Virtual Reality as a Tool for Delivering PTSD Exposure Therapy and Stress Resilience Training

The incidence of post-traumatic stress disorder (PTSD) in returning Operation Enduring Freedom and Operation Iraqi Freedom military personnel has created a significant behavioral health care challenge. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive virtual reality (VR). Initial outcomes from open clinical trials have been positive, and fully randomized controlled trials are currently in progress. Inspired by the initial success of our research using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we have developed a similar VR-based approach to deliver resilience training prior to an initial deployment. The STress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (derived from our existing virtual Iraq/Afghanistan PTSD exposure therapy system) that are part of a multiepisode interactive narrative experience. Users can be immersed within challenging virtual combat contexts and interact with virtual characters as part of an experiential approach for learning psychoeducational material, stress management techniques, emotional coping strategies believed to enhance stress resilience. This article describes the development and evaluation of the virtual Iraq/Afghanistan exposure therapy system and then details its current transition into the STRIVE tool for predeployment stress resilience training.