thedrifter
02-09-07, 05:49 AM
Virtual war, real healing
By Larry Gordon, Times Staff Writer
February 9, 2007
San Diego — NONE of this is really happening, but the experience is almost overwhelming in "virtual Iraq."
The Humvee plows along a desert road. The engine rumbles underfoot and Blackhawk choppers whirl overhead. A sandstorm blows in, and insurgents pop up and start to shoot with sickening blasts that shatter the windshield. Is that the smell of burning rubber?
Those sensations of war are being fed into a special helmet, goggles and earphones. They are conjured by a computerized virtual reality developed in part by gaming engineers and psychologists at USC and being tested, among other places, at the Naval Medical Center in San Diego. The goal is to treat post-traumatic stress disorder.
Universities, private firms and the federal government are pouring millions of dollars into creating and testing such virtual Iraqs to help ease the psychological disorder that, according to a 2004 study by the Walter Reed Army Institute of Research, affects more than 15% of combat personnel returning from Iraq.
Sufferers may have anxiety, nightmares, flashbacks, emotional numbness, extreme jumpiness and physical pain. Unable to return to combat or civilian jobs, some receive disability payments for years or for life.
With a therapist's supervision, the virtual Iraqs are designed to vividly, yet safely, allow those veterans to confront war experiences in ways that go beyond traditional counseling and drug therapy. The computer programs, even with the somewhat cartoonish digital depictions of combat, seek to relieve trauma by repeatedly revisiting its origins and not letting fear fester. Lt. Cmdr. Robert McLay, a Navy psychiatrist who is a research leader on virtual-reality treatment of PTSD in San Diego, explained that more customary forms of exposure therapy for trauma may require visits to actual locations, such as returning a rape victim to the scene of the assault. "You don't want to send someone who is traumatized back to Iraq," he said. "This allows us to bring someone back, but within the situation here."
And, he said, some PTSD sufferers are unable or unwilling to recall things in counseling sessions without stimuli, such as the digital images of a combat hospital, a recorded Islamic prayer melody or the smell of cordite explosives misted into a psychologist's office.
In 2005, the Office of Naval Research awarded $4 million to support tests of such virtual-reality treatments in San Diego and at Tripler Army Medical Center in Hawaii. The funds also bolster related work by USC's Institute for Creative Technologies in Marina del Rey, the University of Washington and allied high-tech firms.
Cmdr. Russell Shilling, the Office of Naval Research's program officer for medical science and technology, said virtual Iraqs might be especially useful to remove the stigma of psychological therapy for a younger generation who grew up playing video games.
Though it is too early to make judgments about the trial runs, early results "look very promising," Shilling said.
The National Institute of Mental Health is funding a $2-million study at Emory University School of Medicine that uses a virtual Iraq along with a drug, D-cycloserine, that has been shown to reduce the fear of heights.
"The potential impact for men and women with stress adjustment problems is really substantial" and the possible impact on medical research "is extraordinarily important," said Farris Tuma, chief of the national institute's traumatic stress disorders program.
But Tuma cautioned that no treatment is a panacea. "We want to be careful not to oversell it as a simple fix for very complex conditions," he said.
AT the sprawling Navy hospital near San Diego's Balboa Park, researchers are testing two somewhat different systems: one for combat fighters who saw no relief from other therapies, the other for medics and support staff traumatized by war.
So far, McLay said, nine people have completed the cycle of 10 sessions. The goal by next year is have 150 treated at San Diego and Camp Pendleton, including some also suffering from concussions and crushed limbs.
Marines put on a helmet and goggles that allow them to be visually and aurally engulfed, often for 45 minutes. They stand or sit over a small platform that can vibrate. They work a joystick that allows them to walk or ride at various speeds. They can change directions on computerized streets and alleys by twisting their heads and bodies. In one biofeedback version, their respiration, heart rate and palm sweat are monitored.
Psychologists such as Karen Perlman sit at computers and help tailor the experience to the patients, conversing with them throughout.
The treatment usually starts with a digital scene and no violence. But in subsequent sessions, the therapists — after giving warning — heighten the intensity and specifics of the re-created event. They can make the platform shake more violently. They can set off simulated explosions and gunfire and add fog, smoke and night-vision effects, along with the smells of body odor and Iraqi spices.
"Habituation occurs when they repeat their story over and over again," Perlman said. "They start to learn they can tolerate their distress, they can work through it."
If all of that proves to be too much, the session can be interrupted for a discussion or be made less vivid.
Researchers say they want to ensure the experience feels real enough to trigger emotions without being overly bloody. Though some patients have temporarily removed the goggles or asked for a break, no one has completely freaked out, according to McLay. "We are prepared for that experience," he said. "The great thing about virtual reality is that you can turn it off."
Citing privacy issues, authorities did not allow interviews with patients. But a reporter was permitted to talk to a Navy medic who recently served in Iraq and who, though not a PTSD patient, tried one system.
Researchers say they want to ensure the experience feels real enough to trigger emotions without being overly bloody. Though some patients have temporarily removed the goggles or asked for a break, no one has completely freaked out, according to McLay. "We are prepared for that experience," he said. "The great thing about virtual reality is that you can turn it off."
Citing privacy issues, authorities did not allow interviews with patients. But a reporter was permitted to talk to a Navy medic who recently served in Iraq and who, though not a PTSD patient, tried one system.
Ellie
By Larry Gordon, Times Staff Writer
February 9, 2007
San Diego — NONE of this is really happening, but the experience is almost overwhelming in "virtual Iraq."
The Humvee plows along a desert road. The engine rumbles underfoot and Blackhawk choppers whirl overhead. A sandstorm blows in, and insurgents pop up and start to shoot with sickening blasts that shatter the windshield. Is that the smell of burning rubber?
Those sensations of war are being fed into a special helmet, goggles and earphones. They are conjured by a computerized virtual reality developed in part by gaming engineers and psychologists at USC and being tested, among other places, at the Naval Medical Center in San Diego. The goal is to treat post-traumatic stress disorder.
Universities, private firms and the federal government are pouring millions of dollars into creating and testing such virtual Iraqs to help ease the psychological disorder that, according to a 2004 study by the Walter Reed Army Institute of Research, affects more than 15% of combat personnel returning from Iraq.
Sufferers may have anxiety, nightmares, flashbacks, emotional numbness, extreme jumpiness and physical pain. Unable to return to combat or civilian jobs, some receive disability payments for years or for life.
With a therapist's supervision, the virtual Iraqs are designed to vividly, yet safely, allow those veterans to confront war experiences in ways that go beyond traditional counseling and drug therapy. The computer programs, even with the somewhat cartoonish digital depictions of combat, seek to relieve trauma by repeatedly revisiting its origins and not letting fear fester. Lt. Cmdr. Robert McLay, a Navy psychiatrist who is a research leader on virtual-reality treatment of PTSD in San Diego, explained that more customary forms of exposure therapy for trauma may require visits to actual locations, such as returning a rape victim to the scene of the assault. "You don't want to send someone who is traumatized back to Iraq," he said. "This allows us to bring someone back, but within the situation here."
And, he said, some PTSD sufferers are unable or unwilling to recall things in counseling sessions without stimuli, such as the digital images of a combat hospital, a recorded Islamic prayer melody or the smell of cordite explosives misted into a psychologist's office.
In 2005, the Office of Naval Research awarded $4 million to support tests of such virtual-reality treatments in San Diego and at Tripler Army Medical Center in Hawaii. The funds also bolster related work by USC's Institute for Creative Technologies in Marina del Rey, the University of Washington and allied high-tech firms.
Cmdr. Russell Shilling, the Office of Naval Research's program officer for medical science and technology, said virtual Iraqs might be especially useful to remove the stigma of psychological therapy for a younger generation who grew up playing video games.
Though it is too early to make judgments about the trial runs, early results "look very promising," Shilling said.
The National Institute of Mental Health is funding a $2-million study at Emory University School of Medicine that uses a virtual Iraq along with a drug, D-cycloserine, that has been shown to reduce the fear of heights.
"The potential impact for men and women with stress adjustment problems is really substantial" and the possible impact on medical research "is extraordinarily important," said Farris Tuma, chief of the national institute's traumatic stress disorders program.
But Tuma cautioned that no treatment is a panacea. "We want to be careful not to oversell it as a simple fix for very complex conditions," he said.
AT the sprawling Navy hospital near San Diego's Balboa Park, researchers are testing two somewhat different systems: one for combat fighters who saw no relief from other therapies, the other for medics and support staff traumatized by war.
So far, McLay said, nine people have completed the cycle of 10 sessions. The goal by next year is have 150 treated at San Diego and Camp Pendleton, including some also suffering from concussions and crushed limbs.
Marines put on a helmet and goggles that allow them to be visually and aurally engulfed, often for 45 minutes. They stand or sit over a small platform that can vibrate. They work a joystick that allows them to walk or ride at various speeds. They can change directions on computerized streets and alleys by twisting their heads and bodies. In one biofeedback version, their respiration, heart rate and palm sweat are monitored.
Psychologists such as Karen Perlman sit at computers and help tailor the experience to the patients, conversing with them throughout.
The treatment usually starts with a digital scene and no violence. But in subsequent sessions, the therapists — after giving warning — heighten the intensity and specifics of the re-created event. They can make the platform shake more violently. They can set off simulated explosions and gunfire and add fog, smoke and night-vision effects, along with the smells of body odor and Iraqi spices.
"Habituation occurs when they repeat their story over and over again," Perlman said. "They start to learn they can tolerate their distress, they can work through it."
If all of that proves to be too much, the session can be interrupted for a discussion or be made less vivid.
Researchers say they want to ensure the experience feels real enough to trigger emotions without being overly bloody. Though some patients have temporarily removed the goggles or asked for a break, no one has completely freaked out, according to McLay. "We are prepared for that experience," he said. "The great thing about virtual reality is that you can turn it off."
Citing privacy issues, authorities did not allow interviews with patients. But a reporter was permitted to talk to a Navy medic who recently served in Iraq and who, though not a PTSD patient, tried one system.
Researchers say they want to ensure the experience feels real enough to trigger emotions without being overly bloody. Though some patients have temporarily removed the goggles or asked for a break, no one has completely freaked out, according to McLay. "We are prepared for that experience," he said. "The great thing about virtual reality is that you can turn it off."
Citing privacy issues, authorities did not allow interviews with patients. But a reporter was permitted to talk to a Navy medic who recently served in Iraq and who, though not a PTSD patient, tried one system.
Ellie