How Virtual Reality Declared War On PTSD

Virtual reality has experienced a major renaissance in the last few years, thanks in large part to Oculus’s hugely successful Kickstarter back in 2012. Yet as the world-at-large froths at the mouth about VR’s potential for gaming and entertainment, one group are quietly developing ground-breaking virtual reality programs to treat a myriad of difficult psychological conditions.

Enter Albert “Skip” Rizzo, a clinical psychologist, Director of Medical Virtual Reality and owner of one of the coolest job titles you never knew existed until now. His goal in life is to drag the field of psychology, “kickin’ and screamin’ into the 21st Century.” Even before new technology saved virtual reality from the unfortunate pigeonhole of being ‘just a gimmick’, Skip was convinced of its ability to improve the way that multiple conditions — PTSD first and foremost amongst them — were treated.

He first encountered the idea of using games to rehabilitate patients in the 1990s, working in a brain injury rehab centre. After finding that one patient was more engaged and stimulated by his new GameBoy than by any of the prescribed treatments, Skip wasted no time in installing a then-new game called SimCity for his patients. While millions of children worldwide enjoyed building (and destroying) their little Sim towns, Skip discovered an astoundingly useful training device for cognitive rehab, cunningly packaged as a game.

In the early 1990s virtual reality was experiencing its first hype cycle. Skip was just one of many who were ready to jump on that emerging technology. After seeing all the good that games like SimCity were doing for his patients, he could only imagine how effective fully immersive virtual reality could be as a treatment. Yet in 1995, when he began to work with computer scientists to develop a prototype, virtual reality took a sudden nosedive into its proverbial ‘nuclear winter’. Developers realised that contemporary technology just wasn’t advanced enough to facilitate true virtual reality to the standard they required. Research and development halted.

Luckily, VR is back. Skip’s current VR research institute in LA is an unholy amalgam of academics, the military and Hollywood. The first provided the ideas, the second the funding and the third the visual effects and technology to make it all come tigether. With the available technology and funding finally on his side, Skip and his team have been able to develop multiple projects that each use VR technology for psychological treatment in a different way.


Bravemind is an immersive, interactive military simulation that’s designed to deliver exposure therapy for military servicemen with PTSD. Exposure therapy is a traditional, evidence-based treatment where sufferers of anxiety, phobias or PTSD (which constitutes the higher end of the anxiety spectrum) are slowly exposed to their fears or anxiety triggers. This is one of the most obvious uses for VR as psychological treatment, as immersive virtual environments are the perfect way for therapists to expose their patients to their fears in a slow, safe and controlled manner. And as realistic as the technology can be these days, research even suggests that VR doesn’t run the common risk of retraumatising people with PTSD.

Bravemind began its life as a total conversion of the 2004 war game ‘Full Spectrum Warrior’. This was initially used as a prototype to test the potential of the technology. Its next step saw the system travelling to the battlefield in Iraq in order to test it with currently serving soldiers, making sure that even the smallest details were accurate to reality.

The way it is used today, Bravemind presents an immersive situation that is tailored as closely as possible to match the patient’s past trauma. It includes 14 different levels, each with a number of sound and visual effects that are controlled by the attending clinician. This way when the PTSD sufferer begins the ‘game’ they can be slowly eased into the scene — beginning with just a smattering of gunfire, for example, and slowly building toward introducing more confronting sights.

The good news? Research says it works. In a test of the experimental treatment, psychologists chose 20 PTSD sufferers who had previously been unsuccessful in treating their condition through other means. From the test group, 16 showed significant improvement after treatment, with only four being unsuccessful. “Going through it in the game is better than going through it in my head at night, in quiet times,” says one patient who underwent the treatment via Bravemind.

Skip has found that VR treatment is successful where other traditional methods fail, largely because of its interactive format. This is especially relevant when dealing with members of the digital generations — more and more of whom are now returning from warzones with PTSD. For them, these gamelike treatments minimise stigma and maximise engagement.

Many sufferers simply refuse to engage with exposure therapy in traditional ways. These often involve techniques like guided meditation, where the patient is led through the process of visualising their trauma. With the added military funding his institute is now receiving, Skip hopes they can eventually develop this technology for civilian applications as well — treating other sufferers of PTSD like firefighters, first responders and even victims of sexual trauma.

Virtual Humans

Skip’s “virtual human” technology seems a little offbeat compared to traditional exposure therapy, but when it comes down to it, it’s still a variation on the same theme. Two of the technologies he demonstrated were the VITA (Vocational Interview Training Agents), and SimCoach, another tool developed for military service people and their families.


Meet Maria soft-touch. She’s a virtual human who was designed to guide high functioning people with autism through the sometimes challenging process of a job interview. These are people who have been trained with all the necessary skills for the jobs they are applying for, but are let down when it comes to face-to-face interaction. VITA lets them practice for what can be a confronting and difficult experience — without having to face a real person at all.

Soft-touch is the lowest ‘difficulty setting’, or so to speak. Users of the software can choose between a soft-touch interviewer, a neutral character, or what Skip describes as a “real son of B stress interviewer” — otherwise known as the ‘hostile’ option. The users are also given a choice of interviewers — featuring both men and women in a range of ages — and can pick from a number of different backgrounds where a real life interview would potentially be held.


Ah, SimCoach. William Ford — AKA Bill — is a military veteran with a comforting Southern twang. He’s here to listen. He’s also a virtual human, “which means I’m based on the real experiences and personalities of actual war fighters and their families,” says Bill in his own words, introducing himself to the users of SimCoach.

While PTSD is a huge problem for soldiers who have served in active warzones, the nature of the military culture means that there is a heavy stigma against speaking out about it. SimCoach is a service that lets these issues be explored in a safe and anonymous manner, with the sometimes comforting knowledge that the person they may be baring their soul to is not actually real. While it is more of a ‘toe in the water’ than a final solution, it still lets servicepeople and their families begin to explore a painful issue. And as Bill says: “if you don’t dress a wound it gets worse, dunn’it?”

Virtual reality’s immersion, realism and interactivity make it an ideal platform for psychological treatment, but above all else it is safe. VR can provide a controllable, secure environment for patients to confront their past traumas, with the knowledge that nothing in that virtually constructed world can hurt them. While most tech-heads are excited about what new developments in VR can do for gaming and visual experiences, Skip’s introduction of this tech to the medical sphere is even more ground-breaking and — for some — life changing.

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