Army's virtual reality therapy helps Soldiers combat PTSD

June 28, 2017

By T'Jae Ellis, ARL Public Affairs

Story Highlights

  • ARL's "virtual healing" provides treatment for PTSD for some Soldiers, other warfighters
  • Bravemind, an immersive therapy aid, incorporates virtual reality into psychotherapy sessions
  • More than 20 locations around the country offer Bravemind to PTSD sufferers

ABERDEEN PROVING GROUND, Md. (June 26, 2017) -- For Chris Merkle, it was an honor for the former Marine and Army reservist to sign up for three consecutive deployments to Iraq then Afghanistan "so terrorism won't affect my family," he said. But once he came home, he faced war's biggest enemies, and it would take Army scientists to help him beat them.

Merkle is one of the estimated 20 percent of the 2.7 million American Iraq and Afghanistan war veterans who suffers from post-traumatic stress disorder. Many also suffer from depression. About half of them never seek treatment.

"After you've taken a life, you feel normal as a Soldier but when you come back home, you feel a moral injury," he said. Family, community, religious guidance are often in conflict with normal soldiering, he said, and for many, it's hard to be called a hero for the acts of war that are lauded in the military but would be deemed criminal in the civilian world.

He said moral injuries can come from reliving roadside bombings, witnessing the aftermath of suicide bombers, handling human remains, killing an enemy, seeing fellow Soldiers and friends injured or dead, and feeling helpless in the most violent situations. Emotional avoidance can be detrimental, even deadly; but for Soldiers and veterans who want help, there's a new kind of therapy designed to help them confront and move beyond their pasts.

It's called Bravemind, an immersive, interactive military simulation that Army Research Laboratory researchers in Calif., designed to deliver exposure therapy for military servicemen with PTSD. "Patients are asked to verbally recount their trauma experience in the first-person, as if it were happening again, with as much attention to sensory detail as possible. By doing this in the safety of the clinical environment with a well-trained clinician to pace the exposure, a process referred to as extinction learning reduces the existing 'fight or flight' response," explained its creator Dr. Albert "Skip" Rizzo, Research Professor at USC Davis School of Gerontology and USC Keck School of Medicine Department of Psychiatry & Behavioral Sciences.

"It's almost like a confessional, confronting the past and moving beyond it," he said.

Created at the ARL-funded Institute for Collaborative Technologies at the University of Southern California, Bravemind uses computer-generated imagery accompanied by realistic sensory stimuli—sounds, vibrations, even smells provided by a machine loaded with vials of scents—to approximate the circumstances of a veteran's traumatic memories. The software's 14 environments, ranging from remote Afghan villages to crowded Baghdad markets, include attackers, bombs, and innocent bystanders.

"Stored memories aren't always in the conscious mind. A person might only realize something is a cue when that cue appears outside of the traumatic event. Logically, you know you're not back in that situation, but that cue tells your brain otherwise. With exposure therapy, the goal is to reduce the charge around these cues. I think this works so well in treating PTSD because we're recognizing the instinctive human response to experiencing trauma: avoidance," Rizzo said.

VR technology offers unique capabilities for the treatment of PTSD not only because it allows interactive, multisensory, immersive environments to be readily created that can be tailored to a patient's needs, but also because it provides the ability for clinicians to control, document, and measure stimuli and patient responses, offering clinical assessment, treatment and research options that are not available via traditional methods. The software is free for its clinical and research use upon documenting clinician/researcher expertise in the area of Prolonged Exposure Therapy for the treatment of combat-related PTSD.

"I got ejected out of a vehicle in Iraq and crashed my neck and back," said Merkle, who first enlisted in 1990. "I never processed any of the trauma I saw in war. I would just drive forward, be the best Marine and Soldier I could be.

"Anger was part of being a strong Marine, but when you get back to the civilian world, you realize you shouldn't be this angry. You should be able to concentrate. I realized that I needed to talk to someone. Psychotherapy was challenging because it's hard to talk about these things as a man. The big thing with PTSD is avoidance; we just keep shoving it deep down. Once you're exposed to trauma, you tend to normalize it, you don't realize you couldn't control it. It just stayed down there, and grew and grew, and the next trauma just piled on top on it.

Until it bursts.

"I have two boys who are rambunctious," said Merkle, who said he doesn't like to be caught off guard, so when his children would sneak up on him and tackle him for fun, Merkle found himself reeling back in defense before quickly realizing it's only his children whose faces move from broad smiles to confusion and sadness in a split second.

"Now, you feel guilty that your kids are afraid of you, and your spouse is always having to say 'you have to be careful around dad'. That makes the family feel like they have to be on eggshells around us, and we start to wonder, 'maybe I don't fit in?

He sought help from a mental health therapist, who he said was "great" but he couldn't "break that line and take off the mask to really ask for help." His therapist introduced him to Bravemind. He said "no one wants to relive their trauma over and over again," but with virtual reality, he was able to place his memories in the visual contexts of the combat scenes and answer therapist's questions as they probed for his emotions about what he was seeing and hearing.

Today, Merkle is an outreach specialist at the Long Beach Veterans Affairs center in North Orange, Calif., where he works with a number of Operation Iraqi Freedom and Operation Enduring Freedom veterans. Merkle is in graduate school now, completing a doctorate degree in clinical psychology not only as a personal goal, but to help other veterans.

The ICT is part of ARL's West Coast operations, the laboratory's largest university outpost and the first one west of the Mississippi. It leverages USC and regional expertise to broaden its abilities for the discovery, innovation and transition of science and technology. Established in 1999, ICT is a DoD-sponsored University Affiliated Research Center working in collaboration with ARL. UARCs are aligned with prestigious institutions conducting research at the forefront of science and innovation.

The U.S. Army Research Laboratory, currently celebrating 25 years of excellence in Army science and technology, is part of the U.S. Army Research, Development and Engineering Command, which has the mission to provide innovative research, development and engineering to produce capabilities that provide decisive overmatch to the Army against the complexities of the current and future operating environments in support of the joint warfighter and the nation. RDECOM is a major subordinate command of the U.S. Army Materiel Command.


Last Update / Reviewed: June 28, 2017