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New Technologies For Coping With PTSD Explored

Aired May 4, 2013 - 14:30   ET


DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Today on a special edition of THE NEXT LIST, living Boston strong.

UNIDENTIFIED FEMALE: A loud noise went off. And I remember turning around and looking and seeing smoke and seeing people screaming, and it immediately reminded me of 9/11.

GUPTA: After the horrors witnessed during the April attacks, survivors and first responders may be facing a new threat -- post- traumatic stress disorder, or PTSD.

CHARLES BUCHANAN, BOSTON FIRE DEPARTMENT: I saw a little girl, they put her inside the balance, and the only thing that I could see, and see to this day, are her little eyes looking up at me.

GUPTA: The bombings turned the city into a warzone.

BRIAN FITZGERALD, BOSTON MARATHON ATHLETIC TRAINER COORDINATOR: I mean, I've seen open fractures. I've seen open wounds. But I've never seen anything like that.

GUPTA: But new advances in the military's battle against PTSD may offer new coping tools when overwhelming violence strikes right here at home.

SKIP RIZZO, PH.D., CLINICAL PSYCHOLOGIST: I think it's an important problem. And I want to dig in hard to address this.

GUPTA: Clinical psychologist Skip Rizzo first made headlines in 2007 with his virtual reality PTSD therapy for vets.

PAUL RIECKHOFF, IRAQ AND AFGHANISTAN VETERANS OF AMERICA: 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: Today he's re-imagining that technology to help trauma victims from Boston and West Texas to Newtown, Connecticut. Chris Lawrence got a first look.

RIZZO: You know, I think that 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 the marines a finished product.

RIZZO: I want to prepare people to deal with stress better and if that doesn't work out, to help them to fight through the challenges in the aftermath of stress. I'm Skip Rizzo, clinical psychologist at the University of Southern California Institute for Creative Technologies.

Anybody that goes to war is going to be changed. It's 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.

RIECKHOFF: We've seen now potentially hundreds of thousands of veterans who may be returning from Iraq or Afghanistan with post- traumatic stress disorder. Conservative estimates say one in five folks coming home.

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

JOANN DIFEDE, PH.D., NEW YORK PRESBYTERIAN/WEILL CORNELL: And 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 you learn and your brain learns, if you will, that you're no longer experiencing the traumatic event.

CHRIS LAWRENCE, CNN NATIONAL CORRESPONDENT: How did you first think 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, 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.

CLARK 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.

RIZZO: What we're going to do here is we're going to set up some psychophysiological recording, which is from this system here. What we're trying to strive is a next level where we're actually trying to imbed a user into a story, an interactive narrative.

ARNO HARTHOLT, INSTITUTE FOR CREATIVE TECHNOLOGIES: It's important that we have an interactive experience.

UNIDENTIFIED MALE: Hey little man. That's my boy right there.

HARTHOLT: Our participants are really part of his world, part of a mission that they need to fulfill. RIZZO: So 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.

HARTHOLT: When we look at the stress moments that need to appear in these episodes, we first brainstorm a variety of ideas, things we can get in there. What can actually happen in Iraq and Afghanistan has happened? So once we have the high level overview, we can work with our art group to define all the visual assets, we can work with a voice actor to record the lines. We can work with our motion capture stage next door to capture all the animations that these characters need to have.

RIZZO: You bring in a virtual character or mentor character that pops up periodically and guides the user through the events, the strategies and a way to put it all together. 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 of 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.

RIZZO: In this case with Boston, what I envision is that we would have a crowd source approach.


GUPTA: The Boston Marathon bombings turned the city into a battlefield. Police, medics, innocent bystanders were suddenly thrust into a war that none of them could have foreseen. And like thousands of combat vets every year, the warriors of Boston's front line, they may need help overcoming that trauma.

BRIAN FITZGERALD, BOSTON MARATHON ATHLETIC TRAINER COORDINATOR: That was a warzone. That was something I haven't ever been involved in. I can imagine how that is over in Afghanistan and Iraq. And what our veterans go through.

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: The first time I came under fire, it was in 2006, going up and down in Tampa. Your first reaction isn't really feelings. It's instinct. You just respond off of instinct.

RIZZO: OK. So you'll be putting on this head monitor display.

LAWRENCE: Oh wow. That feels a lot more real.

On the convoy I was injured on, I wasn't with my unit. I was detached to do a separate mission, to escort a specific general. And our mission, on the way back, our vehicle ran over an IED. So the vehicle exploded.

RIZZO: We 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 truck anymore. It was just a ball of metal. I never met the person that saved my life. I don't remember his name and I didn't know the soldier that 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 that can address the wide range of experiences that people come back, that they say are the things they remember and that 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 it to me. I was having a hard time sleeping. I was having a lot of nightmares and just memories and flashes. So they diagnosed me with post-traumatic stress. I didn't seek help. I was told I had to seek help.

DIFEDE: What we do is we have the person go over their memory as if it were happening, but yet they're in a safe environment.

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

RIZZO: The challenge is, 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. We'll jump into a market area.

LAWRENCE: Yes, I can see you've got the fruit and vegetable stands, all the trash in the street, which is pretty realistic.

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

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

RIZZO: I really think the visual sort of a stage or context, but the sound can really serve to drive emotion.

UNIDENTIFIED MALE: This is vehicle three. We just got hit.

PHILLIPS: You may think, Oh, it just looks like a video game, but when you put the goggles back on, it really brings you back to the same scenario that you're working through.

RIZZO: We can put ambient city sounds now, 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.

RIZZO: The body experience is a key element of this.

DIFEDE: You smell a smell or hear a sound, hear a prayer called. 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 because it's not a comfortable feeling.

RIZZO: At its core, exposure therapy 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 happen was coming a lot less frequently.

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 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 will recommend this therapy to all different types of soldiers, police officers, firemen.

RIZZO: Those folks deserve our best effort as much as a service member that's going into combat. We were funded to rebuild everything on the latest software and I expect that 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.

TERRY KEANE, PH.D., NATIONAL CENTER FOR PTSD: This brick may help us with disasters, Newtown, West Texas, disasters of all kinds.


DIFEDE: The nature of terror is that it's unpredictable.

UNIDENTIFIED FEMALE: Something just blew up! Run!

CHARLES BUCHANAN, JR., BOSTON FIRE DEPARTMENT: It's the worst day in my career. I can still see this little girl. I still see the little boy. I know people that know this little boy.

DIFEDE: Firefighters and cops are prepared in the course of their training to expect a certain amount of danger. But what happened in Boston that day went beyond what anyone expected in their wildest dreams.

RIZZO: I think what we have to look forward to in the future is that the types of simulation technologies that we use, virtual reality, will be more available for the kinds of traumatic events that people are exposed to due to these terrorist attacks or natural disasters.

DIFEDE: Most people will recover from their grief and stress reaction on their own with the support of their loved ones.

RIZZO: Really what we look for is people that after a period of time, typically 30 days we use as a bench mark, they're still feeling these problems. That gives us a 30-day window to be able to construct simulations that will be useful for an exposure therapy approach for PTSD.

UNIDENTIFIED MALE: They shot a few more times and all the kids were running.

RIZZO: The first time I had the idea was after Columbine. At that time, it was least a decade ago, it was a challenge to do that within the timeframe. One of the steps that we're taking is to try to build tools to where it's not going to take six months to build the relevant content for an exposure therapy approach. It might take six days.

ARI SHAPIRO, INSTITUTE FOR CREATIVE TECHNOLOGIES: We're creating a highly realistic digital person. So the idea is we want to create realistic face, realistic hair, realistic movements. But we also want the character to have a realistic behavior.

UNIDENTIFIED MALE: All right, so here we go.

RIZZO: The key is getting content that's relevant to whatever the traumatic event is. So in this case with Boston, what I envision is that we would have a crowd source approach. In fact, I set up a Facebook page to get this kicked off, called "Virtual Volunteers," people that are content creators, people that have built game content or virtual reality content. And at the first minute we hear about these things, we mobilize this group of volunteers, put out what our requirements are, and then we can begin to integrate all that varied content that the crowd produces.

KEANE: It can be done in a matter of hours or days if the right resources are brought to bear on the problem. Not only can it be done with great speed, it doesn't have to be perfectly accurate, because if I were standing in front of the Boston public library and you were standing in front of the restaurant, we would have had very different views and images of what it is that happened. But you just need to get close enough to help people understand what it was that they were experiencing. SHAPIRO: Eventually I think clinicians could design their own scenarios because they would simply use an authoring tool where you would take a character, put it in a scene, infuse the character with a certain behavior or role in that scenario and then run a simulation.

RIZZO: One of the things that's going to make this rapid prototyping effort more doable is getting hardware in the hands of clinicians so that they can actually do this therapy.

DIFEDE: When we started this 12, 15 years ago, it was very expensive back then. The virtual reality headset that we used cost $25,000.

RIZZO: So what we have here is a commercial product that's just come out and it's been driven by the game industry. So $300 for this head-mounted display is really a groundbreaking effort so that plugged into a laptop with this headset, you're good to go. It's really the future of how we're going to be able to get virtual reality out of the lab and into the wild.

KEANE: This work may apply very effectively to war veterans. But it has a much broader set of implications, implications that may help us with disasters, Newtown, West Texas, disasters of all kinds. All of these areas leave behind a sense of death and destruction, and there is a need for people to master the material associated with it. And this technology can help us in this way.


RIZZO: We've got 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.

PHILLIPS: Yes, I still have sleep issues. I still have migraines. I still have nights or weeks at a time where I can go without sleeping. Those situations where I've lost some people over there that I don't talk about now, I don't talk about. But you're 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'm macho. I can take care of myself.

PHILLIPS: There is a stigma for seeking help medically for I would say anything. But if it's something physical, people can understand it. 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 it's kind of a tactical necessity. You don't want to send somebody back into combat who's got post-traumatic stress disorder any more than you want to send somebody with a pulled hamstring back on the football field.

RIZZO: That's a big problem. In some regards we still have a culture in the military that admitting you need help is like admitting weakness. So we're trying in the military to get past that, with the idea that it's OK to ask for help. It's going to be a generational shift. I think the military is really putting a serious effort into normalizing the act of asking for help.

DIFEDE: And, not surprisingly, this is a younger generation. When given the choice, many soldiers and marines would say that they 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: You know, we get to see real change. We get to see people that are initially, you know, bound up and tight and almost afraid to even go into a virtual world to confront the process of challenging memories. And then over a few sessions, we start to see them come out of that a little bit. And that's really uplifting.

DIFEDE: The good news is there are short-term interventions that are effective for the treatment of PTSD.

FITZGERALD: Of course, the things were looping in my mind on a daily basis. You know, you wake up and I just can't go to sleep because I start thinking about stuff. But it's been better every day.

LAWRENCE: What would you say to people who are having such a hard time coping emotionally?

KEANE: Well, it does take time. And it takes I think an active effort to reconcile this. It's why we recommend that people talk with others, trusted friends, to help oneself put all of this in perspective. It's not easy to get a rational perspective on what happened because these were all very irrational acts, frankly.

RIZZO: The three that passed away, and that's horrific as it is, but there were a lot of lives that were saved. So you have to feel good about the good things, about being able to move on, and that they can move on, and hopefully they will heal.

BUCHANAN: We will heal. We will not forget. We will unite. And we will be stronger.

GUPTA: In Boston, in Newtown, or in the hometowns of thousands of veterans who return from war every year, being stronger means seeking help. And by helping to erase the stigma of therapy, Skip Rizzo is saving lives. And that's what earns him a spot on THE NEXT LIST.

I'm Dr. Sanjay Gupta. Hope to see you back here next Saturday.