Imaginal Exposure Using Virtual Reality for Treating PTSD
Michael Roy, MD, Col. (Ret.) talks about how using virtual reality to treat people with PTSD can be incredibly effective because it helps trigger recalls and stimulate the senses in ways that pure talk therapy cannot.
[Dr. Michael Roy] Imaginal exposure is not for everybody. Avoidance of reminders of the trauma is so strong in many that they can't really find themselves able to engage in imaginal exposure. Virtual reality, I think, provides advantages for many subjects— not for everybody. There are trade-offs here. On the one hand—I think—using a virtual environment to trigger recall because that's what it does more than anything else. So let's take a service member who was in a vehicle that hit an IED. We can ask them to close their eyes, picture they're back driving that Humvee through the desert and to describe all of that or we can put them in a virtual environment where we reproduce that. They're driving the Humvee through the desert. Eventually we progress to where maybe there's an ambush, somebody is shooting at them, a bomb goes off—that kind of thing. What are the advantages and disadvantages? I think the advantage to the virtual environment is not everything is on the patient's shoulders. It's not totally up to them to recall everything that happened to them session after session in excruciating and increasing detail. So the virtual environment— they're presented with this, and they start to say, "Oh, that reminds me of when Bobby got shot." They start to be able to come up with things. So it helps with triggering those memories— enabling them to recall things and describe them to the therapist. I think that's one of the real advantages of it. Perhaps, the greatest advantage. There is an element of desensitization that occurs, as well. "I fear that that bag on the side of the road is going to blow up," and that's why they swerved across four lanes of traffic on the Beltway this morning. So presenting them with things like that where there are things on the side of the road—they don't blow up— or they at least have a chance to kind of work through that— to talk about what that's triggering—what that's making them feel. Now when you want to avoid reminders of the trauma, there's also a lot of trepidation with being put in that virtual environment. So, "Oh! You're going to show me—a bomb goes off." "I'm anxious about that. I don't want to do that." But you start off very slowly. You start off very gradually. We have four different senses we can stimulate in the virtual environment. The visuals, of course. So we show them a market place or a convoy going through the desert. They see all of these things. It's very high-quality graphics. There's a lightweight headset that's pretty comfortable to wear. It shows a little computer screen in front of each eyeball to create the 3D representation. There's a newer version we're just starting to implement where it actually provides a full 180 degrees of freedom so they can literally see everything. Right now it's like 40 degrees. They can turn all the way around in the environment. So there are 360 degree views—very realistic. There are sounds. Again the audio is very high-quality, and I think that's particularly important. We have a vibration platform. So there's an explosion. They can actually feel the explosion. If they're driving a vehicle, they can feel the rumble of the vehicle. Finally, there is smell that we can introduce. We have a smell machine. There are little pellets that we heat up, so we can create unpleasant smells— body odor, burning trash, the smell of the explosion, Cordite— or more positive ones—roasting lamb, Middle Eastern spices. So at the appropriate moments— you're going through the marketplace— we can introduce the smell of the market—good and bad. By kind of stimulating all these different senses, we can, hopefully, trigger different parts of the brain— trigger lots of memories.
Posted on BrainLine May 28, 2013.
Michael Roy, MD, Col. (Ret.) is professor of Medicine and director of the Division of Military Internal Medicine at Uniformed Services University and director of Recruitment for USU's Center for Neuroscience and Regenerative Medicine.
Produced by Victoria Tilney McDonough, Justin Rhodes, and Erica Queen, BrainLine.