Video games used to treat posttraumatic stress

Around the country, there is intensive study going on as to whether a therapy program using a realistic war video game can be effective in treating the stresses of real war.

Several sites across the country are using "Virtual Iraq" to treat war-related posttraumatic stress disorder by breaking down barriers associated with psychotherapy. Early advocates of the program say because so many patients are comfortable with video games, it helps ease resistance to the difficult tasks of rehabilitation.

Josh Spitalnick, PhD, director of research and clinical services for Virtually Better, which developed "Virtual Iraq" and several other virtual reality games designed to treat posttraumatic stress disorder, said preliminary testing -- a two-year open clinical trial of 20 participants funded by the Office of Naval Research -- showed positive results. But more rigorous testing is needed to fully understand the advantages or disadvantages of using virtual reality as a treatment method.

"Usually when you do an initial study, very rarely is it the highest echelon of research protocol ... you usually start with an open clinical study as proof of concept, just to see if it works," Spitalnick said.

Gaming has already shown nonclinical benefits, including acceptance by the younger generations, relative low cost and accessibility. So if these games prove to be as effective as traditional treatments, "we have success," Spitalnick said.

Robbi Saletsky, PhD, clinical associate professor and director of the Cognitive Behavior Therapy Program for Depression and Anxiety Disorders at Upstate Medical University in Rochester, N.Y., is conducting one of about 15 studies of "Virtual Iraq" going on around the country.

Saletsky said she has found similar virtual reality programs to be successful because they open up options to a population that might not respond well to traditional exposure-method treatments that rely on the patient's imagination.

Separately, the U.S. Air Force for the next year is conducting a study of virtual-reality treatment for posttraumatic stress disorder, which it just began at its Lackland base in San Antonio.

"Virtual Iraq," modeled after the 2004 consumer video game "Full Spectrum Warrior," allows clinicians to customize the experience for each patient. Therapists can recreate the traumatic event down to specifics, including time of day, sites, sounds and even smells associated with the event. A chair simulates movement while 3-D goggles enhance immersion into the fabricated scene.

The games also help address the stigma associated with psychotherapy, virtual reality backers say. It's much easier to sell a virtual reality experience to someone who grew up playing games than it is to engage them in talk therapy sessions, Spitalnick said.

Barbara Rothbaum, PhD, a psychologist at Emory University School of Medicine in Atlanta, who has used virtual reality for several years, is conducting tests on this game's effectiveness in tandem with medications.

Rothbaum, who is also training therapists from several VA centers from across the country on how to use the program, saw many success stories with a similar program developed for Vietnam veterans. Many who had been considered treatment failures in years-long traditional PTSD programs made gains with the use of "Virtual Vietnam" in just a few months, she said.

But, quicker doesn't necessarily mean better, says Arthur Blank, MD, a Vietnam veteran who practices psychiatry in Bethesda, Md. He does not use virtual reality in his practice.

Dr. Blank said exposure therapy is a common treatment for PTSD, but how big of a role it plays in the overall treatment plan varies by patient. The same considerations should apply whether a doctor uses virtual reality or traditional exposure-therapy tools, and patients should be allowed a "great deal of say as to whether they will do it."

Spitalnick agrees virtual reality is best as an enhancement, rather than a replacement, to traditional exposure therapy. Studies that have found virtual reality to be less effective have had flaws in the way treatment was administered, he said.