Treating PTSD with VR tech

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JoAnn Difede’s groundbreaking treatment of 9/11 first responders


  • In her pioneering research into the use of virtual reality technology in PTSD treatment, JoAnn Difede has worked with 9/11 first responders and veterans of the wars in Iraq and Afghanistan. Photo: John Abbott

JoAnn Difede’s office looks like many others on the sprawling medical campuses of the Upper East Side, but within the walls of her workplace patients are transported from their ordinary surroundings to virtual worlds as part of an innovative protocol for treating post-traumatic stress disorder.

Difede, a professor of psychology in psychiatry at Weill Cornell Medicine and attending psychologist at NewYork-Presbyterian Hospital, began studying PTSD as a doctoral student at a time when the disorder was not yet a household concept and treatments had not yet been developed.

Difede would go on to conduct research into a PTSD treatment protocol known as behavioral exposure therapy for burn patients. In the course of the research, the September 11 terrorist attacks took place. Difede soon sought to apply exposure therapy in combination with virtual reality simulations in treating disaster workers who were at Ground Zero.

“It sounds dramatic, but given the number of people that were in Lower Manhattan, I was aware that there would literally be thousands and thousands of people who would have post-traumatic stress symptoms, yet we had no treatment that was considered effective,” Difede said.

For individuals who were at the World Trade Center on September 11, 2001, a range of stimuli associated with the events, from tall buildings to airplanes to blue skies, could prompt PTSD symptoms. To those suffering from the disorder, Difede said, “It’s like it’s happening again and you’re there. I’m talking to you and all of a sudden I see, in my mind’s eye, a plane crashing into the World Trade Center. That’s distracting, upsetting and intrusive. And what it is is a fragment of a memory that hasn’t been stored in the file drawer that says ‘the past, it’s over.’”

Difede’s study on virtual reality treatment of World Trade Center survivors, which proved successful, was one of the very first to research the use of the technology to reduce PTSD symptoms. In virtual reality treatment sessions, patients put on headsets and find themselves immersed in computer-generated scenarios designed to help them engage emotionally with their memories. The software developed for World Trade Center scenario places the viewer at ground-level near the towers; in subsequent research Difede has applied the treatment to veterans experiencing combat-related PTSD.

By re-engaging with their trauma in a safe environment, patients eventually learn to reassess cues that became associated with danger, such as tall buildings. “The idea is that if you’re numb and avoidant, you’re pushing what’s fearful away and that sort of bypasses the brain’s sense of agency,” she said. “All of those images are popping around in your mind anyhow, and this helps a person gain mastery over it, a sense of control.”

Difede continued, “It helps them process all of that, so that their brain goes, ‘Oh, this is actually a memory that happened years ago. It’s not happening now.’”

Difede, who serves as director of the Program for Anxiety and Traumatic Stress Studies, a joint Weill Cornell Medicine and NewYork-Presbyterian program, said that advances in technology in recent years — as virtual reality has become a burgeoning multibillion-dollar industry used in education, entertainment and gaming — have lowered barriers to those who could benefit from the mental health applications or virtual reality.

The rig used to treat World Trade Center first responders requires a $25,000 head-mounted display weighing 10 pounds. Today, a smart phone can be placed in a widely available plastic headset to create a portable treatment device for a fraction of the cost, opening an avenue for PTSD treatment to be widely disseminated in community clinics.

“We can now offer the treatment in a way that’s much more easily accessible to many people,” Difede said.

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