Controlled Studies: PTSDControlled Studies: PTSDAuthorAuthor YearYear # of Pts# of Pts EquipmentEquipment ResultsResults

RothbaumRothbaum 20012001 1616 V6 Head-Mounted DisplayV6 Head-Mounted Display CAPS scores at 6 month CAPS scores at 6 month follow-up showed reduction follow-up showed reduction in PTSD symptomsin PTSD symptoms

TarnanasTarnanas 20012001 5050 VPL Eye Phone 1, MR VPL Eye Phone 1, MR toolkit, vibrations platetoolkit, vibrations plate

Less negative thoughts Less negative thoughts toward earthquake scenariostoward earthquake scenarios

DifedeDifede 20022002 11 Head Mounted DisplayHead Mounted Display 90% reduction in PTSD 90% reduction in PTSD symptoms after VR symptoms after VR exposure therapy exposure therapy

Univ. Of Univ. Of BuffaloBuffalo

20032003 44 UB SimulatorUB Simulator Preliminary results are Preliminary results are promisingpromising

WiederholdWiederhold 20032003 88 EEG, PC computerEEG, PC computer VR environment increased VR environment increased performance on taskperformance on task

LivanouLivanou 20032003 1010 Earthquake simulator, shake Earthquake simulator, shake table (9 levels of intensity)table (9 levels of intensity)

Significant improvement (8 Significant improvement (8 patients improved, 2 patients improved, 2 slightly improved) slightly improved)

WalsheWalshe 20032003 1414 3D Head Mounted Display3D Head Mounted Display Significant post-treatment Significant post-treatment reductions on all measuresreductions on all measures

PTSD EnvironmentsPTSD Environments

Virtual Earthquake

Virtual Vietnam

Virtual World Trade Center

Driving

(David G. Walshe et al., 2003)

Subject Population: 14 participants who met DSM-IV criteria for specific phobia, situational

type-driving or PTSD with driving phobia.

Environment: Game Reality Environment

Midtown Madness IIRally Championship London Racer

Virtual Reality Driving Environment

Apparatus: VFX-3D Head Mounted Display

PTSD due to MVA

Walshe et al…Walshe et al… Method:

7 of 14 were immersed in one of driving simulationsThese 7 patients went through CBT

exposure programGraded driving simulation tasks

with physiological feedback

Results:Results: - Significant reduction in Travel Distress, Travel - Significant reduction in Travel Distress, Travel Avoidance, and Maladaptive driving strategies.Avoidance, and Maladaptive driving strategies. - 92% felt sense of Presence- 92% felt sense of Presence

Conclusion:Conclusion:- Virtual Reality and Game Reality may serve as a tool in - Virtual Reality and Game Reality may serve as a tool in treating post-accident driving phobia.treating post-accident driving phobia.

PTSD due to MVA

Driving Study: 14 participants(Walshe, Lewis, Kim, O’Sullivan, & Wiederhold, 2003)

VGVRVGVR VRVR

PTSD due to MVA

Conclusion

PTSD due to MVA

50% of the participants felt task specific anxiety and immersion 50% of the participants felt task specific anxiety and immersion caused by the combination of VR caused by the combination of VR and GR tasksand GR tasks

7 subjects were treated; SUDs decreased throughout the 7 subjects were treated; SUDs decreased throughout the treatmenttreatment

Subjects’ performance in the simulation translated well into real-Subjects’ performance in the simulation translated well into real-life driving with a decrease in anxietylife driving with a decrease in anxiety

The overall decrease in heart rate at the end of the experiment The overall decrease in heart rate at the end of the experiment signifies that “habituation on a psychological level was matched signifies that “habituation on a psychological level was matched with physiological habituation”with physiological habituation”

While the experiment did not focus on the accident experiences While the experiment did not focus on the accident experiences of the victims, it did manage to decrease PTSD measuresof the victims, it did manage to decrease PTSD measures

Vietnam War VeteransVietnam War Veterans

Two environments: Open Field Huey Helicopter

34% decrease on clinician-rated PTSD 45% decrease on self-rated PTSD Treatment gains maintained at 6-month follow-up

World Trade Center PTSD(Difede & Hoffman)

•Environment:11 Graded Levels of Exposure 1st Stage: Normal day in NYC with view of WTC towersFinal Stage: Entire re-enactment of 9/11

Results: •Participant showed decrease in SUDs rating over time •83% decrease in depression levels •90% reduction PTSD symptoms•Patient no longer met criteria for PTSD

World Trade Center Video Clip

1 20

10

20

30

40

50 Before VRAfter VR

Post-tramatic Stress Disorder from Sept 11thS

ever

ity

Depression PTSD Total score

Difede and Hoffman (2002)

“Combat experiences reported by members of the U.S. Army and Marine Corps after deployment to Iraq or Afghanistan”

Taken from: New England Journal of Medicine

ONR Funded Project Develop VR worlds for non-combatants Test VR worlds for treating PTSD in non-combatants VR will be created with off-the-shelf videogame

engine Received funding letter on Thursday (last week) Conducting focus groups with military personnel at

Camp Pendelton, Balboa Naval Hospital, and San Diego VA Hospital

Stress Inoculation Training

Simulator Adjunct Training

Scenario 3

0

20

40

60

80

100

120

140

160

:01 :02 :03 :04 :05 :06 :07 :08 :09 :10 :11 :12

Time (Minutes)

Hea

rt R

ate

(BP

M) subject 1

subject 2

subject 3

subject 4

subject 5

subject 6

VillageGame Description:

Features:First Person shooter GameGame Mode:

~ With Enemies- Task: eliminate all enemies in the

village~ Without Enemies

- Task: navigate through the villageIraqi Village includes:

~ Buildings

-60

-50

-40

-30

-20

-10

0

floor1 floor2 floor3 floor4 floor9 floor14 floor19

placebo

DCS

Post-Pre SUDS per floor (LOCF)

*

D-cycloserine shows improvement compared to placeboin level of fear within the VR environment.

(Ressler, Rothbaum et al., 2004)

N = 30 acrophobics, N = 30 acrophobics, 2 weekly 2 weekly in virtuoin virtuo exposure sessions exposure sessions(35 to 45 minutes)(35 to 45 minutes)2 doses of DCS (50 / 500).2 doses of DCS (50 / 500).

From B. RothbaumFrom B. Rothbaum

-60

-50

-40

-30

-20

-10

0

placebo drug

POST-PRE Highest SUDSfloor 19 completers only

3 Month Post-Pre Acrophobia Anxiety Questionnaire

-60

-50

-40

-30

-20

-10

0placebo DCS

F(19,1)=4.36, p=.05

Indexed in:Indexed in:- MedLine- MedLine- PsychInfo- PsychInfo- Excerpta Medica- Excerpta Medica- Social Sciences Citations- Social Sciences Citations

Published by:Published by:American Psychological AssociationAmerican Psychological Association

Recently Indexed in Recently Indexed in PsycINFOPsycINFO

Introducing the Introducing the Journal of CyberTherapy and Journal of CyberTherapy and RehabilitationRehabilitation

Publications

Coming in 2006:Coming in 2006:Virtual HealersVirtual Healers

Carl JungCarl JungJoseph WolpeJoseph Wolpe Sigmund FreudSigmund Freud

VR & videogames are tools. They do not

take the place of good clinical skills or clinical

judgment…