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Recalling Iraq's Terrors Through Virtual Reality

The system used in California, which is based on the video game Full Spectrum Warrior, puts the patient in the middle of a city. Therapists will gradually expose the patient to more radical scenarios. In the first session, the scene might be an empty street. In the second, other troops or civilians might be added. Near the end of the treatment -- which could last weeks or months, depending on the person -- the patient may be put through a full-scale attack. Researchers say they also plan to introduce smells and to superheat the treatment room to the 100-degree-plus temperatures the patients experienced in Iraq.

"We're trying to discourage them from escaping," said Hunter Hoffman, a research scientist at the University of Washington who is working on the Hawaii program. That one will simulate a convoy drive.

Military psychologist James L. Spira uses virtual reality to treat patients who have post-traumatic stress disorder. (Ariana Eunjung Cha -- The Washington Post)

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The virtual-reality scenarios serve as conversation starters between patient and therapist, who then try to pinpoint the event that triggered the syndrome. One possible complication is that the patients' experiences are varied and complicated and are not necessarily linked to a single incident.

The researchers worry that the technology may turn out to be just a distraction, a gimmicky, new-age twist on traditional therapies that may not work as well -- or, worse, that it could end up aggravating some patients' conditions by re-exposing them to their traumas too quickly if it is not used by a skilled therapist.

To avoid that, the therapists will make use of biofeedback sensors, measuring heartbeat, breathing, temperature and moisture on the skin. These statistics will help doctors determine the patients' reaction to certain stimuli -- such as the sounds of Arabic-accented voices yelling at them, helicopters landing and mortar shells striking -- and whether they are nearing the edge of what they can tolerate.

"We are not developing a self-help tool. This is something that needs to be used hand in hand with the help of a good clinician," said Albert Rizzo III, an assistant professor at the University of Southern California who is collaborating with Spira.

On a recent afternoon, while Blythe was immersed in the virtual Iraq, Spira was a few feet away controlling the environment. With his computer, the psychologist was changing the weather, the time of day, the sounds.

Blythe, who said he suffers from milder aspects of post-traumatic stress syndrome, is helping Spira work out the kinks in the system before the treatment is offered to those with major post-traumatic stress disorder.

Although Blythe is able to do his job as a medical technician, he has nightmares, thrashes in bed at night and gets spooked by large crowds because they remind him of how insurgents would surround themselves with innocent people, making it difficult to tell who the real enemy was. (He hasn't been to a mall since his return in October and doesn't like to go to bars anymore.)

He told Spira that the colors of the day and night sky are exactly right and the sound of the helicopters is realistic but that the streets are too clean; trash was everywhere in Iraq, he said. He suggested making the chair vibrate like a Humvee on a dirt road. He also noted that the sound of machine-gun fire in the background has become so commonplace in the war zone that it needs to be ratcheted up in the simulation to have an effect. He said the virtual-reality system hasn't produced a strong reaction in him, "not so much, not yet."

But his instinctive reaction to the bullet passing by so close surprised him. "In the end," he said, "I think the noises is what'll get people."

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