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Therapy for traumatized Iraq vets: “Virtual Iraq

March 6, 2007
Courtesy University of Reading
and World Science staff

Sci­en­tists be­lieve they may have de­vel­oped just the ther­a­py for war-weary, trau­ma­tized vet­er­ans of the Iraq war.

Put them back in Iraq—a sim­u­lat­ed ver­sion of the rav­aged land, that is.

The re­search­ers at Uni­ver­si­ty of Read­ing, U.K. are put­ting in­to prac­tice a “vir­tual Iraq,” de­vel­oped at the Uni­ver­si­ty of South­ern Cal­i­for­nia in Los An­ge­les.

A scene from the vir­tu­al Iraq sim­u­la­tion. The rec­re­a­tion uses graph­ics from a  train­ing game called Full Spec­trum War­ri­or. (Cour­te­sy Uni­ver­si­ty of Read­ing)


While the idea might strike some who are un­ac­quaint­ed with the ways of psy­cho­ther­a­py as sick, psy­chol­o­gists say it’s no loony scheme. It follows a long tra­di­tion of en­cour­ag­ing trau­ma vic­tims to re­live and con­front pain­ful mem­o­ries, in or­der to move past them.

The proj­ect ap­pears to be “sim­ply a tech­no­log­i­cal en­hance­ment of some­thing that we know works well to help some trau­ma­tized peo­ple. Not all of them, but many,” Lau­ra S. Brown—a clin­i­cal and fo­ren­sic psy­chol­o­gist in Se­at­tle, Wash., who was­n’t in­volved in the proj­ect—wrote in an e­mail.

A “vir­tual reality” is an im­ag­i­nary three-di­men­sion­al vis­u­al world cre­at­ed by a com­put­er, some­thing like a vid­e­o game, which sur­rounds a us­er. The us­er typ­i­cal­ly we­ars spe­cial gog­gles or a hel­met in or­der to en­ter this world and in­ter­act with ob­jects as if he or she were in it.

The Iraq treat­ment sees pa­tients talk through their trau­ma with a ther­a­pist while we­ar­ing gog­gles that im­merse them in a vir­tu­al real­i­ty bat­tle­field. The ther­a­pist can add smells, sights and sounds. These can in­clude road­side bombs, spe­cif­ic odours such as gun­pow­der, burn­ing rub­ber, Iraqi spices and body odour, and spe­cif­ic sounds such as gun­fire and he­li­copters buzzing over­head.

The scheme appears to be an en­hance­ment of a stand­ard, well-researched ther­a­py called Pro­longed Ex­po­sure, Brown wrote. In this, typ­i­cal­ly, a cli­ent “is asked to read from a de­tailed script and vis­u­alize her/his trau­ma with the aid and sup­port of the ther­a­pist, who as­sists the cli­ent to be­come re­laxed, and thus re-condition the bod­y’s fear mech­a­nisms to not re­spond to the trau­ma any longer.”

“Our aim here is not to re-trau­matize peo­ple, but rath­er to re-expose them to rel­e­vant trau­matic events in a grad­u­at­ed way that they can han­dle,” said Read­ing’s Al­bert “Skip” Rizzo. “You want to help peo­ple man­age their emo­tion­al re­sponses... For ex­am­ple, when a car back­fires, you want to help a pa­tient get to the point where he does­n’t have a flash­back of a gun go­ing of­f.”

The sys­tem lets pa­tients ex­pe­ri­ence com­bat sce­nar­i­os in a “low threat” con­text, the re­search­ers said, in which his or her ex­po­sure is care­ful­ly con­trolled by psy­chol­o­gists. The “fully-immersive” sim­u­la­tion, they added, has pro­duced prom­is­ing re­sults for the first hand­ful of pa­tients treated. 

Paul Sharkey, a di­rec­tor of the uni­ver­si­ty’s Vis­u­al­i­sa­tion Cen­tre, said the vir­tu­al real­i­ty soft­ware recre­ates the sights, smells, sounds and jolts of the bat­tle­field. He ac­knowl­edged one draw­back: “Through ask­ing pa­tients to wear head­sets, there is a po­ten­tial risk of height­en­ing the trau­ma, as this is akin to put­ting on a hel­met in the field.” 

The in­ves­ti­ga­tors are work­ing on ways to avoid us­ing the hel­mets, he added. “It is hoped that this will lead to pi­lot stud­ies with ther­a­pists and psy­chol­o­gists to test the ef­fi­ca­cy of the ap­proach as a tool for ther­a­py.”


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Scientists believe they may have developed just the therapy to help aid traumatized Iraq war veterans. Put them back in Iraq—in a simulated version of that ravaged land, that is. The researchers at University of Reading, U.K. are putting into practice a “virtual Iraq,” developed at the University of Southern California in Los Angeles. While the idea might sound sick to some who are unacquainted with the ways of psychotherapy, psychologists say it’s no loony scheme. It falls in line with a long tradition of encouraging trauma victims to relive and confront painful memories, in order to get past them. The project appears to be “simply a technological enhancement of something that we know works well to help some traumatized people. Not all of them, but many,” wrote Laura S. Brown—a clinical and forensic psychologist in Seattle, Wash., who wasn’t involved in the project—in an email. A “virtual” environment is an imaginary three-dimensional visual world created by a computer, something like a complex video game that surrounds a user. The user typically wears special goggles or a helmet in order to enter this world and interact with objects as if he or she were in it. The virtual reality scheme at Reading seems to be an enhancement of a standard, well-researched therapy called Prolonged Exposure, Brown wrote. In this, typically, a client “is asked to read from a detailed script and visualize her/his trauma with the aid and support of the therapist, who assists the client to become relaxed, and thus re-condition the body’s fear mechanisms to not respond to the trauma any longer.” The Iraq treatment sees patients talk through their trauma with a therapist while wearing goggles that immerse them in a virtual reality battlefield. The therapist can add smells, sights and sounds. These can include roadside bombs, specific odours such as gunpowder, cordite, burning rubber, Iraqi spices and body odour, and specific sounds such as gunfire and helicopters buzzing overhead. “Our aim here is not to re-traumatize people, but rather to re-expose them to relevant traumatic events in a graduated way that they can handle,” said Reading’s Albert “Skip” Rizzo. “You want to help people manage their emotional responses in a way that makes them more functional in their day-to-day lives and relationships. For example, when a car backfires, you want to help a patient get to the point where he doesn’t have a flashback of a gun going off.” The system allows patients to experience combat scenarios in a “low threat” context, the researchers explained, where exposure of the patient is carefully controlled by psychologists. The simulation is “fully-immersive,” they added, and has produced promising results for the first handful of patients treated. Paul Sharkey, a director of the university’s Visualisation Centre, said the virtual reality software recreates the sights, smells, sounds and jolts of the battlefield. He acknowledged one drawback: “Through asking patients to wear headsets, there is a potential risk of heightening the trauma, as this is akin to putting on a helmet in the field,” he said. The invest igators are working on ways to avoid using the helmet technology, he added. “It is hoped that this will lead to pilot studies with therapists and psychologists to test the efficacy of the approach as a tool for therapy,” he said.