SAN JUAN, P.R. — Virtual reality exposure therapy shows promise for relieving symptoms of posttraumatic stress disorder in Vietnam veterans, according to a study. Based on the findings, the principal investigator is now field testing the same high-tech approach with American soldiers in Iraq.
“We've used this as a new way to do exposure therapy,” said Barbara O. Rothbaum, Ph.D., at the annual meeting of the American College of Psychiatrists.
With virtual reality, “the person experiences a sense of presence. It's immersive, so it's more than simply a multimedia experience.”
In the Vietnam veteran study, participants donned a virtual reality headset and experienced a virtual Vietnam War clip (J. Clin. Psychiatry, in press). To more closely simulate actual combat, each veteran stood or sat on a platform above a vibrating speaker during the therapy session.
“People got better; we see it as a slice, or part, of the treatment,” said Dr. Rothbaum, director of the trauma and anxiety recovery program, department of psychiatry and behavioral sciences, at Emory University in Atlanta.
Dr. Rothbaum and her associates observed good end-state functioning immediately post therapy and at 6-month follow-up with virtual reality among 10 Vietnam veterans with posttraumatic stress disorder (PTSD). For example, 70% had good functioning after virtual reality exposure, compared with 50% after eye movement desensitization and reprocessing exposure (EMDR). EMDR is a form of exposure combined with saccadic eye movement—patients follow the therapist's finger while a traumatic story is recounted. At 6 months, the figures were 78% for virtual reality and 35% for EMDR, said Dr. Rothbaum.
“We're just about to start a study of Iraqi veterans with a series of virtual realty images we can individualize for patients,” Dr. Rothbaum said.
The virtual reality application was developed at the University of Southern California's Institute for Creative Technologies by Skip Rizzo, Ph.D., and Jarrell Pair, in collaboration with Ken Graap at Virtually Better Inc. in Atlanta.
It is unknown whether a combination of exposure therapy and medication for PTSD would enhance outcomes. Once field testing is complete, participants in the Iraq war veteran study will take D-cycloserine (Seromycin), alprazolam (Xanax), or a placebo before each virtual reality exposure “to see how they do,” Dr. Rothbaum said.
Several research teams around the world are using virtual reality for treating PTSD, Dr. Rothbaum said. For example, investigators at Cornell University, Ithaca, N.Y., and the University of Washington, Seattle, are simulating the World Trade Center attacks; researchers at the University of Washington and the University of Haifa, in Israel, are simulating terrorist bus bombings; University of Buffalo, N.Y., investigators are simulating motor vehicle accidents; and investigators at the University of Lusofona in Portugal are creating a virtual Angola.