thedrifter
06-17-07, 05:43 AM
'Virtual Iraq': A real help to stressed vets
High-tech therapy at Emory shows promise in reducing fears, long after soldiers' battle traumas.
By Bill Hendrick
The Atlanta Journal-Constitution
Published on: 06/17/07
He smells cordite, burning rubber, the sour scent of diesel fuel, even body odor. He's been awake so long he's starting to doze behind the steering wheel of his Humvee. Then suddenly gunfire crackles and a woozy Aaron Beach feels a jolt as a rocket-propelled grenade blasts his vehicle, shattering his hand and wounding a buddy.
Blood flows. And adrenaline. His mind races wildly, so he jumps out and yells for medic Christopher Wortham to care for his wounded friend. And for him.
For Beach, a 23-year-old Iraq war vet from Atlanta, the scene plays out all too often —- in the middle of the night and at odd moments of the day, at home and even on the road.
And lately, here in an air-conditioned lab at Emory University, where he's enrolled in a five-year study designed to find a new, better way to reduce or eliminate symptoms of Post Traumatic Stress Disorder (PTSD) by zipping him back to Iraq through a high-tech, video-game-like module in which he sees, smells, feels and hears what happened when he was there.
Scientists hope the "Virtual Iraq" experience —- and a new use for an old drug —- will help Aaron recover from the trauma of war that plagues up to a third of the troops returning from "the big sandbox."
Since he was wounded Nov. 20, 2004, while driving a Humvee near Fallujah, visions of Iraq come to Beach when he hears a loud noise, when he closes his eyes, while riding his motorcycle, in crowds, when he spots garbage or parked cars on the roadside.
And now, also when he dons the Darth Vader-like "virtual reality" helmet in the Emory lab of Dr. Maryrose Gerardi that whisks him back to the moment a fiery flash from the RPG almost took off his head.
"I remember the day I got hit. I was so tired I was leaning over and driving," says Beach. "We hadn't slept in like two days. I heard a blast. Saw blood. The gunner took shrapnel in his arm and leg. I looked at my hand and arm but kept driving for a while on three flat tires."
He remembers a large chunk of shrapnel stuck in the windshield "right in front of my face that could have taken off my head."
He remembers killing his first Iraqi a month after arriving in-country.
Virtual reality "exposure" therapy has been used to battle post-traumatic stress for a decade. It is considered effective because it gradually desensitizes patients to specific fears. One study found that Vietnam vets' symptoms were reduced by 34 percent when they were treated by psychologists using a "Virtual Vietnam" developed at Georgia Tech.
But this study of Beach, an Army specialist or E-4, and 149 other soldiers and Marines with PTSD, is different. It is designed to prove that VR can work better and faster when subjects take a drug once widely used to treat tuberculosis.
The drug, d-Cycloserine, or DCS, affects a region of the brain called the amygdala that processes memories and emotional reactions like fear. Mounting research on PTSD and other anxiety problems shows that the drug can also decrease fear.
A 2002 study showed that rats on DCS learned to be less fearful of electric shocks. In a 2004 Emory study, 28 people terrified of heights took DCS or a placebo before donning virtual reality goggles that zipped them skyward in a virtual glass elevator. Those who took DCS enjoyed a significant reduction in their fear of heights that lasted at least three months. And last year, Boston University investigators found that DCS helped people with anxiety disorders learn to overcome fear of social situations, such as public speaking.
Emory boasts top expert
Based on those results and others, scientists are trying to get the Food and Drug Administration to approve wider use of DCS for post- traumatic stress disorder.
Because the Emory study is "double blind," neither Aaron nor the scientists yet know whether he is taking DCS, the tranquilizer Xanax or a placebo, but after five virtual reality sessions, Aaron, says he's less jumpy and is feeling better.
Dr. Barbara Rothbaum, head of Emory's Trauma and Anxiety Recovery Program and head of the study with co-leader Dr. Kerry Ressler, thinks the vets on DCS will do better.
"It's just too cool," says Rothbaum, recognized as one of the world's top experts on PTSD. "It makes the therapy work better and faster. And we're going to need better therapy because these wars are going to cause so much PTSD it's unimaginable. We've just got to find a better and faster way to treat the symptoms."
DCS is not a tranquilizer, like Xanax, which provides a temporary balm for anxiety. It opens up channels in the brain that allow more chemicals to flow that are involved in memory and emotion, Rothbaum says. And it only works on fear in conjunction with exposure therapy. The pill alone has no effect.
"We think [the virtual reality module] helps people make the connections with traumatic memories faster," says Dr. Skip Rizzo at the Institute for Creative Technologies and School of Gerontology at the University of Southern California, who created the Virtual Iraq module being used at Emory.
Troops who don the VR helmet to experience Virtual Iraq see themselves behind the wheel, or in a passenger seat. They hear explosions, or see hostiles popping up and firing with AK-47s. Or grenade launchers. They see planes and helicopters flying over. And rising smoke. A Nintendo controller lets them steer, but not fire back.
The details don't have to "match perfectly," Gerardi says, "but rather be close enough to cue each veteran's individual experience and allow them to fill in their own details."
Beach says it is more real than he or other vets could imagine. "It puts you back there, for sure," he said. "The stuff doesn't look totally real, but it all feels real. It's scary. You sweat like an E-5 tryin' to read."
During the sessions, Gerardi keeps up a soft running banter. She presses buttons to squirt out different smells, to make the "rides" bumpier or smooth on a moving platform.
She constantly asks questions: "What are you thinking? How do you feel? How are you feeling that in your body? What happens next? Stay with it."
She can sense their emotions, both fear and relief. And she can see what they do through the helmet on two large computer screens near her desk, adjacent to the vibrating platform on which they sit. While troops are going through Virtual Iraq, she constantly asks questions.
The soldiers often get nervous. A few have had to take off helmets for a break. Others have cried.
A researcher and a mom
Putting the troops through the VR is often an emotional experience for Gerardi. She may be a scientist, but she's also a mom, and her daughter just graduated from Brookwood High, Beach's alma mater in Gwinnett County.
"I am deeply touched by the pain I witness," Gerardi says, "and it's always an honor for me to be allowed to share it."
"The science aspect of this work is also very important to me because the more we can understand about this process the better we can be at keeping PTSD from becoming a chronic problem in people's lives."
Overwhelmed by the increase in war-caused anxiety disorders, the Army announced last week that it plans to hire 200 more psychiatrists, psychologists and social workers to help traumatized soldiers, at a cost of $33 million. About 600 uniformed and civilian mental health professionals already work at three dozen Army medical centers like the VA Hospital in Decatur, which referred Aaron to Emory.
Gerardi says that in Virtual Iraq, "they learn that their anxiety goes down with repeated exposure to their traumatic memory. This decrease in fear makes the memory easier to control and allows them to be more at peace with the memory."
Memories still raw
For Beach, the memories are still raw, and they do come back.
But he's got his life back together, and thinks it's due to the VR therapy, "even though I don't know what the drug is."
He has a girlfriend. A job. He's a full-time student at Perimeter College.
He feels "normal most of the time" and doesn't talk much about the war except with Gerardi.
"I followed my father's footsteps into the Army," Beach says. "He died last November, but I think he'd be proud."
ON AJC.COM: Go online to experience the virtual reality simulation for yourself.
Ellie
High-tech therapy at Emory shows promise in reducing fears, long after soldiers' battle traumas.
By Bill Hendrick
The Atlanta Journal-Constitution
Published on: 06/17/07
He smells cordite, burning rubber, the sour scent of diesel fuel, even body odor. He's been awake so long he's starting to doze behind the steering wheel of his Humvee. Then suddenly gunfire crackles and a woozy Aaron Beach feels a jolt as a rocket-propelled grenade blasts his vehicle, shattering his hand and wounding a buddy.
Blood flows. And adrenaline. His mind races wildly, so he jumps out and yells for medic Christopher Wortham to care for his wounded friend. And for him.
For Beach, a 23-year-old Iraq war vet from Atlanta, the scene plays out all too often —- in the middle of the night and at odd moments of the day, at home and even on the road.
And lately, here in an air-conditioned lab at Emory University, where he's enrolled in a five-year study designed to find a new, better way to reduce or eliminate symptoms of Post Traumatic Stress Disorder (PTSD) by zipping him back to Iraq through a high-tech, video-game-like module in which he sees, smells, feels and hears what happened when he was there.
Scientists hope the "Virtual Iraq" experience —- and a new use for an old drug —- will help Aaron recover from the trauma of war that plagues up to a third of the troops returning from "the big sandbox."
Since he was wounded Nov. 20, 2004, while driving a Humvee near Fallujah, visions of Iraq come to Beach when he hears a loud noise, when he closes his eyes, while riding his motorcycle, in crowds, when he spots garbage or parked cars on the roadside.
And now, also when he dons the Darth Vader-like "virtual reality" helmet in the Emory lab of Dr. Maryrose Gerardi that whisks him back to the moment a fiery flash from the RPG almost took off his head.
"I remember the day I got hit. I was so tired I was leaning over and driving," says Beach. "We hadn't slept in like two days. I heard a blast. Saw blood. The gunner took shrapnel in his arm and leg. I looked at my hand and arm but kept driving for a while on three flat tires."
He remembers a large chunk of shrapnel stuck in the windshield "right in front of my face that could have taken off my head."
He remembers killing his first Iraqi a month after arriving in-country.
Virtual reality "exposure" therapy has been used to battle post-traumatic stress for a decade. It is considered effective because it gradually desensitizes patients to specific fears. One study found that Vietnam vets' symptoms were reduced by 34 percent when they were treated by psychologists using a "Virtual Vietnam" developed at Georgia Tech.
But this study of Beach, an Army specialist or E-4, and 149 other soldiers and Marines with PTSD, is different. It is designed to prove that VR can work better and faster when subjects take a drug once widely used to treat tuberculosis.
The drug, d-Cycloserine, or DCS, affects a region of the brain called the amygdala that processes memories and emotional reactions like fear. Mounting research on PTSD and other anxiety problems shows that the drug can also decrease fear.
A 2002 study showed that rats on DCS learned to be less fearful of electric shocks. In a 2004 Emory study, 28 people terrified of heights took DCS or a placebo before donning virtual reality goggles that zipped them skyward in a virtual glass elevator. Those who took DCS enjoyed a significant reduction in their fear of heights that lasted at least three months. And last year, Boston University investigators found that DCS helped people with anxiety disorders learn to overcome fear of social situations, such as public speaking.
Emory boasts top expert
Based on those results and others, scientists are trying to get the Food and Drug Administration to approve wider use of DCS for post- traumatic stress disorder.
Because the Emory study is "double blind," neither Aaron nor the scientists yet know whether he is taking DCS, the tranquilizer Xanax or a placebo, but after five virtual reality sessions, Aaron, says he's less jumpy and is feeling better.
Dr. Barbara Rothbaum, head of Emory's Trauma and Anxiety Recovery Program and head of the study with co-leader Dr. Kerry Ressler, thinks the vets on DCS will do better.
"It's just too cool," says Rothbaum, recognized as one of the world's top experts on PTSD. "It makes the therapy work better and faster. And we're going to need better therapy because these wars are going to cause so much PTSD it's unimaginable. We've just got to find a better and faster way to treat the symptoms."
DCS is not a tranquilizer, like Xanax, which provides a temporary balm for anxiety. It opens up channels in the brain that allow more chemicals to flow that are involved in memory and emotion, Rothbaum says. And it only works on fear in conjunction with exposure therapy. The pill alone has no effect.
"We think [the virtual reality module] helps people make the connections with traumatic memories faster," says Dr. Skip Rizzo at the Institute for Creative Technologies and School of Gerontology at the University of Southern California, who created the Virtual Iraq module being used at Emory.
Troops who don the VR helmet to experience Virtual Iraq see themselves behind the wheel, or in a passenger seat. They hear explosions, or see hostiles popping up and firing with AK-47s. Or grenade launchers. They see planes and helicopters flying over. And rising smoke. A Nintendo controller lets them steer, but not fire back.
The details don't have to "match perfectly," Gerardi says, "but rather be close enough to cue each veteran's individual experience and allow them to fill in their own details."
Beach says it is more real than he or other vets could imagine. "It puts you back there, for sure," he said. "The stuff doesn't look totally real, but it all feels real. It's scary. You sweat like an E-5 tryin' to read."
During the sessions, Gerardi keeps up a soft running banter. She presses buttons to squirt out different smells, to make the "rides" bumpier or smooth on a moving platform.
She constantly asks questions: "What are you thinking? How do you feel? How are you feeling that in your body? What happens next? Stay with it."
She can sense their emotions, both fear and relief. And she can see what they do through the helmet on two large computer screens near her desk, adjacent to the vibrating platform on which they sit. While troops are going through Virtual Iraq, she constantly asks questions.
The soldiers often get nervous. A few have had to take off helmets for a break. Others have cried.
A researcher and a mom
Putting the troops through the VR is often an emotional experience for Gerardi. She may be a scientist, but she's also a mom, and her daughter just graduated from Brookwood High, Beach's alma mater in Gwinnett County.
"I am deeply touched by the pain I witness," Gerardi says, "and it's always an honor for me to be allowed to share it."
"The science aspect of this work is also very important to me because the more we can understand about this process the better we can be at keeping PTSD from becoming a chronic problem in people's lives."
Overwhelmed by the increase in war-caused anxiety disorders, the Army announced last week that it plans to hire 200 more psychiatrists, psychologists and social workers to help traumatized soldiers, at a cost of $33 million. About 600 uniformed and civilian mental health professionals already work at three dozen Army medical centers like the VA Hospital in Decatur, which referred Aaron to Emory.
Gerardi says that in Virtual Iraq, "they learn that their anxiety goes down with repeated exposure to their traumatic memory. This decrease in fear makes the memory easier to control and allows them to be more at peace with the memory."
Memories still raw
For Beach, the memories are still raw, and they do come back.
But he's got his life back together, and thinks it's due to the VR therapy, "even though I don't know what the drug is."
He has a girlfriend. A job. He's a full-time student at Perimeter College.
He feels "normal most of the time" and doesn't talk much about the war except with Gerardi.
"I followed my father's footsteps into the Army," Beach says. "He died last November, but I think he'd be proud."
ON AJC.COM: Go online to experience the virtual reality simulation for yourself.
Ellie