Anxiety Treatment with Virtual Reality Exposure (cont.)

marzel2_WebMD: Yes, I find that I always have to have a couple of drinks before boarding a plane. Would you call this self-medication, and is that the wrong way of going about easing anxieties?

Dr. Rothbaum: Yes, that is called self-medication. It is not my preferable way to deal with anxiety. Some people have told me that they have to fly the day before a business trip, because they're sloshed when they get off the plane and need to recover. I consider that interfering with their life, that maybe there are more effective ways to handle their anxiety.

tenuli_WebMD: How many treatment sessions does it take to get over a fear of public speaking?

Dr. Rothbaum: We are about to start that study and we are anticipating 10 to 12 sessions. For fear of flying, people are treated in eight sessions over six weeks. For the fear of heights, usually six sessions is sufficient. For PTSD, approximately eight to ten sessions are needed.

Moderator: Ken, how did you get involved?

Grapp: That's a good question. I guess it was about three years ago, I started work on my dissertation for screening veterans for participation for the VR project for Atlanta VA. I have a background in working in start up companies, and this seemed like a very exciting area to be involved in.

Moderator: Please tell us about your work with Vietnam veterans at the Atlanta VA hospital.

Grapp: Yes. The idea is to use VR to help get the veterans back into and reprocess the information from their war experience. There is a good history of using exposure therapy with trauma survivors to help overcome symptoms of PTS. So, Larry and Barbara built a VR environment that allows the therapist to control the amount of stimulation they provide. And that can be done in a very therapeutic manner.

Dr. Rothbaum: We have two VE for the Vietnam veterans that we use. One is a Virtual Huey helicopter that flies over different Vietnam terrains, such as rice paddies, rivers and jungle, and the other is a virtual clearing surrounded by jungle. We expose the veterans in a therapeutic manner to their most traumatic Vietnam memories, while immersed in this virtual Vietnam.

Dr. Hodges: The Vietnam war veteran experiences the VE wearing a head mounted display that has a position tracker that we can track what he sees and hears. We spent a lot of time on the audio effects so you can hear gunfire, helicopters overhead, you can see and hear them. And when they're riding in the helicopter, they're sitting in a special chair so they can feel the vibrations of the helicopter. We try to engage as many of the person's senses that we can to make it a more realistic experience.

Grapp: Dr. David Ready, at the Atlanta VA is still recruiting patients and doing this kind of work. There's another place, as well.

Dr. Rothbaum: The Boston VA at the National Center for PTSD they're offering this treatment.

Moderator: How do you gather the information to create such a realistic Vietnam environment?

Dr. Hodges: When we began, we interviewed Vietnam veterans, talked with therapists who worked with Vietnam veterans to see what their common experiences were. We can't create every environment, so we look for common experiences that they all went through, so we can use the software with the greatest number of veterans. We also measured and took photographs of real Huey helicopters to make it more realistic. We also looked at videos from the Vietnam war, and so we had 3 scenarios. One was you went everywhere as a Vietnam war participant on the helicopter. That's the way you were evacuated if wounded, and the way you were carried in to a battle zone. So that was a common experience. Being out in an open clearing was another experience because you don't know who is in the tree line. Helicopters usually landed in an open clearing, and your first job was to get into cover once you were deposited there. So we built those two environments in VR because they seemed like ones that we could build with today's technology, and could possibly be useful to the therapist in treatment.

Moderator: How have the veterans you've worked with responded to this therapy?

Dr. Rothbaum: Overall, well. We were worried before we started doing this that it would be too much, and too intense for the veterans. But we take it slow, and we explain everything that is going on, and most of the veterans have reported that after therapy, the memories that they worked on in therapy are no longer as distressing to them.

Moderator: If someone wants to participate in this treatment at the Atlanta VA hospital, how can he/she get in the study?

Grapp: They should contact Dr. David Ready at 404-321-6111, extension 7082. Also to go back to the previous question, we used a lot of screening measures to try and ensure that people who came in to the study would likely benefit from the environments that were created.

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