Virtual Reality in Military Health Care

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Table of Contents

Abstract
Overview of the Technology
VR and Psychological Disorders
VR and PTSD
Conclusion
References

Abstract

Virtual Reality (VR) has become extremely popular in the last few years because of the significant progress of underlying technology and hardware that allows processing large data. The purpose of the research is to identify the capabilities of VR and its applications in military health care. This study is designed as secondary research. For its purposes, relevant peer-reviewed articles will be collected, summarized, and analyzed. All research data will be gathered from sources published within the past ten years to ensure the currency. This study will explore the current uses of VR, its different functionalities, applications in the field of military health care, and future developments of the technology.

Virtual reality (VR) is being widely used in almost every sphere of human endeavor. It is an extremely important technology applied in science, medicine, and entertainment, among other fields (Burdea & Coiffet, 2008). Moreover, VR has surpassed all theories about its application that have been developed within the last couple of decades and has even entered the military sector. Considering that upcoming budget cuts threaten to impact the military substantially, it can be argued that VR promises a viable solution for the forthcoming challenges that a new era of defense might hold for military personnel worldwide (De Paolis & Mongelli, 2014).

VR could be an effective means for solving numerous medical problems and finding new solutions for delivering health care. The technology also promises to substantially improve the field of emergency medicine and medical training of armed forces. Considering the specific nature of a battleground, it stands to reason to come up with sustainable solutions that would allow medical students to perform specific procedures in a controlled environment of VR simulation. It would also allow them to study in a unique setting without risk of harming a patient. Even such complex procedures as diagnosis, treatment, surgery, or counseling could be transferred into the realm of a virtual environment (Rizzo et al., 2013).

According to a recent report, there is increasing the incidence of combat-related posttraumatic stress disorder (PTSD) among the United States military personnel deployed for numerous military conflicts around the world (Rizzo et al., 2013). The findings of the US Army University Affiliated Research Center and the University of Southern California suggest that almost two million soldiers have served in “the Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) conflicts in Afghanistan and Iraq” (Rizzo et al., 2011, p.176).

It means that significant numbers of service members returning home after experiencing extremely stressful events would be “at risk for developing posttraumatic stress disorder “(Rizzo et al., 2011, p.176). The Rand Analysis suggests that the deployment level of 1.5 million will result in around 300,000 service members developing “symptoms of PTSD and major depression“ (Rizzo et al., 2011, p.177). According to a report presented by the Military Health System, 66, 934 active-duty soldiers have been diagnosed with some form of PTSD (Rizzo et al., 2011, p.177).

Therefore, it could be argued that there is a pressing need for evidence-based approaches to treating numerous mental disorders that have a significant impact on the health and well-being of both service members and veterans. This paper will explore the medical application of VR technology across different points of the deployment cycle.

Overview of the Technology

VR is the use of a computer interface for creating a simulated three-dimensional environment of a visual or full-sensory nature that allows a user to experience immersion in a virtual space (Rizzo et al., 2011). The sensory stimuli produced by VR equipment could be delivered with the help of visual display technologies sending computer graphic images and other forms of audio, haptic/touch, or even olfactory signals (Rizzo et al., 2011).

The very nature of VR suggests that it could be used to create naturalistic, multisensory environments providing interactive 3D stimuli that could be precisely measured and controlled. Therefore, it stands to reason that the capacity of VR to produce controlled conditions is a key for developing numerous training programs for clinical assessment, diagnosis, treatment, surgery, and counseling, among other similar applications.

According to Rizzo et al., the US Department of Defense (DoD) spends increasingly bigger portions of its budget on R&D in the field of VR (2013). The investment in the underlying engineering technology made by the R & D departments of various information technology companies also helps build a framework for the development of VR-based clinical assessment methods that could be used in the military and civilian sectors alike (Rizzo et al., 2013).

Virtual environments can offer endless possibilities for “sophisticated interaction, behavioral tracking, user response, and performance recording” during training or treatment procedures, making sure that the users experiencing VR scenarios could benefit from functionally relevant interactions (Rizzo et al., 2013, p. 124). Numerous, clinicians and researchers have already recognized the vast application areas of VR technology.

VR and Psychological Disorders

A comprehensive study conducted by Rizzo et al. suggested the following uses of VR simulation technology: fear reduction, PTSD treatment, stress management in postoperative patients, acute pain reduction during operation procedures, physical therapy of patients undergoing a variety of painful medical procedures, the reduction of body image disorders, functional skill training for patients undergoing motor function rehabilitation or having dysfunctions of the central nervous system including the brain and spinal cord injuries, development of mental and special skills for children and adults as well as “cognitive functions in both clinical and unimpaired populations” (2013, p. 125).

VR reality offers new approaches to psychological practices, especially in the field of cognitive-behavioral therapy. A book titled “Computer-Assisted and Web-Based Innovations in Psychology, Special Education, and Health” written by Luiselli and Fischer provides a comprehensive look at the existing applications of VR for treatment of a wide variety of phobic disorders such as fear of heights or acrophobia, fear of spiders or arachnophobia, fear of closed spaces or claustrophobia, and fear of public speaking among others (2013). The authors note that there is a rapid growth of research laboratories studying the use of VR technology systems in clinical settings worldwide.

The authors argue that the next step in the delivery of VR treatment is introducing therapy programs that can be provided via the Internet, thereby eliminating the need for a patient to be present in the same physical location as their therapist (Luiselli & Fischer, 2013). Some such projects are already being sponsored by the Visualization & Simulation Research Center (VSRC), supported by grants from the Department of Army and the US Army Research Office (Luiselli & Fischer, 2013).

VR and PTSD

The article “Effectiveness of Virtual Reality Exposure Therapy for Active Duty Soldiers in a Military Mental Health Clinic,” written by Reger et al., argues that virtual reality exposure therapy (VRE) could be effectively used for the treatment of PTSD (2011). The authors discuss a retrospective study that shows that even those soldiers who were treated with other therapeutic methods were proven to have a significant reduction of combat-related symptoms of PTSD after prolonged exposure to VRE treatment. It can be said that the research is inconclusive due to the lack of a consistent approach to the number of sessions which prevented scientists from establishing a dose-response relationship (Reger et al., 2011).

A book titled “Novel Approaches to the Diagnosis and Treatment of Posttraumatic Stress Disorder,” written by Michael Roy, argues that military doctors could combine cognitive-behavioral therapy (CBT) methods with VR approaches for the significant reduction of combat-related disorders (2006). He claims that immersing patients in a simulation that reproduces traumatic experience can better understand the roots of their problem and neutralize its cues.

Moreover, Roy argues that the treatment based on the intense exposure to VR environments includes proximity, immediacy, and expectancy (PIE) that are helpful in the treatment of mental disorders (2006). The author says that the PIE aspect of VR could be used in combination with CBT approaches to create timeless spaces in which patients could reimagine their traumatic experiences and recover. Roy provides an account of an open trial in which ten veterans of the Vietnam War were exposed to VRE treatment. The study results suggest that there was a consistent trend toward reducing PTSD symptoms across the whole study group (2006).

An article titled “Virtual Reality Exposure Therapy for Combat-Related Posttraumatic Stress Disorder,” written by Rothbaum, Rizzo, and Difede, explores VR exposure therapy as a tool for treating different conditions experiencing life-threatening circumstances of combat situations (2010). The authors focus their attention on the following VR scenarios: Virtual Vietnam, Virtual Iraq, and Virtual World Trade Center (Rothbaum et al., 2010).

Those scenarios were created with the help of Veterans returning home from war conflicts. VR exposure therapy allows immersing patients in specific conditions that are closely adjusted to their needs and match their combat experiences. According to Rothbaum et al., there was a positive trend of alleviation of PTSD-related symptoms in a clinical study with twenty participants (2010). Psychophysiological evaluation and interviews revealed that all subjects of the experiment “no longer met DSM criteria for PTSD at post-treatment on a self-report measure of PTSD” (Rothbaum et al., 2010).

Current literature on VR reveals that technology could be highly effective for treating numerous combat-related psychological disorders (McLay et al., 2012). Moreover, the application of VR could help with fear reduction, PTSD treatment, stress management in postoperative patients, acute pain reduction during operation procedures, physical therapy, the reduction of body image disorders, functional skill training for patients undergoing motor function rehabilitation or having dysfunctions of the central nervous system including the brain and spinal cord injuries among other disorders (Rizzo et al., 2013).

Conclusion

VR is widely used in almost every sphere of human endeavor. It is an extremely important technology that found numerous applications in science, medicine, entertainment, and even entered the military sector. Numerous clinicians and researchers have already recognized the vast application areas of VR technology in military health care.

Countless clinical trials suggest that VR simulation technology could be used for fear reduction, PTSD treatment, stress management in postoperative patients, acute pain reduction during operation procedures, physical therapy of patients undergoing a variety of painful medical procedures, the reduction of body image disorders, functional skill training for patients undergoing motor function rehabilitation or having dysfunctions of the central nervous system including the brain and spinal cord injuries (Rizzo et al., 2013).

It could be argued that the choice of a systemic review for data analysis is a study design limitation that could have been addressed by combining it with meta-analysis. The study’s future direction could include exploring the implications of cognitive and perceptual dimensions of VR technology.

References

Burdea, G., & Coiffet, P. (2008). Virtual reality technology. Hoboken, NJ: Wiley-Interscience.

De Paolis, L., & Mongelli, A. (Eds.). (2014). Proceedings of the First International Conference, AVR: Augmented and Virtual Reality, New York, NY: Springer.

Long, S., & Dhillon B.S. (Eds.). (2014). Proceedings of the 13th International Conference on Man-Machine-Environment System Engineering: Lecture notes in electrical engineering. Heidelberg, Germany: Springer-Verlag.

Luiselli, J., & Fischer, A. (2013). Computer-assisted and web-based innovations in psychology, special education, and health. New York, NY: Routledge.

McLay, R., Graap, K., Spira, J., Perlman, K., Johnston, S., & Rothbaum (2012). Development and testing of virtual reality exposure therapy for post-traumatic stress disorder in active duty service members who served in Iraq and Afghanistan. Military Medicine, 177(6), 635-642.

Motraghi, T., Seim, R., Meyer, E., & Morissette, S. (2013). Virtual reality exposure therapy for the treatment of posttraumatic stress disorder: a methodological review using CONSORT guidelines. Journal of Clinical Psychology, 70(3), 197-208.

Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2011). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depression and Anxiety, 29(2), 85-93.

Reger, G., Holloway, K., Candy, C., Rothbaum, B., Difede, J., Rizzo, A.,…Gahm, G. (2011). Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. Journal of Traumatic Stress, 24(1), 93-96.

Rizzo, A. S., Buckwalter, J. G., Forbell, E., Reist, C., Difede, J., Rothbaum, B. O.,…Talbot, T. (2013). Virtual reality applications to address the wounds of war. Psychiatric Annals, 43(3), 123-138.

Rizzo, A., Parsons, T. D., Lange, B., Kenny, P., Buckwalter, J. G., Rothbaum, B.,…Reger, G. (2011). Virtual Reality Goes to War: A Brief Review of the Future of Military Behavioral Healthcare. Journal of Clinical Psychology in Medical Settings, 18(2), 176-187.

Rothbaum, B., Price, M., Jovanovic, T., Norrholm, S., Gerardi, M., & Dunlop (2014). A randomized, double-blind evaluation of d -Cycloserine or Alprazolam combined with Virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War Veterans. American Journal of Psychiatry, 171(6), 640-648.

Rothbaum, B., Rizzo, A., & Difede, J. (2010). Virtual reality exposure therapy for combat-related posttraumatic stress disorder. Psychiatry Report, 12(8), 126-132.

Roy, M. (2006). Novel approaches to the diagnosis and treatment of posttraumatic stress disorder. Amsterdam: IOS Press.

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