Posttraumatic stress disorder (PTSD) is a chronic, debilitating, psychological condition that occurs in a subset of individuals who experience or witness life-threatening traumatic events. PTSD is highly prevalent in those who served in the military. In this paper, we present the underlying theoretical foundations and existing research on virtual reality exposure therapy, a recently emerging treatment for PTSD. Three virtual reality scenarios used to treat PTSD in active duty military and combat veterans and survivors of terrorism are presented: Virtual Vietnam, Virtual Iraq, and Virtual World Trade Center. Preliminary results of ongoing trials are presented.

Virtual reality exposure therapy for combat-related posttraumatic stress disorder.

According to Moore’s Law, there is a correlation between technological advancement and social and ethical impacts [13]. Many advances, such as quantum computing [22], 3D-printing [11], flexible transparent screens [1], and breakthroughs in machine learning and artificial intelligence [17] have social impacts. One area that introduces a new dimension of ethical concerns is virtual reality (VR). VR continues to develop novel applications beyond simple entertainment, due to the increasing availability of VR technologies and the intense immersive experience. While the potential advantages of virtual reality are limitless, there has been much debate about the ethical complexities that this new technology presents [9], [19]. Potential ethical implications of VR include physiological and cognitive impacts and behavioral and social dynamics. Identifying and managing procedures to address emerging ethical issues will happen not only through regulations and laws (e.g., government and institutional approval), but also through ethics-in-practice (respect, care, morals, and education).

Virtual Reality: Ethical Challenges and Dangers [Opinion]

Background Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation. However, little is known about the effectiveness of VR rehabilitation for TBI-related cognitive deficits. In response to these clinical and research gaps, we developed Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), an intervention designed to improve cognitive performance, driving safety, and neurobehavioral symptoms. Objective This pilot clinical trial was conducted to examine feasibility and preliminary efficacy of NeuroDRIVE for rehabilitation of chronic TBI. Methods Eleven participants who received the intervention were compared to six wait-listed participants on driving abilities, cognitive performance, and neurobehavioral symptoms. Results The NeuroDRIVE intervention was associated with significant improvements in working memory and visual search/selective attention- two cognitive skills that represented a primary focus of the intervention. By comparison, no significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills. Conclusions Results suggest that immersive virtual environments can provide a valuable and engaging means to achieve some cognitive rehabilitation goals, particularly when these goals are closely matched to the VR training exercises. However, additional research is needed to augment our understanding of rehabilitation for driving skills, cognitive performance, and neurobehavioral symptoms in chronic TBI.

Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury.

In this paper we profile the stress responses of patients diagnosed with post-traumatic stress disorder (PTSD) to individual events in the game-based PTSD stress inoculation and exposure virtual environment StartleMart. Thirteen veterans suffering from PTSD play the game while we record their skin conductance. Game logs are used to identify individual events, and continuous decomposition analysis is applied to the skin conductance signals to derive event-related stress responses. The extracted skin conductance features from this analysis are used to profile each individual player in terms of stress response. We observe a large degree of variation across the 13 veterans which further validates the idiosyncratic nature of PTSD physiological manifestations. Further to game data and skin conductance signals we ask PTSD patients to indicate the most stressful event experienced (class-based annotation) and also compare the stress level of all events in a pairwise preference manner (rank-based annotation). We compare the two annotation stress schemes by correlating the self-reports to individual event-based stress manifestations. The self-reports collected through class-based annotation exhibit no correlation to physiological responses, whereas, the pairwise preferences yield significant correlations to all skin conductance features extracted via continuous decomposition analysis. The core findings of the paper suggest that reporting of stress preferences across events yields more reliable data that capture aspects of the stress experienced and that features extracted from skin conductance via continuous decomposition analysis offer appropriate predictors of stress manifestation across PTSD patients.

/pdf/to-rank-or-to-classify-annotating-stress-for-reliable-ptsd-3eqsgd1z5m.pdf

To rank or to classify? Annotating stress for reliable PTSD profiling

SUMMARY STATEMENT Despite the significant role that stress plays in clinical care and education and the potential benefit of virtual reality (VR) as a simulation modality, there is a dearth of literature on stress and VR. The results of this scoping review have shown the positive effect that VR simulation can have on mitigating the negative aspects of stress during simulation and clinical training as well as improving provider performance and affect. Virtual reality technology, and immersive VR specifically, has the potential to powerfully transform how simulation education is being conducted. Because of this, the authors encourage researchers to put more focus into this topic and in determining how VR can be used to provide simulations with excellent training and a strong sense of presence for the purpose of addressing how stress can impact learners' clinical training and performance.

Healthcare Provider Stress and Virtual Reality Simulation: A Scoping Review.

Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experience including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that at least 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) delivered exposure therapy for PTSD has been used with reports of positive outcomes. The aim of the current paper is to present the rationale and brief description of a Virtual Iraq PTSD VR therapy application and present initial findings from its use with PTSD patients. Thus far, Virtual Iraq consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback needed to iteratively evolve the system was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial at San Diego Naval Medical Center of the first 18 treatment completers indicate that 14 no longer meet PTSD diagnostic criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up. Clinical tests are also currently underway at Ft. Lewis, Emory University, Weill Cornell Medical College, Walter Reed Army Medical Center and 10 other sites. Other sites are preparing to use the application for a variety of PTSD and VR research purposes.

/pdf/virtual-reality-post-traumatic-stress-disorder-ptsd-exposure-4ohn923x6d.pdf

Virtual reality Post Traumatic Stress Disorder (PTSD) exposure therapy results with active duty Iraq war combatants

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Virtual reality Post Traumatic Stress Disorder (PTSD) exposure therapy results with active duty Iraq war combatants