BOB GARFIELD:
This is On the Media. I'm Bob Garfield.
BROOKE GLADSTONE:
And I'm Brooke Gladstone. A recent RAND study concluded that 300,000 U.S. military personnel have returned from Iraq and Afghanistan with post-traumatic stress disorder or major depression. PTSD is the focus of a recent lawsuit in which two veterans' groups are suing the Veterans Administration for not adequately providing health care to vets.

Last week, a federal judge reopened the case to consider new evidence suggesting that V.A. counselors had been discouraged from making PTSD diagnoses because it can be a long and costly process. And while it's hard to diagnose, it's even harder to cure.

Psychology researcher Dr. Albert “Skip” Rizzo says he has a new tool for combating PTSD, a virtual reality simulator based on the video game Full Spectrum Warrior.

With an adapted version of the video game, a virtual reality headset, a vibrating seat and various smells, Rizzo has created a program he calls "Virtual Iraq," where soldiers can confront their traumatic experiences.

Of the 15 soldiers who have gone through the full treatment, 12 no longer meet the criteria for PTSD. All that from a video game?
DR. SKIP RIZZO:
Well, we did start off with the basis of a computer game. It's not really a game anymore. It's a tool that allows a clinician to put somebody back in an environment, in an immersive environment, but in a very controlled fashion, whereas in a game you're in the game and you're shooting at things and you may get shot at and all that. None of that happens in this system.

In fact, we specifically don't have it so that you can shoot a weapon in this environment.
BROOKE GLADSTONE:
Why not?
DR. SKIP RIZZO:
Well, we feel that that is at odds with the whole premise, and we're not trying to foster some kind of a cathartic revenge fantasy. That doesn't prepare someone for civilian life.

The goal is, is for the person to revisit what they've experienced but in a very graduated fashion, a very safe manner and in a supportive fashion where they can begin to start to talk about what they went through.
BROOKE GLADSTONE:
Before we talk about Virtual Iraq, can you tell us about other psychological conditions for which using a safe virtual environment is therapeutic?
DR. SKIP RIZZO:
I think virtual reality really got its start in the area of clinical application with the treatment of simple phobias - people that have fear of heights, fear of flying, fear of spiders.

And by putting a person in an environment, say, being in a virtual airplane - could be gradually introduced, it works better than doing it in imagination, and it's as good as doing it in the real world.
BROOKE GLADSTONE:
Just as good as the real world?
DR. SKIP RIZZO:
What you find is that humans have a tremendous capacity to suspend disbelief. So you do see, even in a very primitive virtual environment say, a glass elevator for fear of heights, and they know they're not in a real elevator, but they get sweaty palms as you go up. Their heart rate goes up. And they react to it as if it's the real environment. But, you're in the clinician's office.
BROOKE GLADSTONE:
So you can simulate an elevator, but how do you simulate war?
DR. SKIP RIZZO:
What we've done to develop Virtual Iraq, first off, is had soldiers in Iraq actually try out Virtual Iraq and tell us what we got right and wrong. And, armed with that feedback, we went back to the drawing boards where we're continually evolving the application.

We looked at what are some of the standard environments, and we isolated being on a desert road in a Humvee, and also going on a foot patrol through an Iraqi-type city. Within any of those environments, the clinician has a separate control panel where they can adjust the settings in a fashion that matches what the patient has already reported to the therapist and add in elements that make it more provocative.
BROOKE GLADSTONE:
So walk us through it, and we will insert some of the audio that you sent us before this interview.
DR. SKIP RIZZO:
Okay. So you may start off in the Humvee by the side of the road without any sound, except the sound of wind.
[SOUND OF WIND]
Then as the patient begins to adjust to that, we can add in perhaps the sound of the Humvee motor and the vibration from the platform that they're sitting on, so you actually feel the motor.
[SOUND OF WIND AND MOTOR]
We invite them to pull out onto the roadway and start driving. The next step would be to add some provocative elements, maybe gunfire in the distance.
[ADDED SOUND OF GUNFIRE]
Maybe an American weapon, an M-4 sound.
[ADDED SOUND OF M-4]
We can add in the sound of a helicopter flying over, an A-10 flying over the scene.
[SOUND OF HELICOPTER]
And as you progress through the therapy, you can add in an IED going off.
[SOUND OF DETONATED IED]
BROOKE GLADSTONE:
So you have a pretty complex web of sounds. Describe what they're seeing through their virtual reality visor.
DR. SKIP RIZZO:
The neat thing with the virtual reality headset is that it's got a head tracker built into it, so that as you turn your head, the graphics update and you get the illusion of being in the environment.

And as you're driving in the Humvee, you can look to the right of you and see a passenger, a fellow in the turret up above you, and you can also eliminate those folks, if those aren't relevant to the patient's story.
BROOKE GLADSTONE:
But if they are relevant, if part of their trauma involves the death of a buddy, say, you'll have someone representing that buddy, perhaps in that position when the accident occurs?
DR. SKIP RIZZO:
Yes.
BROOKE GLADSTONE:
Will the soldier that you're treating see that death reenacted?
DR. SKIP RIZZO:
Now, if the clinician feels that the patient is prepared for it, that virtual passenger can, in fact, sustain a wound, a mild wound or a more significant wound, and slump over in the vehicle.

Now, lot of times that might not even be necessary. We're very careful not to do this in a fashion that might push someone over the edge, but rather to do it in alliance with the therapist and the patient together deciding what will come next.
BROOKE GLADSTONE:
What sense triggers the most intense reactions? We've heard some of the sounds. You've described some of the visuals. I was intrigued to learn you also use smells.
DR. SKIP RIZZO:
Some people are going to react more to one type of stimuli than another. What I could say generally is that I think the visuals sort of set the stage. It puts a person back in a place.

But what really drives the emotion, number one, is the sound. Some of the sounds, like when you walk through the city, you hear an ambient soundtrack of city sounds–
[AMBIENT CITY SOUNDS]
- and you hear a baby crying in the distance.
[SOUND OF BABY CRYING]
Very evocative.

We know from theory that the sense of smell directly connects to the brain in the area that's responsible for memory and emotion.
BROOKE GLADSTONE:
What are some of the smells you use in the program?
DR. SKIP RIZZO:
Burning rubber, diesel fuel, gunpowder, rotting garbage, body odor, Iraqi spice. We're looking to get the smell of cooked lamb because that is something that soldiers report. The smell of burnt hair is also one that's on order.

And that's one, I think, that has relevance, because the smell of burnt hair is something that you would get in a civilian environment. Walking by a hair salon, you might get a whiff of that, and that could bring you right back.
BROOKE GLADSTONE:
Do you think this treatment does something dramatically different, or is it just a way to get people who are otherwise opposed to therapy in the door, like slipping crushed-up medicine into a kid's ice cream?
DR. SKIP RIZZO:
There's so much stigma associated with the diagnosis of PTSD that a lot of soldiers are hesitant to seek treatment. And some soldiers are just not of the type where the traditional talk therapy is something that they're attracted to.

And I've even proposed changing the name from therapy to post-combat reintegration training. And by having the V.R. as a tool, it sort of takes the heat off of the interpersonal nature, even though that does occur in the therapy naturally.
BROOKE GLADSTONE:
You mentioned that virtual reality has been used to treat other things – phobias, like, you know, spiders or flying. But I just wonder whether this technology could be applied to patients who suffer from PTSD based on experiences that can't be so easily simulated in a video game.
DR. SKIP RIZZO:
The key is to use good clinical judgment in determining when it's useful and when it's a good tool, and not just think you're going to throw technology at every clinical problem and it's going to fix itself.

I don't propose that V.R. is the panacea for all forms of PTSD. I certainly would not advocate that you create a sexual assault virtual reality environment.

But for the areas where V.R. is well matched to the clinical condition, I think we can do things better.
BROOKE GLADSTONE:
Thank you very much.
DR. SKIP RIZZO:
Thank you.
BROOKE GLADSTONE:
Psychology researcher - Dr. Albert Rizzo.