Facing down PTSD | The Big Issue


“We tell patients it’s going to get harder before it gets easier. We’re not bullshitting anybody,” says Dr Albert ‘Skip’ Rizzo on the phone from his base at the University of Southern California. Rizzo is at the forefront of innovative research into how virtual reality ‘exposure therapy’ – exposing a patient to virtual reconstructions of a traumatic event – can be used to treat patients suffering from post-traumatic stress disorder (PTSD).

The foundations of this work are in the treatment of military veterans, with a ‘Virtual Vietnam’ developed in 1997 to help veterans still suffering with PTSD four decades after the end of the conflict. Virtual reality was first seriously looked at as a tool to treat terror-related PTSD victims four years later, in the month ­following the September 11 World Trade Center attacks.

The 9/11 firefighter would only move on to more intense reconstructions once a significant reduction in stress was shown

Dr JoAnn Difede from Weill Cornell Medical College and Dr Hunter Hoffman from the University of Washington set out to develop a virtual reconstruction in ­anticipation of the thousands of disaster workers and civilians who could ­potentially develop PTSD. A key feature of this first reconstruction was the use of ‘gradual exposure’ – giving a clinician the ability to control the pace of exposure to the virtual world a patient experiences, as well as the nature of the visual and audio stimuli.

The 9/11 reconstruction began with a patient called David, a firefighter suffering from PTSD who had arrived soon after the second plane hit the South Tower. Initially David was exposed to just a virtual reconstruction of a clear sunny day in Manhattan. However, by the third of 10 sessions he began to be exposed to the most intense parts of his experience, like the collapse of the towers.

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