Therapy in the Treatment of PTSD


The intent of this paper is to supply a comprehensive literature reappraisal of Virtual Reality Therapy ( VRE ) in the intervention of Post Traumatic Stress Disorder ( PTSD ) in combat soldiers from the Vietnam, Iraq, and Afghanistan War. Traditional exposure therapies such as imaginal or in vivo exposure introduce the possibility of turning away, a status inherent in PTSD, and patients may show trouble conceive ofing or depicting their traumatic experiences in item. However, VRE therapy eliminates this possibility because it allows participants to go immersed in a practical environment through the incorporation of sound, ocular, olfactive, and haptic stimulation in a human-computer synergistic plan. VRE therapy creates a multimodal experience for the participant because it taps into all centripetal modes, which basically provokes a realistic re-creation of their traumatic experience. With VRE therapy, the healer can fit the patient ‘s personal narration to a practical environment, leting patients to face their injury, while helping them in the alteration of dysfunctional ideas and beliefs to cut down PTSD symptoms.

Exposure Therapy in the Treatment of PTSD in Combat Soldiers

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Post-Traumatic Stress upset, or PTSD, is a chronic and enfeebling status that occurs in persons who have been exposed to an utmost life threatening or a traumatic experience. Harmonizing to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association ( 2002 ) , symptoms of PTSD include reliving of the original injury through incubuss or flashbacks, turning away, and hyperarousal symptoms that badly disrupt and impair one ‘s life. PTSD symptoms frequently intensify when the person is exposed to a stimulation resembling the original injury.

Virtual world therapy, or VRE therapy, has been a proposed intervention option for combat veterans exhibiting Post-Traumatic Stress Disorder, or PTSD. The therapeutical attack allows patients to go immersed in a practical environment that reflects combat veterans ‘ part of deployment. Users do non simply observe images on a computing machine screen in a inactive mode ; in fact, they are actively take parting and interacting with a computer-generated 3-dimensional universe that may be a practical Reconstruction of the content and environment that may resemble their original injury. Practitioners can readily administrate the computer-generated environment to the patient within the office and custom-make the stimulations and state of affairss to each single instance, so that it will resemble the original injury, and authorise the patient to take control of the memory.

VRE therapy allows the patient to go prosecute more emotionally, instead than holding to tell an experience mentally, which may ensue in the callback of the injury in a level, asleep, or passionless mode, ensuing in an turning away of the state of affairs. Traditional exposure therapies require that the patient conceive of the traumatic experience through memory in as vivid inside informations as possible. The patient repeats the intervention repeatedly until the emphasis is reduced. However, patients undergoing VRE therapy still recite the traumatic experience, but they are witnessing a assortment of computer-generated stimulations in a plan that allows them to see the experience in a concrete mode. The patient wears a head-mounted show, or picture spectacless, while either siting or driving a fake convoy or military vehicle, while the healer matches the event with the patient ‘s personal narration of the injury. As a consequence, the incorporation of assorted stimulations during a therapy session can significantly cut down the job of patients showing trouble mentally visualizing the anxiety-provoking scenes VRT can supply stimulations for patients who have trouble in conceive ofing anxiety-provoking scenes or are excessively dying and scared to see existent state of affairss.

Harmonizing to Van Etten and Taylor ( 1998 ) , although behavioural therapy through exposure is much more effectual over other intervention options for PTSD related symptoms, most participants express trouble visualizing their traumatic experiences. One can see the principle behind VRE therapy because there is a considerable difference between a patient repeatedly holding to shut his eyes to tell and conceive of the state of affairs as opposed to reciting the narrative and holding the same type of event happening through the show of practical sights and sounds. Prior to the application of VRE therapy, the bing criterion of attention for the intervention of PTSD was imaginal exposure therapy, which involves repeatedly live overing a traumatic event through memory and imaginativeness through a systematic ranked hierarchy. The coveted consequence is a de-conditioning of the erudite association of fearful stimulations raising a fearful or anxiousness bring forthing emotional response through the procedure of addiction and extinction. Although this signifier of intervention is low-threat, many patients may be unwilling or unsuccessful in the effort to efficaciously visualise the traumatic event. In add-on, turning away of the reminders of the traumatic event is frequently a status inherent in PTSD.

Research reveals that the battle of emotion and fright activation play an indispensable function in exposure therapy ; in fact, the deficiency of emotional battle in imaginativeness on portion of the client may ensue in intervention failures or inauspicious intervention results ( Jaycox, Foa, & A ; Morral, 1998 ) . Behaviorally, turning away is what keeps the trauma alive ; nevertheless, with VRE therapy, it allows the healer to set the patient back in the minute in a gradual and controlled mode, which facilitates emotional processing and minimizes turning away. Successful intervention necessitates the emotional processing of the fright construction in order to modify their pathological elements, in such a manner that the stimulation no longer raise fright. VRE therapy diminishes the chance of distraction and turning away to the feared state of affairs or stimulation. The intervention aim is to assist veterans come to footings with what they have experienced in war zones by plunging them in the sights and sounds of those similarly encountered during combat, which includes the ocular and audio effects of the gunfires.

VRE therapy can bring forth stimulations at a greater magnitude than criterion in vivo or imaginal exposure techniques. VRE therapy serves a practical intents as it extends the shared experience between the patient and the healer within the confines of the office since “ it would be impossible to acquire clinicians on the battleground with combat PTSD clients, and it is presently impossible to portion the clients ‘ imagined scenes ” ( Rizzo, Rothbaum, & A ; Graap, 2006 ) . The meeting of therapy with engineering allows the healer to systematically expose the patient to the injury, as opposed to simply trusting on their imaginativeness. An advantage of VRE includes the ability to administrate the therapy within the healer ‘s office, diminishing the hazard of injury or embarrassment for the client, and the ability to command the exposure to the stimulation. The perennial battle of the fright construction through VRE therapy in a safe, controlled environment enables the patient to virtually re-experience the traumatic events in a governable mode that allows for addiction and a lessening in anxiousness, which thereby, allows the incorporation of new information to happen. The balance of this paper will discourse the application of VRE therapy to different instances affecting combat veterans exhibiting PTSD.

Virtual Vietnam

Participant Choice

Research workers at Emory University developed the first practical world application for the intervention of PTSD to a Vietnam combat veteran. In Rothbaum et Al. ‘s ( 1999 ) instance survey, a 50-year old Caucasic male, had served as a Vietnam chopper pilot and met the DSM-IV-TR standards for PTSD, major depressive upset, and substance abuse 20 old ages following the Vietnam War. Despite finishing intervention at the Atlanta VA Medical Center, he still exhibited the depressive symptoms and suffered from PTSD. During intervention, the patient was exposed to two practical environments, affecting a practical Huey chopper winging over Vietnam and a land mass surrounded by jungle.


The intervention was administered in 14, 90-minute Sessionss conducted bi-weekly over 7 hebdomads. The intervention involved exposing the patient to both audio and ocular effects in a practical jungle. The practical chopper included sounds of the rotor, gunshot, bombs, engine sounds, and wireless yak. The ocular effects included flashes from the jungle, choppers winging operating expense, landing and take off, fog, every bit good as the terrain below the chopper. The audio effects included recordings of gunshot, choppers, mine detonations, and work forces shouting orders, such as “ Move out! Travel out! ” All of these effects could be increased in strength. As the patient is exposed to the ocular and audio stimulation, the patient is asked to depict the explicit memories triggered by the computer-generated practical environment several times in the present tense. This is to bring on addiction and lessening anxiousness.

Unlike standard exposure therapy, the patient is confronted with the images and scenes being described in his personal narration of the memory in real-time, as opposed to re-living the experiences mentally. The healer efforts to fit the practical world experience every bit closely as possible to the patient ‘s relation of the injury. In add-on, the patient is asked to maintain his eyes open in order to face the fearful stimulation. During the procedure, healer is able to see the practical environment that the patient is interacting with on a picture proctor. As a consequence, the healer is able to pass on with the patient and farther continued exposure to the fearful stimulation until anxiousness is habituated, so the ultimate end is to do the injury go a memory, instead than a flashback or incubus that controls them. The healer can pull strings practical state of affairss to outdo suit the single patient during a standard therapy session. By bit by bit reintroducing the patients to the experiences that triggered the injury, the memory becomes tolerable.


Consequences from the VRE therapy indicated that the patient experienced a 34 % lessening on clinician-rated PTSD, every bit good as a 45 % lessening on self-rated PTSD. In add-on, consequences of the test indicated a lessening in his turning away mark and an betterment on all steps of PTSD, every bit good as care of these additions 6 months after the disposal of the exposure therapy ( Rothbaum et al. , 1999 ) . Furthermore, depression, choler, and substance maltreatment were non adversely affected. Although the study is rather limited in range and can non be generalized across all combat veterans exhibiting PTSD since it is merely one topic, the consequences have deductions for future research in the intervention constituent for combat veterans with PTSD. The survey was subsequently followed by an unfastened clinical test with 16 Vietnam male veterans, which followed the same processs as the original Virtual Vietnam instance. Consequences from the follow-up survey revealed that after 13 VRE therapy Sessionss, there was a important decrease in PTSD related symptoms ( Rothbaum, Hodges, Ready, Graap, & A ; Alarcon, 2001 ) . Such consequences suggest that the usage of practical world, combined with valuable engineering, may be a promising intervention attack for veterans with combat-related PTSD.

Virtual Iraq and Afghanistan

The University of Southern California Institute for Creative Technologies ( ICT ) and Virtually Better, Inc. ( VB ) besides initiated a practical world application for the intervention of PTSD in returning Iraq or Afghanistan War military forces. Virtual Iraq and Afghanistan is presently being implemented in the undermentioned locations: Madigan Army Medical Center at Ft. Lewis, the Naval Medical Center in San Diego, Camp Pendleton, Emory University, Weill Medical College of Cornell University, and at 24 other Veterans Affairs military and laboratory sites. Consequences from the Naval Medical Center in San Diego from a clinical sample test revealed statically and clinically meaningful decreases in PTSD symptoms, including anxiousness and depression. In add-on, harmonizing to Reger, Gahm, Rizzo, Swanson, and Duma ( 2009 ) , the patient studies suggested, “ They saw betterments in their mundane life state of affairss. ”

Unlike VRE therapy for Vietnam Veterans, the undertaking takes a few stairss frontward in pragmatism through the incorporation of olfactory and haptic stimulations into the practical Iraq and Afghanistan environment. Olfactory stimulation is delivered through a computing machine device called ES-1 Scent Machine, which utilizes eight aroma cartridges, a series of fans, and an air compressor presenting aromas to the participants. Olfactory stimulation incorporated in the practical plan include fume, firing gum elastic, refuse, organic structure olfactory property, Diesel fuel, Iraqi spices, and gunpowder. In add-on, Virtual Iraq and Afghanistan incorporates haptic input in the package through the signifier of quivers that reverberate on the client ‘s floor platform. Explosions, gunshot, or the motion of a military vehicle over uneven paving can trip the tactile input.

With similar bringing characteristics as those in Virtual Vietnam, like audio and ocular effects, and the coincident bringing of olfactory stimulations and haptic stimulation, the consequence is the creative activity of a multimodal experience for the participant because it taps into all the centripetal modes. As a consequence, this enables the participant to go immersed in the practical environment through the senses. Assorted scenarios of the landscape exist such as little rural small towns, desert bases, desert convoys, metropolis edifice insides, and checkpoint patrolling. Overall, the consequence is an enhanced sense of presence in the environment. However, the most of import characteristic of the plan is the incorporation of a clinical interface that is easy customizable to the demands of the client, as there is such great flexibleness in the healer ‘s ability to supervise and modify client anxiousness through the assorted centripetal stimulations.


VRE therapy provides a context by leting persons to treat their emotions relevant to the injury in a curative mode, engage in extinction preparation, and finally diminish the symptoms from the conditioned fearful stimulations to the emotional responses ( Pitman, Orr, Forgue, de Jong, & A ; Claiborn, 1987 ) . The healer can accomplish this by helping the patient in modifying the dysfunctional ideas and beliefs through cognitive restructuring. The current province of VRE therapy necessitates farther demand of research, even if writers from the Virtual Vietnam survey found a decrease of PTSD symptoms and a diminishing of PTSD symptoms in 45 % of them ( Rothbaum et al. , 1999 ) . Virtual Vietnam and Virtual Iraq and Afghanistan are instances that utilize VRE therapy ; nevertheless, they have obvious restrictions.


Although unlike traditional exposure therapy methods, VRE therapy allows the person to live over the traumatic experience through confrontation in a practical presence, instead than mere imaginativeness and memory callback, the sense of practical presence is dependent on what the participant can convey psychologically. VRE therapy requires that the participant give up their sense of physical presence in their current environment in order for practical presence in their injury to genuinely be effectual. In other words, participants must plunge themselves onto the practical universe. Harmonizing to Glantz, Rizzo, and Graap ( 2003 ) , participants must split their overall sense of presence in their current real-time universe by the practical environment. Consequences from old VRE therapy consequences reveal that the longer topics remained in the practical environment within and between Sessionss, there was a lessening in the sense of presence between the current environment and the practical universe, even with minimum stimulations ( Rizzo, Schultheis, Kerns, & A ; Mateer, 2004 ) .

Therefore, how VRE therapy affects intervention outcome chiefly depends upon non merely the practical content itself, but it besides depends on the grade of the participant ‘s willingness to partake in fanciful presence. Furthermore, the physical characteristics of plan, such as colour declaration, sum of interactivity between the participant and the plan, the grade of pragmatism in the practical environment and its stimulation, and single perceptual experience of the healer ‘s ability to fit the content with the personal narration. The aforesaid qualities of the VRE plan can non be ignored because they all contribute to meaningful content and the patient ‘s ability so subjectively confront the injury. Therefore, how good the content represents the injury, in respects to emotional symbolism and pragmatism take into history intervention effectivity. However, VRE therapy should be supplemented with other signifiers of aid, including medicine and societal service.


Although the literature is limited since VRE therapy has late emerged for the intervention of PTSD, findings from the research has deductions for future applications of VRE therapy in the intervention of specific phobic disorders, including fright of winging, fright of public speech production, the fright of being in certain state of affairss, and assorted other scenarios. In add-on, the application of VRE therapy could help in the appraisal combat preparedness and emphasis decrease for soldiers, when the plans are used as combat simulators. Virtual world systems can assist soldiers increase their competence and certainty in the battleground. Through practical world preparation simulations, soldiers can go cognizant of unsafe state of affairss.

VRE therapy allows research workers to farther understand the function of emotions in developing state of affairss or combat state of affairss likewise, which has deductions for the possible bar of PTSD symptoms, such as incubuss, insomnia, and flashbacks, after an brush with a traumatic experience. Most significantly, VRE therapy allows research workers to understand the extent of how combat and war experiences can determine and impact the function of emotions in one ‘s life afterwards.

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