But experimentation is costly and slow. Advances in virtual reality technology have been sluggish, and equipment prices are still prohibitively high. Moreover, few people are involved with the research. "We have people who wear a lot of hats," says Hollander, who does 3-D modeling, sound engineering, scripting, coding, web design and hardware configuration. "I'm constantly running around in little circles, trying to get everything to work."
He adds that one of the biggest challenges facing developers is the design of a user-friendly interface for psychologists and clinicians, who tend to be technology-averse. "Therapists don't know anything about technology. Frequently, they don't even know anything about computer games," says Hollander. "So you have to make this bizarre, exotic hardware as simple as possible to use." This means that the very flexibility that makes virtual reality so attractive as a therapeutic tool becomes a liability in terms of programming and design. The challenge becomes finding a happy medium between flexibility and ease-of-use.
Virtual Iraq has currently entered the clinical testing phase, with research groups running trials and pilot programs across the country. At Emory, Rothbaum is currently examining the effectiveness of combining virtual reality therapy with medication. In her study, PTSD patients take a pill approximately thirty minutes before engaging in four sessions of virtual exposure therapy. One group takes D-cycloserine, a drug that reduces fear symptoms; another takes Xanax, a common anti-anxiety medication; and a third takes a placebo pill. The hope is that drugs will prove to be a useful complement to the virtual reality.
Imprint's bus bomb simulation has also entered the clinical testing phase, but finding appropriate respondents has been difficult. "They had a bunch of trouble in Haifa getting a population of patients who were compatible," says Hollander. "They kept getting patients who were the absolute worst-case scenario, and so nothing worked on them."
Rizzo, Rothbaum and Hollander all agree that good feedback is hard to find, but it's the most critical element in designing these applications. "You can't design these things from the ivory tower," says Rizzo. "You need that feedback on what you've gotten right and wrong to drive your work."
But where do you draw the line between reality and virtual reality? How realistic should these applications strive to be? Rizzo admits that the limits are still hazy. He mentions that people have requested he add the smell of burning or rotten flesh to his smell box, and logically, he can see the reasoning. "When somebody's gone through the whole thing, and you think they just need that one last experience to really pull out that emotion and deal with it, then maybe that's when you hit that button.
"But what is the smell of death?" he asks uncomfortably. I don't know how to answer that question, either. "I mean, I smelled a dead cat once, and I almost puked. The smell of rotting human - I - I don't know. I'm not sure how far up the hierarchy of exposure we really need to go."
Although Rizzo asserts that a therapist should do whatever is necessary to help the patient, he argues that realism by itself isn't the point of virtual reality therapy. "No matter what, we're not going to exactly replicate and eradicate any memories of what has happened here," he says. "But how they deal with the pain, that changes how it impacts their life. We're just helping someone to heal."
Lara Crigger is a freelance science and tech journalist specializing in electronic entertainment. Her previous work for The Escapist includes "Escaping Katrina" and "The Milkman Cometh." Her email is lcrigger [at] gmail [dot] com.