Virtual Iraq for PTSD Treatment

Army Col. Michael J. Roy, who oversees the "Virtual Iraq" exposure therapy at Walter Reed Army Medical Center, conducts a demonstration of a life-like simulator that represents a new form of PTSD treatment with Army Sgt. Lenearo Ashford, Technical Services Branch, Uniformed Services University, on Sept. 16, 2008, in Washington, D.C. Defense Dept. photo by John J. Kruzel (link).

2006 CNN coverage.

At its core, Virtual Iraq consists of a series of customizable virtual scenarios representing relevant Middle Eastern contexts for exposure therapy, including urban environments and desert road convoy settings. These scenarios are built upon the FlatWorld Simulation Control Architecture (FSCA), a sophisticated software framework originally developed for the FlatWorld project at the University of Southern California's Institute for Creative Technologies. The FSCA provides a network-centric system that enables seamless integration and synchronization of multiple sensory elements, which is crucial for creating the immersive experience in Virtual Iraq.

A key innovation of Virtual Iraq is its multi-sensory approach. In addition to highly detailed visual stimuli presented through a head-mounted display, the system incorporates directional 3D audio, vibrotactile feedback, and even olfactory stimuli. The inclusion of these additional sensory modalities enhances the immersive quality of the experience and may contribute to more effective emotional processing and habituation.

The system delivers a multi-sensory experience that goes beyond visual stimuli. In addition to the detailed graphics presented through a head-mounted display, Virtual Iraq incorporates directional 3D audio, vibrotactile feedback, and even olfactory stimuli. This comprehensive sensory approach, made possible by the FSCA, enhances the realism of the virtual environment and may contribute to more effective emotional processing and habituation during therapy.

A key feature of Virtual Iraq is the clinician-controlled "Wizard of Oz" interface. This interface, built on the FSCA's central controller application, allows therapists to dynamically adjust environmental factors and introduce specific trigger stimuli in real-time during therapy sessions. The clinician maintains audio communication with the patient throughout, enabling them to guide the exposure process and provide support as needed.

The use of FSCA in Virtual Iraq facilitates rapid reconfiguration and customization of scenarios, allowing therapists to closely match the virtual environment to the specific traumatic experiences of individual patients. This level of customization includes adjustments to time of day, weather conditions, lighting, population density, and the introduction of various combat-related stimuli.

Initial clinical trials with the Virtual Iraq system have shown promising results. In an open trial with 20 active duty service members who had previously been unresponsive to traditional PTSD treatments, 16 participants no longer met the diagnostic criteria for PTSD following treatment with Virtual Iraq, with these gains largely maintained at a 3-month follow-up.

The development of Virtual Iraq represents a collaborative effort between military, academic, and industry partners. By repurposing assets from the combat simulation game Full Spectrum Warrior and leveraging the FSCA, the project demonstrates an innovative approach to adapting existing technologies for therapeutic purposes.

It's important to note that Virtual Iraq is not intended as a standalone or automated treatment, but rather as a tool to augment the skills of trained clinicians in delivering exposure therapy. The system's flexibility, enabled by the FSCA, allows it to be integrated into comprehensive treatment approaches that may include other therapeutic modalities.