How does virtual-reality therapy for PTSD work?

Robert N. McLay, author of At War with PTSD: Battling Post Traumatic Stress Disorder with Virtual Reality, responds:

post-traumatic stress disorder (PTSD) can appear after someone has survived a horrific experience, such as war or sexual assault. A person with PTSD often experiences ongoing nightmares, edginess and extreme emotional changes and may view anything that evokes the traumatic situation as a threat.

Although medications and talk therapy can help calm the symptoms of PTSD, the most effective therapies often require confronting the trauma, as with virtual-reality-based treatments. These computer programs, similar to a video game, allow people to feel as if they are in the traumatic scenario. Just as a pilot in a flight simulator might use virtual reality to learn how to safely land a plane without the risk of crashing, a patient with PTSD can learn how to confront painful reminders of trauma without facing any real danger. Virtual-reality programs have been built to simulate driving, the World Trade Center attacks, and combat scenarios in Vietnam and Iraq. The level of the technology varies considerably, from a simple headset that displays rather cartoonish images to Hollywood-quality special effects.

A therapist typically observes what patients are seeing while they navigate the virtual experience. They can coach a patient to take on increasingly difficult challenges while making sure that the person does not become overwhelmed. To do so, some therapists may connect the subject to physiological monitoring devices; others may use virtual reality along with talk therapy. In the latter scenario, the patient recites the story of the trauma and reflects on it while passing through the simulation. The idea is to desensitize patients to their trauma and train them not to panic, all in a controlled environment.

The jury is still out as to whether virtual reality is superior to other forms of therapy for PTSD. Several studies have demonstrated that symptoms improve after virtual-reality exposure, and at least one study, which used functional MRI, indicated that the therapy tends to restore patients' brain activity to more normal patterns. No treatment works for everyone, however. Even in the most successful tests of virtual reality, about a quarter of patients continue to meet criteria for PTSD after treatment. Virtual reality may be a useful weapon in the battle against PTSD, but it is by no means the end of the war.