Virtual reality is showing promise for supporting the behavioral health of military personnel.

Greg M. Reger, PhD
greg.m.reger.civ@mail.mil
National Center for Telehealth and Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

James Vess, PhD
james.d.vess3.civ@mail.mil
National Center for Telehealth and Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Combat deployments to Iraq and Afghanistan put US military personnel at increased risk of PTSD and other psychological disorders.  Accordingly, psychological health remains an urgent priority in the Department of Defense (DoD), and innovative technologies are being explored as a potential solution to some of the challenges.  The unique affordances of some technology solutions may provide a useful fit for addressing certain DoD mental health concerns.  Prominent needs currently include improving the quality of care, increasing access to care, and mitigating treatment stigma.  Improvements to assessment procedures may also support military provider’s ability to provide effective consultation on fitness for duty evaluations.  Virtual reality (VR) is one emerging technology that has shown initial promise for certain psychological applications relevant to these challenges.

VR uses computer systems and a range of peripherals to give users a more realistic sense of participating in a computer-generated environment.  Innovative display systems such as large screen or CAVE environments (room size systems with 3-D images projected onto the walls and floor) can be utilized.  Alternatively, head-mounted display systems can deliver 3-D stereoscopic images via separate screens for each eye.  Naturalistic navigation devices, vibro-tactile (i.e., vibration) stimuli and the utilization of manufactured scents that are relevant to the environment can enhance the psychological sense of being immersed within the computerized world.  Also, any number of additional peripherals can be leveraged to enhance a user’s sense of presence in the environment.  Computer environments can be delivered in the same manner to every user, recording and precisely measuring user responses with environmental customizability.  These capabilities are of obvious intrigue to many researchers with a number of clinical applications that might benefit from the unique affordances of VR.

During exposure therapy for PTSD, clinicians seek to activate the patient’s pathological fear structure through imaginal exposure.  Patients revisit their trauma memory repeatedly for prolonged periods of time, and over a number of psychotherapy sessions.  Research suggests that emotional engagement during exposure is important to the clinical outcome (Foa et al., 2006; Jaycox et al., 1998).  Some have hypothesized that using multi-sensory VR environments that resemble the trauma memory in relevant ways may be useful for those patients who have difficulty activating the memory via traditional imaginal exposure.  Several collaborators are working on a randomized clinical trial comparing prolonged exposure using imaginal exposure versus virtual reality exposure therapy for active duty soldiers with PTSD.

Despite DoD’s heroic efforts to address the stigma of seeking treatment for mental health problems, some service members won’t seek help to address their mental health difficulties.  Many websites provide a range of informational services about PTSD, but they typically provide text-based information that may or may not engage a young, technologically savvy military population.  We created the Virtual PTSD Experience to provide non-stigmatizing anonymous information about deployment-related PTSD in a manner that resembles the recreational video gaming interests of our service members.  This 3-D environment in Second Life is similar to a simulation version of an interactive museum.  Users learn by engaging with the environment rather than passively reading website text.  Users, represented by avatars or digital representations of themselves, can move about the 3-D space and interact with the environment or other users.  Video game-like features include a simulated tactical convoy intended to provide information on the causes of PTSD.  Users can take a virtual flight home from combat and explore a shopping mall where simulations of common symptoms take place.  Finally, users can access information about how to get help in the Department of Veterans Affairs and DoD.  Accessible for free from any computer with a broadband Internet connection, the Virtual PTSD Experience may be one of the unique educational resources available on the Web.

After repeated concussive events, military providers collaborate on evaluations to inform management, treatment, and return-to-duty decisions.  These evaluations can include comprehensive neurological, neuropsychological, imaging, and functional assessments.  One can imagine the potential value of a reliable and valid VR assessment of cognitive functions required by real world occupational demands of a service member undergoing evaluation.  For example, if a service member’s role requires manning a turret, scanning the environment for threat, and responding appropriately, a psychometrically valid assessment of these skills in virtual simulation may be more helpful to predict real-world behaviors than  traditional pencil and paper cognitive assessments.  In collaboration with the Institute for Creative Technology at the University of Southern California, we recently evaluated the reliability and validity of the VR Cognitive Performance Assessment Test and found it to be a promising initial move towards the development of an ecologically valid VR-based cognitive assessment battery.  Much work is obviously needed before applying such tools in clinical practice, but the future is promising.

Another project currently under development involves the creation of an online resource that uses interactive virtual environments to support behavior change.  Drawing from such theoretical constructs for behavior change as modeling, self-efficacy, and the Transtheoretical Model’s stages of change, the Virtual Lifestyle Coach (VLC) is intended to provide an individualized program of virtual experiences that responds to the user’s needs and readiness to change.  The initial problem focus for VLC is weight loss in military populations.  The intent is to develop and validate the foundation of a digitally mediated behavior change program that can be adapted to a range of behavioral needs.  Educational virtual environments will be easily accessed through a website with associated mobile applications.  The goal is to provide a low-cost, broad-reach approach to improve the military community’s health.  As with all the work undertaken by the National Center for Telehealth and Technology and its collaborators, the mission is to improve the lives of our military community by leveraging technology in innovative ways.

References

Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotion processing theory: An update. In B. O. Rothbaum (Ed.), Pathological Anxiety: Emotional Processing in Etiology and Treatment (pp. 3-24). New York: Guilford.

Jaycox, L. H., Foa, E. B., & Morral, A. R. (1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185-192.