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Playing Through the Pain

Lara Crigger | 7 Nov 2006 11:00
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On paper, Virtual Iraq sounds like the greatest war game ever made.

You put on the binocular headset, and you're instantly transported behind the wheel of a dusty Humvee. Yours is the second vehicle in a convoy, and as you bounce along the city streets, you uneasily scan the alleyways and rooftops for insurgents. The rumble of the engine vibrates your sweaty flesh. You smell gasoline, body odor and the faint traces of Iraqi cooking (someone must be making dinner nearby). Over the hum of fighter jets and helicopters, you hear the echoing call to evening prayers.

Suddenly, a rocket streaks toward you, and the Humvee in front of yours explodes, billowing smoke and orange flame. As you scramble for cover, your nose is filled with the rank smell of burning rubber and gunpowder. Shots ring out behind you, but they're hard to hear over the screams of civilians fleeing the explosion.

Virtual Iraq may be the most realistic and detailed war simulator to date, but it is no ordinary videogame.

The program is an innovative therapeutic tool, designed to help thousands of veterans suffering from posttraumatic stress disorder. By immersing themselves in a virtual Iraq, soldiers can confront their worst combat memories head on, to deal with their trauma and reconcile their fears.

Posttraumatic stress disorder (PTSD) is a complex cocktail of anxiety, fear and helplessness that results from exposure to life-threatening events, such as military combat. Sufferers will do anything to avoid situations or cues that remind them of the trauma they've experienced. "The root of PTSD is unprocessed emotional memories," says Skip Rizzo, a clinical psychologist at the University of Southern California. "Those memories come out at night, in nightmares and flashbacks."

Military personnel - particularly combat veterans - are especially susceptible to PTSD. A study published in the July 1, 2004 issue of The New England Journal of Medicine revealed that one out of every eight Iraq war veterans has the disorder. (That study was conducted back when the war was relatively new; current estimates place the rate as high as 20 percent.)

But PTSD remains a taboo subject in many military circles. Oftentimes, soldiers are concerned that if they seek therapy, they risk contempt or ostracism from their peers and commanding officers. Only 40 percent of the Army veterans from the Iraq war who tested positively for mental disorders in the study actually sought medical care; rates were even lower among veterans of combat operations in Afghanistan.

Stigma is just one reason veterans avoid therapy; the therapy itself is another big factor. One of the most effective PTSD treatment methods is "imaginal exposure therapy," or confronting trauma through a set of guided, systematic recollections. Therapists repeatedly walk patients through their most painful memories, asking clients to imagine, describe and discuss the traumatic event. As time progresses, patients grow less anxious and more confident with their feelings and memories. "It's almost brain-dead simple, this idea that the more you're exposed to something, the more you get used to it," says Rizzo. But this "touchy feely" style turns off many grizzled, combat-hardened veterans.

Moreover, traditional exposure therapy has its limits. Barbara Rothbaum, an assistant professor of psychology at Emory University, has been using exposure therapy for years to treat anxiety disorders, but she says that the PTSD mental block is hard to crack. "Even in the first study we did, some of the people said they knew what they needed to do, but there was no way they could bring themselves to do it," says Rothbaum. "People with PTSD are pretty avoidant."

Rothbaum started exploring alternative methods for exposure therapy over 10 years ago, when she and Larry Hodges at Georgia Tech experimented with virtual reality to treat the fear of heights and planes. They discovered that the virtual reality therapy worked just as well as traditional exposure therapy did, and soon, Rothbaum started researching its use for other anxiety disorders, such as PTSD.

Many people still see virtual reality as a parody of itself; the goofy headsets and trippy virtual environments have inspired fads like the Virtual Boy and B-movies like The Lawnmower Man. But as a therapy tool, virtual reality has proven exceptionally potent. "We found that people do get better using virtual reality therapy," says Rothbaum. "That it translates into real life."

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