User-Centered Design Driven Development of a VR Therapy Application for Iraq
War Combat-Related Post Traumatic Stress Disorder: From Training to Toy to
Treatment 

Albert Rizzo (1), Jarrell Pair (1), Ken Graap (2), Brian Allen (1), Matthieu
Dautricourt (1), Matthew C. Liewer (1), Barbara Rothbaum (2), Brenda
Wiederhold (3), Mark Wiederhold (3), and James Spira (4) 

1 - University of Southern California - Institute for Creative Technologies 
2 - Virtually Better Inc.
3 - Virtual Reality Medical Center
4 - Naval Medical Center San Diego


War is perhaps one of the most challenging situations that a human being can
experience. The physical, emotional, cognitive and psychological demands of a
combat environment place enormous stress on even the best-prepared military
personnel. Such stressful experiences that commonly occur in warfighting
environments have a considerable likelihood for producing significant numbers
of returning soldiers at risk for developing PTSD. The initial data coming
from both survey studies and anecdotal observations indicate that a large
number of returning military personnel from the Iraq/Afghanistan conflicts
are reporting symptoms that are congruent with the diagnosis of PTSD. In the
first systematic study of mental health problems due to the Iraq/Afghanistan
conflicts revealed that " ... The percentage of study subjects whose
responses met the screening criteria for major depression, generalized
anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1
percent) than after duty in Afghanistan (11.2 percent) or before deployment
to Iraq (9.3 percent)" [1]. 

In 1997, researchers at Georgia Tech released the first version of the
Virtual Vietnam VR scenario for use as a graduated exposure therapy treatment
for Post Traumatic Stress Disorder (PTSD) with Vietnam veterans. This
occurred over 20 years following the end of the Vietnam War. During that
interval, in spite of valiant efforts to develop and apply traditional
psychotherapeutic approaches to PTSD, the progression of the disorder in some
veterans severely impaired their functional abilities and quality of life, as
well as that of their family members and friends. Prior to the availability
of VR therapy applications, the existing standard of care for PTSD was
imaginal exposure therapy. Such treatment typically involves the graded and
repeated imaginal reliving of the traumatic event within the therapeutic
setting. This approach is believed to provide a low-threat context where the
patient can begin to therapeutically process the emotions that are relevant
to the traumatic event as well as de-condition the learning cycle of the
disorder via a habituation/extinction process. With this history in mind, the
USC Institute for Creative Technologies has initiated a project that is
creating an immersive HMD virtual reality system for exposure therapy with
combat-related PTSD. The treatment environment is based on a creative
approach to recycling virtual assets that were initially built for the
commercially successful X-Box game and tactical simulation scenario, Full
Spectrum Warrior. 

Thus far we have created a series of virtual scenarios designed to represent
relevant contexts for this treatment to be conducted in VR, including a city
and desert road convoy environment (Figs. 1-2). User-Centered tests with the
application are currently underway at the Naval Medical Center, San Diego and
within an Army Combat Stress Control Team in Iraq. This feedback with
non-diagnosed personnel is providing feedback on the content and usability of
our application to feed an iterative design process. A clinical trial version
of the application built from this process will be tested with PTSD-diagnosed
personnel in September 2005 and data from the user centered design trials and
from the clinical tests will be presented at MMVR. We have also conducted
brief exposure with two volunteer PTSD patients using our latest prototype.
One of these patients has reported a reduction in nightmares and the other
has reported that the scenario has helped him to cognitively reframe his
experience with positive results. These anecdotal and informal self-report
commentaries are encouraging for our continued efforts in this clinical
direction and a more detailed description of this work can be found in [2]. 

References:

[1] Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I. and
Koffman, R.L. (2004). Combat Duty in Iraq and Afghanistan, Mental Health
Problems, and Barriers to Care. New England Journal of Medicine, 351
(1):13-22. 

[2] Rizzo, A.A., Rothbaum, B.O. & Graap, K. (In press). Virtual Reality
Applications for Combat-Related Posttraumatic Stress Disorder. In: C.R.
Figley & W.P. Nash (Eds.), Combat and Operational Stress Management: Theory,
Research, and Practice. 

Albert Rizzo: arizzo@usc.edu

From: Abstracts of MMVR14 Proceedings