How VR Is Helping Soldiers With PTSD

Soldiers returning from active duty in Iraq or Afghanistan with symptoms of Post-Traumatic Stress Disorder (PTSD) are unlikely to seek help. But as a first step, they might respond to a virtual human who looks, sounds, and acts like their commanding officer (CO), or find therapeutic release inside a simulated environment that mirrors the place they've just left.

PCMag went to the Institute of Creative Technologies (ICT), part of the University of Southern California (USC), to meet Dr. Albert "Skip" Rizzo, whose team has developed Bravemind, a clinical VR immersive environment and SimCoach, a virtual agent.

USC ICT is in Playa Vista, a re-developed area of Southern California that used to house Howard Hughes's aircraft hangars, and is now part of "Silicon Beach." Google, YouTube, numerous emerging technology agency "Labs," and ICT are all there. Rizzo serves as director for Medical Virtual Reality, as well as a research professor at USC Davis School of Gerontology and USC Keck School of Medicine Department of Psychiatry & Behavioral Sciences.

"I grew up in a small town in Connecticut, which had a veterans' home and hospital with a ton of WWII, Korea-era and, eventually, Vietnam vets," said Rizzo. "One day I saw one of the vets I'd got to know, passed out drunk outside a local store. I asked my dad what had happened. My dad turned to me and said, 'Son, this is a man who got hurt by war.' That was when I realized military action wasn't all John Wayne movies, glory, and honor. That really stuck with me."

Years later, after getting his PhD and doing an internship at the VA Hospital in Long Beach, Rizzo developed a clinical practice in brain injury and neuropsychology. One day a patient who had suffered frontal lobe injury brought in his Game Boy, prompting Rizzo's "Eureka" moment about the positive effects of immersive gameplay.

"My patient was glued to the device, totally focused on becoming a Tetris Warlord. This was a young adult who I couldn't get to focus on any cognitive training tasks for more than five minutes. I knew if we could use new technology, we could do rehab better."

Rizzo acknowledged his initial naivety in thinking they could build VR training tools that leveraged existing game elements for building brain function.

"It was a very challenging development task," he admitted. "I ended up spending years trying to create such VR systems using the limited VR technology we had available back in the 20th century!"

By 2003, his team turned their attention to treating PTSD using VR, and in an easier first step, modified the Xbox game Full Spectrum Warrior.

"Armed with that proof of concept system," said Rizzo, "we acquired the funding needed to create something from the ground up to better address the needs of veterans with PTSD."

The prototype, after successful trials that validated Rizzo's theories, became Bravemind, a visionary VR project, now backed by several Army research funding bodies.

Here's what the experience is like: I was given a modified M4 style sniper rifle (motion controller), a Sony head-mounted device, and earphones (which allowed me to hear Rizzo as the guiding therapist on a separate channel). I stood on a block with a subwoofer inside and faced a screen before embarking on a virtual patrol

The modified M4 allowed me to move through the screens as Rizzo talked me through the process, looking to locate the best imagery for memory retrieval. Bravemind contains multiple options for backgrounds, several night/day lighting modes for realistic ambiance, as well as military and civilian virtual agent characters and vehicles.

They also have an entire sound library, recorded in Iraq, so that helicopter I heard was real, as were the muted voices of the villagers. A small black box on a desk gave off highly realistic smells (don't ask) to complete the warzone illusion.

I never deployed with the US Army to Afghanistan, so I didn't expect any adverse reactions to a 24-block virtual village in the Middle Eastern country. But as soon as a Humvee blew up on my right, the subwoofer under the block beneath my feet boomed and tipped me off balance. Several Afghan virtual agents fled the scene, one died in front of me, blood spattering on the street. My finger was on the trigger, and my heart was pounding. It's easy to see how quickly the virtual becomes really effective in recalling past trauma.

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In clinical trials, a soldier might be rigged up to a full Bio-Pac system (to track heart rate, cortisol levels, and so on) or advanced brain imaging, as their therapist leads them through the exercise. It's part of the Exposure clinical theory, taking soldiers with PTSD into a controlled immersive environment, walking them through recall, while in physically safe situations, thereby lessening symptoms over time, and eventually helping them rebuild a saner life.

"In clinical terms, when someone cannot rid themselves of the trauma," explained Rizzo, "is called 'Failure of Extinction" because the potency of the event, the stimuli, has continued to haunt them."

Bravemind doesn't remove the memory, but it does assist in repairing damage to neural networks. "We tell people upfront, we're not here to remove your memories of war," Rizzo pointed out. "This has nothing to with courage, human will, or character, it's about brain function. Bravemind, in clinical trials, has ameliorated PTSD's effects and symptoms, allowing these soldiers to rebuild their lives."

Next I tried the SimCoach. He's an affable retired Marine with a crew cut, Midwest straight-talking manner, and a very clever set of natural-language tools that elicited surprisingly candid responses after a very short interaction.

In contrast, soldiers returning from conflict zones are guarded. When they to fill out a health assessment chart, few ever say "Yes" to the question about whether they showed evidence of PTSD. But after sessions with the SimCoach, in a conversational "just us guys" format, the results change. The aim is to motivate soldiers to admit they are experiencing problems and, in time, accept clinical help.

"Soldiers know that eventually some research droid is going to look at this output, but in the moment, they do tend to tell more of the truth to the virtual agent. That's the big finding from this work: people will tell the virtual human stuff they don't feel able to tell someone who is judging them. There's less worry about impression management, more revelation of sad events, more self-disclosure - it works."

Rizzo will be presenting these latest findings, from recent clinical trials of Bravemind and SimCoach, at the International Conference on Disability, Virtual Reality and Associated Technologies in September.