outdistanced their falling bodies and then were reared back and jerked into the prone corpses on the ground….

• [Antinous]

  Susceptibility to trauma is related to general good or bad adjustment to life. If you have good self-confidence, good coping skills, ways to express your emotions, etc, you might have minimal, short-term trauma whereas someone with, for instance, an unsupportive childhood, might experience severe PTSD because they have no way to process the emotions from the event. So, yes, it’s really helpful to look at the earliest traumas in your life to see how they pre-programmed you for greater trauma. Being abused as a child would be obvious, but your parents’ divorce, a physical stigma like being fat or moving to a new town during your friendship-building years could tenderize you as well.

• [Bren]

  Recently, I learned that my Pop suffers from PTSD. (WWII) He does group therapy at the VA were the rest of the guys are Vietnam vets.

  I can see, in retrospect, his PTSD. In many ways, he protected me from it, when it wasn’t even a diagnosis at the time.

  For an 80+ old guy, not to mention hard of hearing guy, he’s surprisingly tech-capable! (He can convert tapes to mp3 and organize his player, and such, even though I just sent him some how-to links when he asked!)

  So, I send him the links, and see what he thinks.

• [Xopher]

  I’d just like to point out that a violent family is a battlefield to a child.

• [ZippySpincycle]

  Thanks for the reminder about Jerry Lembke’s The Spitting Image, Teresa–Not that mere research is universally persuasive. I was talking about that book’s conclusions with a guy who insisted that he’d personally seen news footage of a hippie spitting in the face of a returning Vietnam vet. Never mind that Lembke was not able to document any such footage…the person I was talking to “knew” he’d seen it, and there’s no trumping what we “know.” Why should he trust some liberal professor* over the evidence of his own eyes and memory?

  *Or worse, my second-hand reporting of a remembered NPR interview I’d heard with that liberal professor…

• [Antinous]

  I’d just like to point out that a violent family is a battlefield to a child.

  Complex PTSD, which is, er, more complex than regular PTSD, is commonly developed from childhood traumas. Children don’t have the reasoning abilities to process and integrate traumatic events. Because children’s brain are still developing in response to stimuli, CPTSD can have a very strong chemical/physiological component. I know two people with lifelong PTSD who had parents with Narcissistic Personality Disorder. The abuse wasn’t physical, but it messed them up anyway.

• [Lexica]

  I would like to point out that none of the comments so far have said “ooh, a spiffy new tool to make American soldiers all better again, and to hell with those traumatized Iraqis whose country we’ve destroyed and whose friends and family we’ve killed and tortured!”

  Leaving American soldiers with PTSD to suffer untreated would not do anything to improve the situation for the Iraqis who are also suffering.

  MarlboroTestMonkey7 @ 41: If you think that American soldiers get to “return home to peace and quiet” you haven’t been paying attention.

• [Antinous]

  If you want a peaceful, helpful military, you do NOT want soldiers with PTSD. Someone trained to kill, having demanding violent memories and dissociating from any moral/emotional core is not a goodwill ambassador.

• [Pipenta]

  Tenn,

  Most folks with PTSD don’t particularly want the memories wiped. You want to hang on to every bit of information you have that would help you avoid getting in a situation like the one that gave you the PTSD.

  But when you have PTSD, you live your life in a panic state. Things that remind you of the event/events trigger you. Things that don’t remind you of the event trigger you. Sometimes you can’t make sense of the triggering, it just seems to happen.

  It’s hell on your body, being in red alert all the time. You grind your teeth, your heart races, your blood pressure goes up, your digestion goes to hell, the neurons in your hypothalamus get toasted. And it goes on for months, for years.

  To respond this way to a crisis is appropriate. No one wants to be numb to horror. Being numb is a symptom too you know. But to be in a constant state of panic is gruesome.

  People develop sleep disorders, drug and drinking problems. If something triggers them, they start to avoid it. And as more and more things trigger them, they avoid more and more things. There is a longing for contact with other people, but also there can be a lack of trust. People with severe PTSD find themselves isolated from family and friends. Some of it the PTSD are doing to themselves, but some of it is because someone in agony is just difficult to be around, even if you care about them. And a lot of people just can’t understand why PTSD sufferers don’t just pick themselves up and shake themselves off and get on with their lives.

  Remember all the Vietnam vets, the homeless guys you’d see wandering around the streets? There was one in my town they called Sgt. Rock. He had wild hair and crazy eyes and people were afraid of him. I’m sure he lived in hell, the poor guy.

  PTSD can take a fully-functioning human being and have them end up on the street. The triggers become a hellish feedback loop.

  So while becoming totally numb would be a bad thing, the point of this and any treatment is not to erase the pain, nor the memories, but to make them tolerable enough so that the body and mind can rest and heal.

  The point is to get people out of hell.

• [Tenn]

  Pipenta; you helped explain better than the article. Thanks. Understood. It seemed to be suggesting an erasure of the pain.

• [arkizzle]

  I can’t tell you how much of that I read before I realized we weren’t talking about animal doctors.

• [nex]

  Am I a bad person for thinking “I want to try that game!”? Not that I’d expect to enjoy it, but still it seems to intriguing and so wrong at the same time.

• [Landowner]

  I bet that thing takes like, eight quarters.

• [rageahol]

  http://www.maps.org/mdma/protocol/

  mdma would probably be a lot cheaper.

• [Davin]

  It doesn’t just work on habituation, re-integrating someone into a scenario that caused PTSD allows them to work through it. You don’t just “toughen them through it” or such.

• [David Pescovitz]

  @LANDOWNER (#2), HAHAHAHAHAH! Totally.

• [trr]

  #18,
  Sounds like a movie: I Married My Babysitter!

• [CraigGNoble]

  Um… so what kind of program is available for the guy who didn’t do anything and was dragged away from his wife and kids in the middle of the night, tortured for four years then thrown out on the street with no job, a huge stigma attached to him, probably a price on his head and no hope?

• [Anonymous]

  reminds me of Manchurian candidate (denzel Washington version)

• [demidan]

  My mother (and sister-in law)is a psychologist who is trained in a method of therapy that uses intermittent pulses of light to help cure people who are suffering from PTSD. This method takes mere days and does not make the patient have to revisit their trauma to “desensitize” these poor veterans. There is no need for weeks and months of therapy and the vet does not have to say a word, just sit relax.

  Check out PTSD Forum for Light Therapy

• [Pipenta]

  Tak,

  To prevent would be better, but how?

  To prevent the traumatic events? How do you do that? People do get PTSD from experiencing things like natural disasters. But the worst cases are from situations caused by and reinforced by other people. Secondary wounding will really lock in a trauma: a vet who comes home to face a community that blames him for the war (I will never be able to fathom that sort of reasoning.) a victim of sexual assault who is shunned for speaking out. It’s a double whammy. If, even after horrible events caused not by humans, there is no support or even if one feels attacked by those from whom one expected support, the trauma is compounded. There’s layers of this stuff.

  So how do you prevent it? I think if we could find a way to cure and prevent future cases of the cluster b personality disorders, we’d be a long way on the road towards ending crime, child and partner abuse and wars. That would be a wonderful way to stop PTSD, cure the perpetrators, reduced the number of human-caused traumatic events.

  Another way to approach the problem is to prepare people to handle traumatic situations better emotionally. The military, for example, does a dandy job of teaching folks how to drive tanks and shoot guns and such. I don’t know how they prepare people emotionally for trauma. It would be a hell of a lot harder than teaching someone to fly a jet. And from the army’s point of view, it is not going to be all that cost effective.

  How do you prepare a soldier for seeing a friend get disemboweled? How do you prepare a child for enduring sexual abuse? I don’t think you can. Obviously, the sounder and stronger we all are, mentally, the better we weather trauma.

  It seems to me there are three components to the problem: the perps, the victims and then the illness that results. If you really want to commit to prevention, you need to commit to understanding and eradicating mental illness. Do that and as a side effect, you’d end crime and violence and war. You’d have world peace. Wouldn’t that be grand?

• [emayoh]

  Of course, if you never went to Iraq in the first place, I suppose you could get a shiny new case of PTSD if you saw this fresh…

  ..and then they could claim that they have to send you to the *real* Iraq to help you get over it.

  Tell me that’s not the real plan?

• [AirPillo]

  If you find this interesting, you should hear about the hypothetical drug-therapies that might be used to potent affect in combination with such simulations.

  http://www.popsci.com/scitech/article/2007-12/can-fear-be-forgotten?page=4

  The printed article was more informative IMO, but for those who don’t want to click, in synopsis the hypothesis is that, under careful pyschiatric care and observation, a patient can be given one of these types of drugs, which affects their brain in a way that lets the memory or memories causing their fears to be, in effect, -overwritten- by the new, controlled experience, such as the virtual reality shown here.

  So, instead of desensitizing them to the trauma inflicted by those memories by having the re-enact it… treat them with a drug, and then have them re-enact it… which works to reverse the original trauma instead of struggling to desensitize them to it.

• [AirPillo]

  Hmmm, forgive me… I just did a quick hunt for the article and posted when I found the right facts in it, so I posted a link straight to page 4.

  Looks like they have the whole article from the magazine there on the website, just skip back to page 1 first.

  PopSci thankfully doesn’t have a paywall that I know of so enjoy what they distribute free, I say :)

• [Tenn]

  Demidan, sounds a lot better than a system that seems (to me) to simply remove the emotional connection that SHOULD be involved with horror like that. No, I don’t think vets deserve PTSD, but I do think remembering the awful things in our life is part of what makes us people.

• [OM]

  …This is nothing new. Shrinks discovered shortly after Gulf War I that Doom provided excellent stress release for our honored Vets who suffered from PTSD. IIRC, a couple shrinks at a VA facility up north were actually sent a set of mods made by ID to convert the various enemies in Doom I to Viet Cong troops, and the Boss Demons to Ho Chi Minh. Vietnam Vets suffering from PTSD were prescribed a couple of hours play a week – yes, I know, piddlin’ compared to the rest of us! – and over a six month period most of them demonstrated significant improvement in their ability to deal with the psychological trauma that previous therapies and medications had failed to provide relief for.

  …And seriously, how many of us have *not* felt relieved of stress somewhat after fragging something in Doom, Quake or Unreal Tournament, or their descendents? Hell, there’s even some relief along these lines to be found setting up a complex megalopolis in SimCity 3000 and then playing a vengeful God/Yahweh/Roddenberry and sending doom, despair and agony on the denizens and their environs. Same thing can probably be said at least double for playing any one of those FPS games while in “Gawd Mode”.

• [imipak]

  There now follows a public information announcement.

  That strange noise was the sound of the skulls of every psychologist who reads BoingBoing exploding.

  I’m sooo not going into this in detail, but: CBT has nothing to do with Pavlov (classical conditioning), and it doesn’t even have much to do with Operant Conditioning (the stimulus/response/reinforce-or-punish cycle that actually forms human, and indeed animal, behaviours) except in the manner that, say gravity or protein folding has to do with it.

• [trr]

  So the treatment for too much stress is more of the same stress, only created by simulation? Neat.

• [Pipenta]

  But during the Vietnam war, vets did face a lot of negative response when they came home. And even if that was exaggerated, it still happened to some and deepened their trauma.

  We’re in different times.

  Watching the responses of their classmates to Iraq war vets who have returned and are in school, mostly I see respect.

• [Landowner]

  Well if it works it works. It makes sense to me. You are deprogramming your brain. If all it did was trigger ptsd symptoms I think they would put a stop to it. According to the article the ptsd didn’t even start till he got home. So if anything the simulation would prevent an episode by giving the brain the stimulation it was looking for.

  @ imipak Lol, Wut?

  David Pescovitz thanks

• [Antinous]

  My mother (and sister-in law)is a psychologist who is trained in a method of therapy that uses intermittent pulses of light to help cure people who are suffering from PTSD.

  As someone with PTSD, there is no miracle cure. The trauma has to be located, addressed and integrated. The therapy mentioned in the post might be inappropriate for some people, but it would be honest. I really don’t believe that you can move beyond PTSD without some sort of cognitive process. War-related PTSD is relatively straightforward. In complex PTSD, it’s not always clear why you were traumatized by something that might not have affected others around you. Understanding the underpinnings of your own sensitivity to the trauma is vital to releasing the shame and guilt. Then you can start actually addressing the trauma itself.