Армия США будет лечить ветеранов виртуальной реальностью
Армия США приступила к испытаниям новой системы виртуальной реальности. Военные медики и психологи считают, что она сможет помочь военнослужащим, воевавшим в Ираке, преодолеть последствия пост-травматических стрессовых расстройств.
Основная идея подобной терапии заключается в том, что военнослужащих заставляют еще раз пережить то, что с ними происходило в Ираке. Очутившись в виртуальном Ираке, пациенты, по мнению психологов, смогут лучше контролировать свои воспоминания. Это позволит положить конец кошмарам, вспышкам немотивированной агрессии и другим критическим моментам, не позволяющим солдатам успешно адаптироваться к нормальной жизни.
Американские медики считают, что в ближайшее время, армия США столкнется с серьезным психологическим кризисом. Исследование, проведенное New England Journal of Medicine в 2005 году, показало, что практически каждый шестой солдат армии США, вернувшийся из зоны боевых действий испытывает депрессию, тревогу или находится под влиянием ПТСР.
По словам 25-летнего медика морской пехоты США, отслужившего 8 месяцев в Ираке, "наши мозги не предназначены для того, чтобы воспринимать такое количество насилия. Если человек вернулся из Ирака и говорит, что не испытывает никаких проблем, он либо отрицает, либо откровенно лжет".
Хотя программа виртуальной реальности является относительно новым методом из арсенала медиков, военные врачи говорят, что они уже находятся под большим впечатлением от ее использования. Впервые ее опробовали на тех, кто выжил в теракте 11 сентября 2001 года.
Терапия в стиле "хай-тек" воспринимается военнослужащими более адекватно, считает Рассел Шиллинг, медицинский директор из Управления военно-морских исследований в Арлингтоне. Поскольку военнослужащие тяготеют к культу "мачо", то для них консультация с традиционным психологом порой рассматривается как событие, "недостойное настоящего мужчины". А подобная технология рассматривается солдатами как своеобразная видеоигра.
Когда солдаты возвращаются домой, они словно бы пойманы между двумя мирами. Простой выхлоп машины может неожиданно пробудить воспоминания об Ираке. Они хотят избавиться, но они не могут, - заявил ведущий специалист по программе виртуальной реальности, штатный психолог Медицинского центра ВМС в Сан-Диего, Джеймс Спира.
Через несколько месяцев, необходимым оборудованием будут оснащены три центра: Медицинский центр ВМС в Сан-Диего, госпиталь ВМС в Кэмп-Пендлтоне и Медицинский центра армии США на Гавайях.
Recalling Iraq's Terrors Through Virtual Reality
Therapy Aims to Alleviate Post-Traumatic Stress
By Ariana Eunjung Cha
Washington Post Staff Writer
Wednesday, March 23, 2005; Page A01
SAN DIEGO -- Joseph Blythe settled into the couch in the psychologist's office, slipped on a pair of high-tech goggles, took hold of the joystick and within a few seconds was transported through time and distance back to Iraq. He walked briskly along the maze-like urban streets, scanning the rooftops for friend or foe, passing by bombed-out cars, listening to the roar of choppers flying past the palm trees.
As he reached an alley, Blythe heard the whoosh of a bullet going past his head and flinched.
"That was scary," he said.
Blythe, a 25-year-old medic who spent eight months with the U.S. Marine Corps in Fallujah during its most turbulent period in 2004, is among the first to test a new virtual-reality system that the military hopes will help servicemen and women suffering from post-traumatic stress disorder.
The idea behind the treatment is counterintuitive. It forces the troops to do the last thing they want to do: relive the experience.
By confronting a make-believe Iraq, military scientists hope, patients will be able to assert better control over their memories. The intent is to stop the nightmares, outbursts of aggression and other readjustment issues that afflict many returning Marines, soldiers and sailors.
As the fighting in Iraq enters its third year, the U.S. military is grappling with what threatens to become a mental-health crisis in the armed forces. A New England Journal of Medicine study published this year estimated that one of every six Army soldiers returning from the war zone experiences major depression, anxiety or post-traumatic stress disorder. Many others, such as Blythe, report milder symptoms.
"Our minds aren't made to process that much death," he said. "Whoever goes to Iraq and comes back and says they have no problems is either in denial or is lying."
The virtual-reality experiment is among the most innovative efforts the government is launching. Among others: military-sponsored support groups for returning fighters, a mock house at a rehabilitation center to teach wounded troops to care for themselves before going home, combat-stress units to counsel personnel on the ground, and psychological questionnaires to earlier identify problems among returning troops.
Although the virtual-reality program is a relatively new idea, military doctors were impressed with results they saw when it was used with survivors of the World Trade Center attack.
In one case, it helped a 26-year-old executive work through her stress after the destruction of the towers. She had flashbacks so frequently that she couldn't sleep, refused to watch TV news and became intensely angry about minor things. Efforts to try to get her to revisit the events yielded "a flat emotionless tale," her therapists wrote in a research report. But when she was exposed to the scenario gradually over a 14-week virtual-reality program, she began to open up. She said that as she struggled to flee the area through a crush of falling bodies, a woman had called out to her. She remembered meeting the woman's eyes and thinking that if she stopped to help, she might not be able to make it out. She looked down to see that the woman's legs had been severed.
Once she had unearthed that memory, her symptoms receded.
The high-tech treatment may be more appealing to the macho culture of the military than traditional counseling, said Russell Shilling, a medical director at the Office of Naval Research in Arlington, which is funding the study. It is estimated to cost at least $4 million over three years and will compare the effect of virtual-reality exposure to having people revisit events by imagining the scenarios.
"There's still a stigma to seeking mental-health therapy," Shilling acknowledged. He hopes more troops will be open to the virtual-reality technology because it is like a video game.
The terrors in Iraq are of a variety and intensity that, many say, has been unseen since the Vietnam War: masked insurgents ambushing even humanitarian and reconstruction convoys, makeshift bombs at every turn in the road, Internet videos of kidnapped victims being beheaded. The mounting U.S. death toll, coupled with the stress of uncertain deployment times and multiple rotations, add up to intense stress.
When fighters return home, many find themselves trapped between two worlds. The sound of a car backfiring -- or even a certain type of food -- may evoke a memory of Iraq.
"The events keep coming back. They have nightmares, flashbacks. They can't get away, and they want to get away," said James L. Spira, a staff psychologist at the Naval Medical Center in San Diego who is a lead investigator in the virtual-reality study. Some turn to alcohol or drugs to block out the experiences, he said.
At first, said Sarah Miyahira, who works for the Department of Veterans Affairs in Honolulu, post-traumatic stress disorder may manifest itself as "simply a sensation, a deep pit in their stomach. . . . The human psyche protects itself by repressing memory, but . . . you're not going to have a whole sense of control if you don't understand what causes you to react the way you do."
The standard treatment is antidepressants plus "talk therapy." Virtual-reality scenarios are considered a supplement.
Within a few months, the virtual-reality treatments will begin to be offered to troops at three locations: the Naval Medical Center and Camp Pendleton Naval Hospital in California -- which together hope to enroll roughly 180 patients -- and Tripler Army Medical Center in Hawaii, which hopes to enroll about 75.
The system used in California, which is based on the video game Full Spectrum Warrior, puts the patient in the middle of a city. Therapists will gradually expose the patient to more radical scenarios. In the first session, the scene might be an empty street. In the second, other troops or civilians might be added. Near the end of the treatment -- which could last weeks or months, depending on the person -- the patient may be put through a full-scale attack. Researchers say they also plan to introduce smells and to superheat the treatment room to the 100-degree-plus temperatures the patients experienced in Iraq.
"We're trying to discourage them from escaping," said Hunter Hoffman, a research scientist at the University of Washington who is working on the Hawaii program. That one will simulate a convoy drive.
The virtual-reality scenarios serve as conversation starters between patient and therapist, who then try to pinpoint the event that triggered the syndrome. One possible complication is that the patients' experiences are varied and complicated and are not necessarily linked to a single incident.
The researchers worry that the technology may turn out to be just a distraction, a gimmicky, new-age twist on traditional therapies that may not work as well -- or, worse, that it could end up aggravating some patients' conditions by re-exposing them to their traumas too quickly if it is not used by a skilled therapist.
To avoid that, the therapists will make use of biofeedback sensors, measuring heartbeat, breathing, temperature and moisture on the skin. These statistics will help doctors determine the patients' reaction to certain stimuli -- such as the sounds of Arabic-accented voices yelling at them, helicopters landing and mortar shells striking -- and whether they are nearing the edge of what they can tolerate.
"We are not developing a self-help tool. This is something that needs to be used hand in hand with the help of a good clinician," said Albert Rizzo III, an assistant professor at the University of Southern California who is collaborating with Spira.
On a recent afternoon, while Blythe was immersed in the virtual Iraq, Spira was a few feet away controlling the environment. With his computer, the psychologist was changing the weather, the time of day, the sounds.
Blythe, who said he suffers from milder aspects of post-traumatic stress syndrome, is helping Spira work out the kinks in the system before the treatment is offered to those with major post-traumatic stress disorder.
Although Blythe is able to do his job as a medical technician, he has nightmares, thrashes in bed at night and gets spooked by large crowds because they remind him of how insurgents would surround themselves with innocent people, making it difficult to tell who the real enemy was. (He hasn't been to a mall since his return in October and doesn't like to go to bars anymore.)
He told Spira that the colors of the day and night sky are exactly right and the sound of the helicopters is realistic but that the streets are too clean; trash was everywhere in Iraq, he said. He suggested making the chair vibrate like a Humvee on a dirt road. He also noted that the sound of machine-gun fire in the background has become so commonplace in the war zone that it needs to be ratcheted up in the simulation to have an effect. He said the virtual-reality system hasn't produced a strong reaction in him, "not so much, not yet."
But his instinctive reaction to the bullet passing by so close surprised him. "In the end," he said, "I think the noises is what'll get people."
