Virtual Reality Treatment for PTSD - Essay Example

Virtual Reality Treatment for PTSD and Other Medical Situations INTRODUCTION Post Traumatic Stress Disorder (PTSD) is a mental health challenge thatis classified as an anxiety disorder. According to the DSM-IV, the diagnostic manual of the American Psychiatric Association, PTSD is an illness that an individual may suffer after a traumatic event in which two situations are present: 1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. 2. The persons response involved intense fear, helplessness or horror. (American Psychiatric Association, 1994, p. 427-428). SYMPTOMS OF PTSD When an individual goes to war they experience traumatic situations that are life threatening or that threaten the lives of people they know which they respond to with fear, helplessness or terror. For some soldiers it is a situation that they naturally heal from after they return home, but for some it is a difficult situation for them to understand and they may begin to have challenges within the first month. PTSD can be difficult to determine according to many experts because the emotional anxiety may not be much different from what a person would experience on a day to day basis. The normal distress of having more bills than money to pay them can result in some forms of anxiety. When it becomes more serious an individual may be going thorough flashbacks when a sound or smell triggers their anxious behaviour. In order to understand PTSD most people will have to go through a very detailed evaluation by a medical professional in order to discover whether they have the disorder or whether their anxiety is "normal". In PTSD trauma is present when there was a death or near death experience and there will be certain symptoms that go with it that include: 1. Re-experiencing can happen when the individual replays part of the trauma or experience with very strong emotional reactions. Their thoughts may be reliving the past action. This re-experiencing can happen during a nightmare or during the day. 2. Avoidance symptoms happen when the individual may avoid activities, places or people that remind them of the trauma. This could be something in their day to day life. 3. Numbing behaviour happens when an individual experiences an emotion that hurt them and they detach from their feelings especially those that are positive. 4. Heightened arousal can happen when an individual feels they must always be "on guard" or when they have "excessive physiological activation" (National Centre for PTSD, Fact Sheet 2, p. 1). When these symptoms are present it could mean that the individual is suffering from PTSD but a formal diagnosis must be made. DIAGNOSING PTSD There are many ways to diagnose PTSD and this is always done by a healthcare professional, preferably a psychiatrist, psychologist or a clinical social worker. These mental health professionals must be trained in the diagnosis of psychological problems (National Centre for PTSD, Fact Sheet 2). Some of the assessments that are used include the Clinician Administered PTSD Scale (CAPS) and The Structural Clinical Interview for PTSD. These are common tools that make evaluations more secure when talking with people who come back from traumatic events. TRADITIONAL TREATMENTS FOR PTSD There are a variety of traditional treatments for PTSD that both the military and commercial hospitals use to assist patients with this disorder. Experts agree that one of the ways to treat it is through psychotherapy. The therapy of choice is Cognitive Behaviour Therapy (CBT). For PTST patients the emphasis is on discovering new ways to think about the trauma and the reactions to it. The goal for the patient is to understand what specific thoughts trigger responses and appear to make symptoms worse. In therapy, PTSD patients learn to look at the world differently by replacing fearful thoughts with more accurate ones that are less distressing (National Centre for PTSD, Fact Sheet 3). One issue for those who serve in the military is that they must find a way to deal with the things they had to do under those circumstances; CBT helps them find a way to change the way they think about what happened. Another traditional treatment is exposure therapy. Patients are "exposed" to talking about their trauma regularly with the therapist. The goal is to help the individual lessen their thoughts of fear, especially about their memories. The therapist works to help the individual put their fear into perspective and change their reaction to any fearful memories. Eye movement desensitisation and reprocessing (EMDR) is a newer type of therapy that is geared towards helping an individual change how they react to memories and trauma. This can be a fascinating therapy because the individual has to look at the distractions that appear when they are talking about the trauma. Things like hand tapping, sounds or eye movements are some of the distractions that can be used. Studies show that this method can help an individual have less PTSD symptoms but they are not exactly sure how it works (National Centre for PTSD, Fact Sheet 3). Other types of therapy include medications (usually anti-depressants), group therapy, brief psychodynamic therapy and family therapy. The challenge for many service men and women when they come back from combat is that they feel disenfranchised and alone. They have missed many family events that were meaningful and they may have missed children growing up. This creates depression in many and can lead to challenges that can become dangerous to the family. This is one of the reasons why it is important for an individual to seek professional assistance if they feel they are having PTSD symptoms. Hospital Treatment of PTSD Traumatic events do not only happen to those in the military. In civilian life many situations can create PTSD symptoms. Natural disasters, terrorism, accidents or violent death of a family member or friend can bring about symptoms. Some people find that their symptoms and reactions are so severe that they have to be hospitalized. Others are finding their way into anxiety clinics that are about to help them decrease their fear. In most hospitals and clinics people with PTSD are treated with a combination of psychotherapy and medication (National Institute of Mental Health, 2009). Hospitals and clinics also state that an individual must be treated by someone who is trained in PTSD. For the civilian all of the primary treatments are used to decrease the PTSD symptoms that are used in the military but they also use stress inoculation therapy. In this therapy, an individual will work to decrease their anxiety and helps them look at their memories in a different way, which is similar to CBT. Clinics that deal with the disasters and terrorism suggest that most people can come away from the situation and eventually heal if they are taken to a safe place, connect with their loved ones and learn about what is being done to help. All of these suggestions are regarded as family and community support. Generally speaking PTSD is treated similarly in hospitals and in the military. The basic difference is the type of people that are being treated and the challenges that they face. It is important to understand that this can be a very serious situation and it can be something that creates a challenge for an individual in attempting to work, dealing with relationships and dealing with life in general. No one really knows why one person gets PTSD while another person does not but researchers are attempting to find a reason. Anxiety has also become one of the more debilitating issues for people in our general society which has also caused challenges. VIRTUAL REALITY AND USE IN MEDICINE Virtual Reality (VR) has been associated with gaming and programs like Second Life and other programs that provide the individual with a 3-D experience. Started in the 1950s, this technique was used to simulate flight for people in the air force and eventually grew into video games where you could wear a helmet and goggles, and "feel" like you were in a specific situation. Today, with more sophisticated technology, the technology has grown to become one of the most widely used in education, medicine and many other fields. VR has become a major contributor to medicine because of its ability to help surgeons. Healthcare clinics and hospitals have used this method to help surgeons do operations. They can simulate the process to the point that new surgeons can "feel" organs and tissues as they work. The Mayo Clinic is a good example of this because they use virtual reality to assist surgeons in doing delicate operations like craniofacial, orthopaedic, brain and prostrate surgery. The U.S. market for VR used in surgery, medical education and therapy is going to grow to $290 million by 2010 (Young, 2007). There is no wonder why it has become a very strong tool for treating PTSD. VIRTUAL REALITY AND USE IN PTSD TREATMENT The treatment of soldiers with PTSD is very important to the mental health of each individual. All veterans who have been deployed at some time have challenges with trauma. Some are able to get on with their lives and do reasonable healing after a time while others have a problem with PTSD (Mitchell, 2007, p. 1). No one really knows why one person has PTSD and another person does not but it is something that the military and other researchers have tried to find a solution to in treatment. When using VR a doctor can simulate the visual, auditory or thermal cues that trigger PTSD symptoms. VR is able to simulate issues such as a bomb or other attack on a military convoy or how an individual would react while walking through a city on patrol; they can also simulate the movement of the Humvee as it sakes and rumbles (Mitchell, 2007). Smells like body odour, gun fire or burning rubber can also be simulated. One of the reasons this method is being used for PTSD is because prior to its use combat could not be simulated. In many cases the other methods of treatment would rely on the individuals ability to visualize and some people have difficulty with this process. It was also difficult for people experiencing PTSD symptoms to totally recall what happened. With VR a scene can be simulated in different ways to help trigger the PTSD responses and then to make them less frightful. Jardin (2007) describes the treatment in that a soldier will wear VR goggles and a set of headphones. They use a tablet-based interface in which a therapist can manipulate sounds and sights or anything else they need to when the individual has a reaction to the situation. The idea of the treatment is to re-introduce the situations that trigger the PTSD symptoms until the individuals memory reduces the impact of the memories. The military uses VR for combat situations and they use it as a type of exposure therapy. They are able to expose the soldier to whatever situation is needed and this helps to eliminate the symptoms. Because they can now stimulate the environment more soldiers and other military are getting help through military channels as well as civilian channels. Dr. David Ready was testing a program called "virtual Vietnam" for the Atlanta Veterans Administration Medical Centre and found that this procedure is helping Vietnam Vets get past the flashbacks and traumatic memory. What many people do not understand is that people who have been in combat are not just remembering, they are re-experiencing the situation and they usually will re-experience until the episode stops. This is one of the reasons why VR is so important because the environment that they have a flashback in can be stimulated in a "safe" environment for the individual and the people around them. PTSD TREATMENT IN COMMERCIAL HOSPITALS AND CLINICS Much of the information on PTSD in work with hospitals centres around working with returning veterans. This is the largest group at this time that is having difficulty with PTSD symptoms. According to Berthold (2007) there was a 50% rise in PTSD cases from returning veterans from both Afghanistan and Iraq in 2007; 27% of the soldiers coming back had symptoms of PTSD or depression. Many people who go to commercial hospitals may have been diagnosed with PTSD but not take care of themselves. This means they often enter into the hospital with other problems like alcoholism or drug overdoses which they have been using to try and cope with the problems. Dr. Joel Johnson, a clinical psychologist states that Virtual Reality makes exposure more convenient because the therapist can simulate every aspect of the situation that causes distress (as cited in Burch, 2007). Dr. Johnson works with individuals who have phobias and fears, particularly with those who are afraid to fly. This is one of the examples of many anxiety clinics that have been created throughout the United States to deal with PTSD and other problems. Bender (2004) reviewed a PTSD program at Virtual Reality Medical Centre (VRMC) in San Diego in which the doctors were using VR with CBT and working with people who had phobias and eating disorders. The process is the same as it would be with other types of PTSD and it worked as effectively because of the exposure opportunity. From the doctors that Bender interviewed it was clear that the patients were being treated in similar ways to veterans. Virtual Reality has been used to help victims and witnesses of the World Trade Centre attacks. It was reported that about 65% of those people who witnessed the tragedy reported PTSD symptoms. All people who were in need of assistance were served by NewYork-Presbyterian/Weill Cornell and they created the environment from the World Trade Centre. They first put the individuals "virtually" inside the World Trade Centre buildings and then gave the individuals psychotherapy and medication to assist in going through the process. This has been a very successful treatment for those who experienced this trauma. Conclusion The information that was available for work with PTSD patients showed that today, this is currently used with returning veterans and with people suffering from traumatic experiences and/or phobias. This is a very popular therapy because it allows the physician and the psychiatrist to expose the individual to the situation that is most troubling to them. Because they can incorporate sights, sounds, smells and other criteria to make the simulation as real as possible, it is an effective treatment for those who need it. This is an area that is important enough that studies are being done on it to help understand the best combination of treatments. References Bender, E. 2004. Virtual Reality Treatment Combats Phobias, PTSD. Psychiatric News. 39(13). p. 45. Available from < http://pn.psychiatryonline.org/ cgi/content/full/39/13/45>. [Accessed 18 May 2009]. Berthold, J. 2008. Fighting the battle against PTSD: How to detect and treat mental illness in returning veterans. ACP Hospitalist. Available from < . [Accessed 18 May 2009. Burch, P. 2001. Virtual Reality and Phobias. The Commercial Appeal. Available from . [Accessed 18 May 2009]. Diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV). 1994. Washington, DC: American Psychiatric Association. Groen, P.J., Goldstein, D., and Wine, M. 2007. Virtual Reality. Medical Informatics, and HER Systems. Available from . [Accessed 19 May 2009]. Mitchell, M. 2007. Doctors to treat PTSD with Virtual Reality. MSNBC. Available from . [Accessed 18 May 2009]. National Centre for PTSD. 2007. Frequently asked questions Fact Sheet 1. United States Department of Veterans Affairs. Available from < http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_faqs_on_ptsd.html>. [Accessed: 17 May 2009]. National Centre for PTSD. 2007. How is PTSD Measured? Fact Sheet 2. United States Department of Veterans Affairs. Available from < http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_lay_assess.html>. [Accessed 17 May 2009]. National Centre for PTSD. 2007. Treatment for PTSD. Fact Sheet 3. United States Department of Veterans Affairs. Available from < http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_treatmentforptsd.html>. [Accessed 17 May 2009]. National Institute of Mental Health. 2009. Post Traumatic Stress Disorder. Available from < http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/complete-index.shtml>. [Accessed 18 May 2009]. Shock, Dr. 2008. Virtual reality exposure therapy for Post Traumatic Stress Disorder. Available from < http://www.shockmd.com/2008/11/13/virtual-reality-exposure-therapy-for-post-traumatic-stress-disorder/>. [Accessed 18 May 2009]. Young, R. 2007. New Virtual PTSD Treatment: Army uses virtual tool in battle with PTSD. Available from . [Accessed 18 May 2009]. Read More