Technological advancement have generated novel opportunities for the health and medical communities. The University of California’s Institute for Creative Technologies (ICT), being managed by the U.S. Army Simulation and Training Technology Center, continues to develop innovations which rep-resent the start of a rapidly growing field. One of the efforts pioneering this growth is Bravemind.
Bravemind is a clinical interactive Virtual Reality (VR) based exposure therapy tool being used to assess and treat Post Traumatic Stress Disorder (PTSD). The assessment and treatment of PTSD is presently a concern to the military because stressful experiences in today’s war-fighting environments have resulted in a significant number of returning soldiers being at risk for developing PTSD.
The efficacy of using graduated trauma-focused exposure therapy to treat PTSD has been well documented. This treatment typically involves the gradual, repeated imaginal reliving of the traumatic event under a clinician’s care by which the patient can begin to process the emotions associated with the trauma and de-condition the learning cycle via a habituation/extinction process.
One of the challenges associated with this treatment is the reliance on PTSD patients being able to effectively imagine their traumatic experiences. Many patients, however, are unwilling or unable to do this. In fact, the avoidance tendency of cues and reminders of the associated trauma is one of the cardinal symptoms of PTSD.
Bravemind was developed to address this challenge by offering a means by which to overcome the natural avoidance tendency of trauma sufferers. The potential of using VR for the treatment of PTSD is supported by previous reports in which patients with PTSD, who were unresponsive to previous imaginal Prolonged Exposure (PE) therapy treatments, went on to respond successfully to Virtual Reality Exposure Therapy (VRET).
In one such study Bravemind, referred to as Virtual Iraq in its early prototypical stages, produced a statistical and clinically meaningful reduction in PTSD symptoms for active duty military personnel who did not previously benefit from traditional forms of treatment. Bravemind consists of a series of VR environments designed to resemble Middle Eastern city and desert scenes that are typical trauma settings for use in VR exposure therapy.
Bravemind allows clinicians to gradually immerse patients into virtual environments representative of their traumatic experiences in a controlled, stepwise fashion by providing capabilities to manipulate multi-sensory emotional stimuli and monitor the intensity of the patients’ stress responses via advanced brain imaging and psychophysiological assessment techniques.
The use of VR technology offers unique capabilities for the treatment of PTSD not only because it allows interactive, multisensory, immersive environments to be readily created that can be tailored to a patient’s needs, but also because it provides the ability for clinicians to control, document and measure stimuli and patient responses, offering clinical assessment, treatment and research options that are not available via traditional methods. As such, Bravemind not only provides a tool for clinicians in the treatment of PTSD patients but also allows them to measure, document and learn from the results in order to better understand the brain and biological factors that serve to inform the prevention, assessment and treat-ment of PTSD.
Open and comparison clinical trials have been performed to test the efficacy of Bravemind in the treatment of PTSD in active duty military personnel. In one study Bravemind produced a statistical and clinically meaningful reduction in PTSD symptoms with military personnel who did not benefit from prior traditional forms of treatment. Another study indicated that Bravemind was more effective than a cognitive behavioral group treatment in a non-randomized “standard of care” comparison.
Bravemind is also being tested in three randomized controlled trials comparing VR with imaginal PE (prolonged exposure) ther-apy. Two of these are focusing on comparisons of treatment efficacy between VRET and imaginal PE while the third investigates the additive value of supplementing VRET and imaginal PE with a cognitive enhancer called D-Cycloserine (DCS). DCS is a broad-spectrum antibiotic that has been used in multiple clinical trials as a cognitive enhancer. The results from these studies will be presented in future publications.
In conclusion, Bravemind provides a promising means by which PTSD sufferers can progress toward treatment through step-wise immersion in virtual environments representative of their traumatic experiences. Additional information regarding the Bravemind application and other technological innovations being developed by the ICT is available at http://ict.usc.edu/.
References available from the author.
Joseph M. Brennan Jr. works for the U.S. Army Simulation and Training Technology Center in Orlando, Fla., where he is the chief engineer for the Institute for Creative Technologies (ICT) Contract. ICT is a Department of Defense University Affiliated Research Center (UARC) which advances the state-of-the-art in immersive virtual reality systems. He may be reached at Joe.Brennan@us.army.mil.