Hospital's 'Virtual Iraq' helps PTSD sufferers face their fears

SYRACUSE — Upstate Medical University on Thursday unveiled a new treatment option for veterans of the Iraq and Afghanistan wars suffering from post-traumatic stress disorder.

"Virtual Iraq" offers an interactive, multisensory experience — like an enhanced video game — allowing soldiers to confront and gradually conquer their fears in a safe, private and controlled environment.

"The young vets seem more likely to take to this kind of therapy," said Robbi T. Saletsky, director of the university's Cognitive Behavior Program for Depression and Anxiety Disorders. "There's less stigma attached to it; it seems cool."

Ms. Saletsky demonstrated a treatment session in her office for the press. Volunteer Cristy L. Samuel, an Iraq war veteran and pre-medical student at Syracuse University, simulated the role of a patient. She is not a victim of PTSD, but said she would recommend the treatment for veterans with the condition.

During the mock therapy session, Ms. Saletsky prepared her patient to relive a moment in combat that had haunted her.

"This is the scene that you've been remembering over and over again," she said to Ms. Samuel, who was wearing a headset to immerse her in the sounds and three-dimensional graphics of the virtual scene. She was seated on a platform that replicated the vibrations and jolts of driving — and bombings.

Ms. Saletsky watched her computer screen to track what her patient was experiencing.

Ms. Samuel used a controller to drive forward along a desert road in her Humvee. She turned her head to see her friend, in military fatigues, in the passenger seat beside her. Ms. Saletsky coached her through the scene as gunshots rang out and the windshield glass fractured with bullet holes. Amid the sounds of shouting, Ms. Samuel turned again, virtually, to check her companion. He was slumped in his seat, blood soaking his clothing.

"How do you feel?" Ms. Saletsky asked.

In a real therapy session, such a scene would be the culmination of a longer process of conquering anxiety reactions bit by bit, perhaps beginning with simply driving the Humvee uneventfully along the desert road, Ms. Saletsky said. The patient and therapist would repeat each scenario over and over, until the patient's stress reactions are reduced to a manageable level.

The $50,000 system was adapted by researchers from the video game "Full Spectrum Warrior" and tailored to the needs of Iraq and Afghanistan war veterans, with scenes set in desert landscapes, a mosque and a marketplace. It also includes a machine that uses vials of concentrated scents to evoke memories of a Middle East combat zone, like diesel fuel, gunpowder and cooking spices characteristic of the region.

"Patients can feel the rumbling of the engines. They can feel the power of the bullets going by them. They can even smell smells that would remind them of the traumatic experience," Ms. Saletsky said.

Such treatments for PTSD seem counterintuitive, the therapist acknowledged. To veterans back from war, reliving the sensations of combat might be the last way they'd like to spend their time. But for those suffering from PTSD, such intrusive and uncontrollable flashbacks can occur without warning.

Many sufferers try to manage their condition by avoiding the sensations that trigger their traumatic memories, Ms. Saletsky said. But since triggers can be the otherwise innocuous background sensations of daily life — like the loud backfiring of a vehicle on a city street, or the simple darkness of night — effective avoidance can lead to social isolation, drug abuse and depression.

PTSD, along with other anxiety disorders such as severe fear of heights or flying, long have been treated through what therapists term "exposure therapy," Ms. Saletsky said. In exposure therapy, like that offered by "Virtual Iraq," a patient gradually becomes less sensitive to the sensations that trigger anxiety by experiencing those triggers in safe, controlled and incrementally increasing doses, accompanied by regular talk therapy.

"It's like watching a scary movie over and over again; by the 100th time you see it, you're not as fearful," Ms. Saletsky said.

In the past, therapists have used imaginative prompts to try to rekindle a patient's traumatic moments, sometimes later having the patient confront his or her fear in real life, by going to a high building or flying in an airplane, for example. Ms. Saletsky said she's had patients pay for her to come along on a flight.

"One of the reasons why these virtual programs are so helpful is that they're convenient," she said. They allow therapist and patient to re-create experiences in the convenience and privacy of an office and control each step according to the patient's particular needs.

They also can help patients who have so deeply repressed their memories that they have trouble rekindling them in a therapeutic setting with imagination or verbal prompting alone, Ms. Saletsky said.

The system at Upstate Medical University is the only one in the state outside of New York City, she said. Veterans interested in treatment should call the university's adult psychiatry program at 464-3165.