Mark D. Wiederhold, M.D., Ph.D., FACP
Mr. Chairman and members of the Subcommittee, I am pleased to be here today to discuss a new and innovative technology, currently undergoing testing in Veterans Administration and Navy facilities, that has promise to speed and improve effectiveness of PTSD treatment. We thank the Committee and you, Chairman Michaud, for your active interest in PTSD research.
My company the Virtual Reality Medical Center is currently testing virtual reality therapy to treat PTSD in 5 VA hospitals with requests from 6 additional facilities for the technology. We have been treating patients with VR therapy for the past 12 years, and have an overall success rate of 92%. This is defined as a reduction in symptoms, improved work performance or the successful completion of a task which was previously impossible. Our centers and clinics have treated more patients with VR therapy than any other center in the world.
The technology that my company and others have been studying is virtual reality, or VR, exposure therapy for PTSD. The research protocol works by allowing the therapist to gradually expose the combat veteran to distressing stimuli in the virtual scenarios, while teaching the study participant to regulate breathing and physiological arousal. After a number of sessions, the “fight or flight” response to distressing stimuli is extinguished. Use of the virtual reality technology, helps veterans of the current engagement to overcome the reluctance they have in coming forward for help. Virtual Baghdad (which is shown in exhibit A) is a realistic environment, consisting of a single “map” that allows the user to navigate seamlessly through a suite of different but thematically connected virtual scenarios. “I can see myself in the village or the marketplace,” said one of the Navy corpsman who participated in our study.
Virtual reality exposure therapy as an investigative treatment modality for PTSD has been in existence for about 10 years. It has been used successfully with Vietnam era veterans and with survivors of traumatic events such as motor vehicle accidents, earthquakes, bus bombings, and 9/11.
A panel of academic and government experts has published a consensus opinion that exposure therapy is the most appropriate therapy for PTSD. But traditional exposure therapy requires that veterans relive the experience in imagination, which is what they are trying to avoid. When our clinician informed a study participant that he wouldn’t have to relive his experiences every session, he said, “I sure hope not.” One advantage of virtual reality is that it helps make it safe for the veteran to engage emotionally, thus allowing the fear structure to be accessed and the abnormal response to be extinguished.
Current research funded by the Office of Naval Research is focused on determining the optimal treatment protocol for Iraqi war veterans with different co-morbidities. For example, those with mild traumatic brain injury and PTSD may require more treatment sessions than those with mild depression and PTSD. Results to date show that the virtual reality protocol is sucessful in decreasing symptoms of PTSD, depression, and anxiety. Study investigators are currently conducting 3-month follow-up visits to ensure that the treatment is lasting. Investigators are also performing periodic physiological assessments to help design a study that would construct a profile of veterans who might do especially well with VR technology. One of my company’s systems is in Iraq right now and could be used in such research. In fact we have received strong interest from the Navy in advancing research in just this context.
However we are here to speak about our experience and success with the VA and to leave you with three additional uses of advanced technology which could significantly help improve the lives of veterans with PTSD.
First, it is important to correlate the progress of VR therapy not only with psychophysiology, but also with brain imaging. In collaboration with other researchers, we have postulated that there may exist an “fMRI signature” or functional brain imaging signature for PTSD, the discovery of which could lead to more targeted treatment.
Second, VR can be used, both alone and in combination with neuroprotective agents such as antioxidants, to conduct stress inoculation training pre-deployment. It is important to track how well both technologies work to avert PTSD.
Third, VR may be an important piece of the puzzle as tools are developed that can assess and treat the many comorbid conditions that accompany PTSD. For example, VR can be useful both in cognitive rehabilitation for TBI and in physical rehabilitation for veterans with amputations.
Mr. Chairman, I thank you for the opportunity to present this important technology today. I would be pleased at this time to answer any questions you may have.