By: Holly Contreras
Post-traumatic stress disorder (PTSD) is more prevalent than ever and has created a significant behavioral healthcare challenge. PTSD is a psychiatric disorder that can occur in individuals who have experienced a traumatic event such as war combat, sexual assault, or a natural disaster. In an era following multiple wars and extremely high rates of reported sexual assault, our healthcare system is in need of a more effective method to diagnose and treat PTSD. Virtual reality exposure therapy (VRET) can address these issues in a more precise and objective way than current therapeutic practices. Immersive virtual reality is created with computers, a head-mounted display, 3D graphics that adapt intuitively to the patient, and body tracking devices to deliver biofeedback. In PTSD cases, a patient is immersed in a trauma-related scenario in which visual stimuli, auditory cues, and even weather conditions can be meticulously controlled by a clinician (Kaplan, 2009). It is believed that with full immersion there will be fewer intrusive thoughts and less avoidance, thus allowing the patient to confront past trauma and treat PTSD over multiple sessions.
Currently, the most effective treatment for PTSD is prolonged exposure (PE) therapy; however, there are flaws to this practice that virtual reality has the potential to eliminate. PE targets fear structures in the brain, such as the amygdala. These structures house information, and they are triggered when the patient reencounters this information through visual or audio cues. The goal of prolonged exposure therapy is to cognitively reprocess the information in these fear structures and relearn responses to previous fear-inducing stimuli. This happens through emotional processing and extinction of the anxiety associated with a particular stimulus. In order for this to be successful, and individual needs to repeatedly relive a traumatic experience through imagination and narrative. In failed cases of this treatment, the patient is unable or unwilling to effectively relive a traumatic experience, commonly blocking some of the most intense triggers (Rizzo and Shilling, 2017). VRET eliminates the possibility for avoidance. A clinician can customize the emotional intensity of every scene to the patient’s specific needs. Triggers can be directly delivered to the patient in a paced and controlled environment. The clinician can objectively uncover the most intense triggers for a patient by tracking biofeedback concurrently with virtual stimuli. This objective documentation is not possible in PE when relying on the unseen world of the patient’s mind.
In a small study in 2011, ten Iraqi veterans with combat-related PTSD underwent VR-graded exposure therapy and ten underwent treatment as usual (TAU) for this condition. Both groups received treatment for ten weeks, and results were monitored using the Clinician Administered PTSD Scale (CAPS). Seven out of 10 patients in the VRET group showed 30 percent or greater improvement, while only one 1 out of 9 patients showed this level of improvement in the TAU group. This is a statistically significant improvement (McLay et al., 2011). This study is limited by sample size, however it is a promising indicator that VRET is a safe and effective treatment for PTSD.
Additionally, research is being done on the diagnostic potential of VRET. One of the challenges in accurately diagnosing PTSD is that it relies on a clinical interview in which, a patient discusses past traumatic events with a medical professional. This method lacks validity due to the subjectivity of self-reports. VRET offers an objective assessment of the patient’s condition. In a study, physiological activity such as heart rate and skin conductance were recorded from 58 male veterans with and without PTSD, while they experienced two trauma-related virtual reality videos. There was a statistically significant difference in physiological feedback between the groups with and without PTSD. Those who were affected with PTSD showed higher physiological arousal upon being immersed in the virtual trauma. These results are promising for VR to be used as a tool in diagnosing PTSD (Webb et al., 2014).
VRET is a relatively new clinical tool to treat and diagnose PTSD. Many of the studies performed to date have been case studies or have used relatively small sample sizes. So, there is still a lot of territory to explore within the VR realm. However, the results collected thus far have shown a significant improvement in patients suffering from Post-traumatic Stress Disorder, particularly those that are prone to avoidance and have a difficult time recounting their traumas. Virtual reality allows clinicians to manipulate the imagination of their patients and create a treatment plan that can rewire fear pathways in the brain ultimately leading to recovery.
1. Kaplan, A. (2009) Virtual Reality for PTSD. Psychiatric Times. http://www.psychiatrictimes.com/traumatic-stress-disorders/virtual-reality-ptsd/page/0/1
2. Mclay, R., Wood, D., Murphy, J., Center, K., Reeves, D., Pyne, J., Shilling, R., & Wiederhold, B. (2007). Combat-Related Post-Traumatic Stress Disorder: A Case Report Using Virtual Reality Exposure Therapy with Physiological Monitoring. CyberPsychology & Behavior10(2): 309-315.
3. Rizzo, A. & Shilling, R. (2017). Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD.” European Journal of Psychotraumatology 8.5
4. Webb, A. K., Vincent, A. L., Jin, A. B., & Pollack, M. H. (2015). Physiological reactivity to nonideographic virtual reality stimuli in veterans with and without PTSD. Brain and Behavior, 5(2).