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The New War on Terror

Robert Rath | 19 Sep 2011 13:00
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PTSD, in simple terms, is a disorder caused by an event that inflicts such emotional trauma on the sufferer that normal trauma responses like anxiety, emotional numbing, and panic responses don't fade away naturally like they should, and instead remain in the background ready to reemerge when stimulated by "triggers." When a trigger stimulates the sufferer, they're transported back to the event either emotionally or mentally, losing touch with the things happening around them. As a result, many sufferers both consciously and unconsciously avoid the stimuli, which further buries and exacerbates the disorder, often leading to depression and substance abuse. The goal of exposure therapy is to decouple the trigger from the negative associations it carries, reminding the patient that the traumatic event happened in a specific time and place and that they are no longer in danger. "Exposure therapy is based on meat and potatoes conditioning and learning theory," explains Dr. Rizzo, "You're confronting stimuli, whether it's virtual stimuli or your own memory of the event, confronting it in a safe place so it no longer elicits a fear or anxiety response."

Another important detail is that Virtual Iraq participants aren't able to use weapons during the simulation.

To create Virtual Iraq, Rizzo modded the Xbox game Full Spectrum Warrior, which ICT created as a training tool for the Army in concert with Pandemic Games. To participate, a patient dons a set of VR goggles and holds a rifle, either standing if the simulation is a foot patrol, or sitting down if the scenario takes place in a convoy. A pair of headphones delivers the sound, and a subwoofer under the floorboards or seat provides the droning vibration of a Humvee engine or the thump of explosions. Therapists can even pump in smells like diesel oil, cordite, or burning rubber to help trigger memories.

The revolutionary element of Virtual Iraq is its incredible customization. After meeting with a patient and talking through their experience, a therapist can quickly tailor a simulation that takes the patient through a simulacrum of their own trauma memory. If, for example, a patient was driving a Humvee one night, passed a dead dog, and suddenly came under fire from a sniper that killed his passenger, a therapist could craft that chain of events down to the dead dog. "We can manipulate an IED going off, a jet flying overhead, an RPG firing off a roof, the time of day, the conditions," says Rizzo, "you then ask the patient to recount their trauma narrative and tell their story as if it's happening right there in the first person." During the experience, the therapist talks the patient through, warning him of each upcoming event before it happens and gradating their experience so that the simulation stimulates enough anxiety for the exposure to be effective, but not enough to overwhelm the patient. Elements are usually added one at a time-first the simulation will only be visual, then when the patient is ready, they add audio, eventually moving onto tactile and olfactory stimuli. Reenacting the trauma over and over, as well as reframing and discussing it in traditional talk therapy afterward, eventually erases the fear and negative emotions associated with the experience. The goal of ridding the patient of symptoms, or "extinction" as Dr. Rizzo calls it, is actually accomplished through talk therapy, but Virtual Iraq can help PTSD sufferers gain leverage and provoke the discussion.

Another important detail is that Virtual Iraq participants aren't able to use weapons during the simulation. The point of the therapy is to explore and come to terms with traumatic memories, not vent aggression on them and try to change their outcome. Dr. Rizzo points out this fact when discussing the sort of informal self-treatment taken on by veterans like Hawker: "If somebody claims they got some benefit from [playing games] and there's something measurable that documents that, then I would say, 'Well, you know, that may be something.' Perhaps when playing a game they're getting sensory stimuli and confronting anxieties, but I wouldn't recommend that as a 'treat yourself' option. The problem is that with some patients, they might see that and freak out, or they might not arise any of the anxiety because it's a game where they foster a sort of revenge fantasy. Maybe [playing games] will help them a little bit, but if they're still having problems, the best bet is a professional."

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