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Using Virtual Reality to Treat Post Traumatic Stress Disorder

Aired January 27, 2013 - 14:00   ET



ANNOUNCER: They are innovators, game changers, people pushing themselves, moving us all forward. They're the next scientists, musicians, poets, the next makers, dreamers, teachers and geniuses. They are "THE NEXT LIST."

UNIDENTIFIED MALE: I think the main mission of what we're trying to do in our lab is to drag psychology kicking and screaming into the 21st Century. We're sort of like the unique alliance of Hollywood the military and academia.

DR. SANJAY GUPTA, CNN ANCHOR: He's a wizard of the virtual world.

UNIDENTIFIED MALE: So, we have people from neural psychology and from the military background. You bring that together with Hollywood story telling.

GUPTA: A clinical psychologist on the cutting edge.

UNIDENTIFIED FEMALE: He's always coming up with new ideas and motivating his colleagues to get involved, get engaged and push the needle forward.

GUPTA: And anything but your average lab geek.

UNIDENTIFIED MALE: Skip Rizzo is a very creative hippy, if you would.

GUPTA: He's also a key combatant in the U.S. military's battle against posttraumatic stress disorder, PTSD.

UNIDENTIFIED MALE: It's not unique to combat, but for veterans what it really has become is one of the signature wounds of Iraq and Afghanistan.

GUPTA: Skip Rizzo first grabbed headlines back in 2006 with his virtual reality PTSD therapy. Today, he's getting in front of the project with STRIDE. Cope with combat stress before their boots hit the battlefield. My colleague, Chris Lawrence, got a first look.

UNIDENTIFIED MALE: I think the military does a pretty good job in preparing people in advance for physically challenging events, for how to operate in a squad, all the tactics of war.

UNIDENTIFIED MALE: Each one of these recruits has to be a basically trained Marine. We have to give our brothers and sisters in the fleet who are going to be in charge of these Marines a finished product.

UNIDENTIFIED MALE: I want to prepare people to deal with stress better, if that doesn't work out, to help them to fight through the challenges in the aftermath of stress.

SKIP RIZZO, PH.D., CLINICAL PSYCHOLOGIST: Hi. I'm Skip Rizzo, clinical psychologist at the University of Southern California, Institute for Creative Technology.

Anybody that goes to war is going to be changed. It is just a reality. On the other hand, PTSD is a significant challenge. It's not about being weak. It's about having an experience of stress that really has a neurological impact.

PAUL REICKHOFF, IRAQ AND AFGHANISTAN VETERANS OF AMERICA: We've seen now potentially hundreds of thousands of veterans who may be returning from Iraq or Afghanistan with posttraumatic stress disorder. Conservative estimate say one in five folks coming home.

RIZZO: The whole virtual Iraq/Afghanistan exposure system is a set of scenarios like villages, Afghan villages, Iraqi villages, city environments resemble Middle Eastern context and we can pop a user into any of these environments that sort of match what their experience was.

JOANNA DIFEDE, PH.D., WEILL CORNELL MEDICAL COLLEGE: The idea is that you need to go over and over what happened to you as if it's happening again, and in a safe environment. So that you learn and your brain learns, if you will, that you're no longer experiencing the traumatic event.

CHRIS LAWRENCE, CNN PENTAGON CORRESPONDENT: How did you first thing, wait a minute, I'm doing all of this after they come home. What can I do before?

RIZZO: It was sort of a logical process where we had to study the process, we had to interact with a lot of patients and we had to see that pain. You know, you think to yourself, well, why don't we do a better job on the front end? So we can put ourselves out of a job on the back end.

CLARKE LETHIN, INSTITUTE FOR CREATIVE TECHNOLOGIES: STRIVE is an important research project for us to determine how we can conduct our training in the military to better prepare our people for the stresses of combat.

What we're going to do here is we're going to set up some psycho- physiological recording, which is from this system here. What we're trying to do with strive is the next level. We're actually trying to embed a user into a story, an interactive narrative.

UNIDENTIFIED MALE: It's important that we have an interactive experience.

UNIDENTIFIED MALE: Little man, that's my boy right there.

UNIDENTIFIED MALE: Our participants are really part of this world. They're part of a mission that they need to fulfill.

RIZZO: Instead of sitting on a couch and watching band of brothers, they're wearing a headset and they're in the story and then things happen that are challenging.

ARNO HARTHOLT, INSTITUTE FOR CREATIVE TECHNOLOGIES: When we look at the stress moments that need to appear in these episodes, we first brainstorm of ideas we can get in there. What can actually happen in Iraq and Afghanistan has happened.

So, once we have that high-level overview, we can work with our art group to define all the assets. We work with voice actors to report their lines and work with our motion capture state next door to capture all the animations that these characters need to have.

RIZZO: You bring in a mentor character that pops up periodically and guides the user through the events, the strategies and a way to put it altogether so, a challenging event, seeing a child die.

How do you get over that? By going through these kinds of events in advance, we're preparing folks for what they may face and giving them tactics for better dealing with it.

LETHIN: The Army research community has funded a portion of this. The office and Naval research and Marine Corps has funded a portion of this.

CAPT. ROGER HOLLENBECK, U.S. MARINE CORPS: I certainly think that anything we can do as a government, as a military to prepare our young men and women for what they might see while deployed is money well spent.

UNIDENTIFIED MALE: On the way back, there was an IED attack and our vehicle ran over an IED.



GUPTA: Skip Rizzo began his battle against PTSD with a post-combat therapy called virtual Iraq. I experienced it first hand back in 2006 and I can tell you it's an intense ride. It's what helped thousands of vets overcome their traumas and move on with their lives.


RIZZO: When you hear some of the stories that people tell about their experiences in Iraq and Afghanistan, the variety of things that affect people are unimaginable.

JOSEPH D. PHILLIPS, U.S. ARMY VETERAN: First time I came under fire, it was in 2006 going up and down in Iraq. Your first reaction isn't feeling this instinct and you just respond off of instinct.

RIZZO: OK, so, putting on this head mounted display.

LAWRENCE: Wow. Feel the vibrations.

RIZZO: That feels a lot more real.

PHILLIPS: On the convoy that was injured, I wasn't with my unit, I was detached to do a separate mission to escort a specific general. And our mission was to place a security team. On the way back, there was an IED attack. Our vehicle ran over an IED. So the vehicle exploded.

RIZZO: Really try to draw on the feedback we get from patients going through this and the stories that they tell to make it a richer experience.

PHILLIPS: You couldn't tell it was a struck any more. Just like a big ball of metal, can't remember the person who saved my life. I don't remember the soldier who was lost, as well. I just remember waking up in Germany.

RIZZO: I think the key here is diversity. To be able to have a variety of contexts set can address a wide range of experiences that people come back and they say are the things that they remember and haunt them.

PHILLIPS: So, when I woke up days later I couldn't feel my legs, couldn't move my head left or right. So I didn't know if I was quadriplegic, paraplegic. I didn't know what was going on until the nurse explained to me. I was having a hard time sleeping, having a lot of nightmares and just memories that flashes. So they diagnosed me with posttraumatic stress. I didn't seek help either. I was told I had to seek help.

DIFEDE: So, what we do is we have the person go over their memory, as if it were happening, again, but they are in a safe environment.

PHILLIPS: So, I did that with therapists. I would have to talk myself through the situation over and over again. To lower my anxiety level and lower my adrenaline levels.

RIZZON: If you can't engage a person using exclusive imagination, then you don't see the treatment effect because they're so walled off from their emotions. Let me pop you into a city environment and jump into a market area.

LAWRENCE: Yes, I could see you have the fruit, vegetable stands, and all the trash in the street, which is pretty realistic.

DIFEDE: Where virtual reality comes in, it basically delivers the context for your memory and the imagery, the sights, the sounds, the smells of being in Iraq or Afghanistan.

LAWRENCE: Like, I hear all these layers of sound and I hear the helicopter and the call to prayer.

RIZZO: I really think the visual sets a stage or context, but the sound can really serve to drive to emotion. PHILLIPS: That just looks like a video game, but when you put the goggles on, it brings you back into the same scenario that you're working through.

RIZZO: We can put ambient city sounds, the sound of wind. Of course, we can blow stuff up.

LAWRENCE: I mean, it was pretty intense, I mean, even when some of the bombs were going off, it wasn't just hearing them in the distance, like I could feel the vibrations of those explosions.

DIFEDE: You can smell a smell or hear a sound, hear prayer call, it's tapping into your memory and helping you recall it and maybe overcome the avoidance that seems to be part of PTSD.

PHILLIPS: The therapy has been effective. I was never a fan of prolonged exposure and things of that nature.

RIZZO: At its core, it has to induce some level of anxiety so that you're processing hard memories.

PHILLIPS: But it did help out a lot because I later kind of noticed that the nightmares were coming a lot less frequently. The sleep issues were coming a lot less frequently and the anxiety when these nightmares were happening were coming a lot less.

RIZZO: There are currently 55 sites that have the original system. You know, I can't underscore enough that the technology doesn't fix anybody. It's a tool in the hands of a well-trained clinician.

DIFEDE: There have been multiple studies done with Marines, Navy personnel and Army and returning from active duty showing that it's effective. People get better. They get better in a relatively short period of time.

PHILLIPS: Absolutely, I would recommend this therapy to all different types of soldiers, police officers, firemen.

RIZZO: We were funded to rebuild everything on the latest software and I expect in the next year, we'll see a significant growth in the use of the technology. Aside from that, we have data to show that this is a safe and effective approach to treating PTSD.

You know, rugby party, but, you know, you want to talk blowing off steam. That is the ultimate place to do it.




RIZZO: I don't know if you've been to a rugby party, but if you want to talk about letting off steam, that is the ultimate place to do it. The beauty of rugby is not only the game play and the sport of it, but there's a bond that grows from rugby players among each other. It's like maybe the closest you could come to combat but still be safe.

LAWRENCE: I've got to ask you this. You're not what I pictured when I thought military.

RIZZO: I think I'm sort of like the token wild eyed guy that they wouldn't want to have in their squad, but they kind of like maybe having me around to come up with some new ideas.

ANTHONY HASSAN, USC SCHOOL OF SOCIAL WORK: I'm a veteran myself. So I really, skip really puts a veteran at ease. Skip is not a suitor. He's a down to earth kind of guy and I'll tell you, that's what veterans like.

RIZZO: I was a child of the '60s, so to speak. And at that time it was a different era with the Vietnam War and everything. I missed out on being in the military. It was the last thing in the world I wanted to do.

When I started to see some of the problems that were coming from out of Iraq and Afghanistan, I felt, well, this is a way for me to sort of do my part in some way. As a kid, I didn't know what I wanted to do, but it wasn't up until I went to college and my first class, first day of college was psychology. And instantly, it was like, man, this is it.

LAWRENCE: Like I know you've got to have that clinical, scientific mind for the processes, but so much of this is created. Where do you get your inspiration from?

RIZZO: I grew up listening to progressive rock. You know, expansive symphonies of sound that created mind movies. I think I always had an imagination that this work gives me opportunity to pull on that imagination and work out my frustrated artist side and frustrated filmmaker side and still keep my clinical side.

LAWRENCE: So, is somewhere in there is a rock star, director waiting to get out?

RIZZO: Guitarist in Pink Floyd, pretty much, yes. But also inspired, I think a lot has to do with people you hang out. We have a mix of people on our team, you know, that are computer scientists, artists, graphic designers, psychologists. You know, it's the best job in the world. We get to go in and play with all these toys and build things that have a really, I think, a really good human purpose.

HARTHOLT: Well, we work at a research institute, so I don't want to say too much, but a typical researcher would have, you know, glasses, lab coat, perhaps and somewhat of a nerdy outlook. But here is this person who is coming on this Harley Davidson and his favorite pastime is seeing how much beer he can with our colleagues.

LAWRENCE: I know these guys got a great look at where you operate. What is with the skulls? Come on.

RIZZO: Look, the skull is the home of the brain and I worked for many years with brain injury. I sort of adopted the skull because I could make the excuse that it is sort of a scientific motif or mascot, but I like skulls because they're cool. You know, it's an artistic entity. It's so cool because that's where your brain lives.




RIZZA: We have a large population that deserves our best attention. I think there's no more higher purpose right now than to take care of the folks that put themselves in harm's way to protect our freedoms.

RIECKHOFF: And what is totally unprecedented is the redeployment pace. More than 500,000 folks have done more than one tour. That's a burden we put on our folks that is unprecedented.

PHILLIPS: I still have sleep issues and I have migraines and still have nights or weeks at a time where I can go without sleeping. It's those situations where I've lost some people over there that I don't talk about now. And I don't talk about, but it just, you are never going to get that back. Never going to get them back and those memories aren't ever going to go away.

RIZZO: We're acknowledging that people are always going to have some effect. We just want them to be able to be better at making that transition back to civilized society and not carrying around that pain of war for the rest of their life, messing up the only life they have.

RIECKHOFF: A lot of vets don't want to go get care. They're saying, I'm tough, I can handle it. I learned in the military, I can handle it.

PHILLIPS: Seeking help medically, I wouldn't say for anything, but if it's something physical, people can understand. But if you say I'm having some emotional issues to your sergeant or to your commander, they kind of don't want to hear that.

RIECKHOFF: But it's really become not only the right thing to do for you, but a tactical necessity. You don't want to send somebody back into combat any more than you want to send somebody with a pulled hamstring back on to the football field.

RIZZO: We still have a culture within the military that admitting needing help is like admitting weakness. We're trying in the military to get past that with the idea that it's okay to ask for help. It's going to be a generational shift. I think the military is really putting a serious effort into normalizing and asking for help.

DIFEDE: And, not surprisingly, this is a younger generation. When given the choice, many soldiers and marines would say they would prefer the virtual reality form of the exposure therapy. Why? It's a gaming generation. Maybe it doesn't feel so much like therapy.

RIZZO: One of the big areas is the development of virtual humans, you know, graphic characters that have some level of artificial intelligence and can understand what you're saying and that you can interact with.

HARTHOLT: They can be mentors or virtual actors that people can train negotiations with or they can train conversations with and all these technologies combined based on research and mental health area is opening up a way to a lot of different possibilities.

RIZZO: You know, we get to see real change. We get to see people, you know, that are initially bound up and tight and almost afraid to even go into a virtual world to, you know, confront and process the challenging memories.

And then over a few sessions, you start it se them come out of that a little bit and that's really uplifting and it's also a heck of a lot of fun. The biggest challenge I face in all this is if we see somebody make a game in therapy and they're still in active duty.

There's a chance that they're going to get deployed, again. So, I'm anxious about, are we fixing them up in a way that is making them stronger so that they're more resilient when they go back or are we putting them at risk, again? That's one of the questions that keep me up at night.

UNIDENTIFIED MALE: This is going to continue. This is a long war and we need to do everything we can to prepare our people for the threats that we face.

RIZZO: I think war is still going to suck no matter, no matter how far into the future you look. There is always going to be pain and tragedy and human wreckage. We're struggling now to think about ways that we can prevent some of that by using the best in technology to prepare people more effectively.

REICKHOFF: I wish him all the best. I know everybody in the military wishes him all the best and I hope all Americans wish him the best. You have to root for this guy and hope what he's doing works and it will be better for everybody.


GUPTA: Skip Rizzo is doing more than helping servicemen and women fight their way back from posttraumatic stress. He's saving lives by teaching troops to handle the horrors of war before they hit the battlefield. That is what earns him a spot on THE NEXT LIST. I'm Dr. Sanjay Gupta, hope to see you back here next Sunday.