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Recovery Aid: A Virtual Iraq, Minus the Shooting

Albert "Skip" Rizzo is a clinical psychologist at the University of Southern California. He developed Virtual Iraq, a simulation program the Department of Defense is hoping can help Iraq veterans suffering from post-traumatic stress disorder, commonly known as PTSD.

The ability to return vets as close as possible to the scene of their trauma has changed the game of treatment, Rizzo says. Until virtual reality — VR — came on the scene, he says, exposure therapy required a therapist guiding the patient with verbal commands. For patients suffering from PTSD, however, one of the key reactions to cues and reminders of trauma is avoidance. As a result, Rizzo says, it has been difficult for soldiers to revisit memories that bring them pain.

"You never know what's going on in the hidden world of imagination," Rizzo says. "VR puts a person back into the sights, sounds, smells, feelings of the scene. ... You know what the patient's seeing, and you can help prompt them through the experience in a very safe and supportive fashion."


Rizzo says the VR program he developed gives therapists total control. As in an optometrist's office, in which the doctor dials in a proper lens strength, Rizzo says Virtual Iraq allows the clinician to craft the most evocative and appropriate scenario for a particular patient. Rizzo says the program can put a soldier in a Humvee, on a desert road, at any time of day, with any kind of weather and with a bevy of ambient sounds. He says they can even make the chair rumble as if the engine is on and that the smell of body odor can be pumped into the room.

But Rizzo says not all soldiers are ready to turn the Humvee on, so to speak. He says some therapy sessions begin with the soldier seated in the virtual Humvee, perhaps with the sounds of the wind in the background. Only then are some veterans prepared to to talk about their traumatic experience.

"As you go through the therapy, the patient may be invited to turn on the motor," Rizzo says. Sounds, helicopters, jets flying over, insurgents coming out of palm groves, IEDs, explosions can be delivered into the environment. "Eventually, as they tell their story, you find out that it wasn't just a vehicle in front, it was a vehicle with five other friends. ... The guy that died was going to be discharged in two months. You start to see a rich depth of story."

But there are limitations, Rizzo says, to the accuracy the machine can achieve. During the first trial, Rizzo says the soldier refused to "drive" the Humvee, because the ignition switch was rendered by developers in the "off" position. Rizzo says they re-rendered the switch.

It's not a game of precision, though. Rizzo says the virtual Iraq doesn't have to be an exact replica in order to have this prompting, evoking effect. "A helicopter's a helicopter," Rizzo says. "The sound is the driving factor. We try to make it more real and relevant."


Certain cues are more effective than others. Rizzo says the sound of an AK-47 belting out rounds, for instance, results in considerable physiological reactions, including a big spike in heart rate. He also says there's a big reaction to one other battle sound: the soundtrack of a baby crying.

Virtual Iraq does have one major departure from real Iraq, Rizzo says. Though soldiers do carry a "gun" — a resin model of an M-4 weighted to approximate an actual weapon carried in Iraq — there is no shooting in Rizzo's world.

"We don't want people to fire back," Rizzo says. "We're not in the business of fostering some sort of revenge fantasy. ... It's about dealing with your own emotional memories and processing it and hopefully healing."

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