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New York --- A tormented veteran returns to a Baghdad battle. A woman deathly afraid of air travel buckles in for a bumpy flight. A World Trade Center survivor relives a chaotic escape through smoke and falling bodies.
These real-life scenes are being reborn inside virtual worlds as therapists and researchers harness the latest computer and video game technology to help patients face their fears and achieve peace of mind.
Virtual reality --- simulated three-dimensional environments typically experienced with gogglelike video screens and earphones --- has been used to treat phobias and post-traumatic stress for about a decade.
While the technique is still in an early stage, it is gaining more recognition as an effective treatment, receiving government research funding and making a mainstream splash by helping terrorism victims and soldiers back from Iraq.
"If you overcome a fear in the virtual world, it translates to the real world," said Ken Graap, president and chief executive of Virtually Better, an Atlanta company that builds and markets virtual reality systems for mental health care.
The small firm has more than 60 clients worldwide using simulations to treat fears of heights, public speaking, storms and flying.
Examples of the technology will be on display at the American Psychiatric Association's annual meeting in Atlanta, which runs today through Thursday.
Virtual reality was touted in the 1980s as a way to revolutionize interaction between people and computers. It placed people into all-encompassing computer-generated worlds. Moving one's head in any direction changed the view, and special gloves could manipulate virtual objects.
A handful of virtual reality games appeared at arcades, but the immature technology was considered too expensive and cumbersome, and eventually faded from public view.
But virtual reality never went away entirely. It became a staple of military training. Medical applications now include helping stroke victims recover mobility and training doctors, who operate on simulated patients before real ones. Overcoming fears
Therapists are using virtual reality to gradually expose patients to their fears while helping them talk about their experiences and cope with them. It is an extension of more traditional therapies in which patients are encouraged to imagine and describe their fears or visit real-world locations that inspire anxiety.
"It would be best to get on a real plane and fly, but that's not really feasible to take yourself and maybe a therapist along," Graap said. Instead, he said, "you can fly on a virtual plane."
Virtual reality also allows therapists to turn off an experience, repeat it or change it to control the level of anxiety while making sure patients feel safe. An initial virtual flight might be calm, while a later one could be turbulent.
"There's no mistaking it for the real thing, although people do report similar feelings," said Robert Reiner, a psychologist and executive director of the Behavioral Associates group in New York. Virtual reality sessions there cost from $75 to $450, slightly more than traditional therapies.
Some therapists remain skeptical of virtual reality, but many practitioners report success rates of about 90 percent.
"We were flat-out curing people," Reiner said. "At some point, if you're treating a phobia and you're not using VR, it's going to be malpractice."
Virtual reality researchers also are looking at treating victims of terrorism, fearful drivers, children with learning disabilities, people with eating disorders and addicts who may learn to resist temptation in virtual bars and crack houses.
Virtually Better sells its equipment --- computers, head-mounted displays with headphones and a vibrating platform to simulate movement --- for up to $7,000. It licenses the software for $400 a month.
Some of its virtual environments mix computer graphics with real-world video.
To introduce smells, a powerful trigger for memories, the company is working with Atlanta-based Envirodine Studios, Graap said.
Using scents is part of one of Virtually Better's latest projects, a partnership with the University of Southern California to create a "virtual Iraq" for returning soldiers with post-traumatic stress disorder, a source of nightmares, flashbacks and other symptoms.
The project is funded by the Office of Naval Research and is being tested in San Diego with Iraq veterans, who are helping to make the program more realistic. It should be ready for a clinical trial this summer, said Albert Rizzo, a research scientist with USC's Institute for Creative Technologies.
The simulations include patrolling an Iraqi city on foot, riding in a Humvee or flying in a helicopter. Therapists can insert changes such as an ambush, the sounds of distant explosions or a sandstorm.
Soldiers navigate the program using a video game control pad, and much of the imagery comes from the Xbox video game "Full Spectrum Warrior," which itself was based on an Army training program.
"You've got a gaming generation of soldiers," Rizzo said. No more 'touchy-feely'
Since traumatized troops often seek to avoid reminders of experiences, virtual reality therapy can work where traditional therapies fail, he said. Soldiers wary of "touchy-feely" talk therapy may prefer the virtual reality alternative.
"VR can meet needs in ways that just can't be done otherwise," Rizzo said. "This is an opportunity for psychology and therapy to advance into the 21st century."
The Iraq project builds on the work of Virtually Better's earlier "Virtual Vietnam" program, which is used at veterans medical centers in Atlanta, Boston and other cities.
Virtually Better, founded in 1996, was built on the research of Barbara Rothbaum, director of the Trauma and Anxiety Recovery Program at the Emory University School of Medicine, and Larry Hodges, formerly with Georgia Tech and now chair of the computer science department at the University of North Carolina at Charlotte.
Some of their earliest work involved helping people afraid of heights through simulations like standing on a balcony or in a rising glass elevator.
Virtually Better recently began work on a program that simulates what it was like to be inside one of the twin towers on Sept. 11, 2001, Graap said. It will help survivors of the terror attack come to terms with memories of their escape.
Therapists have used other virtual therapy programs to treat people troubled by the attacks, including firefighters.
Copyright 2005 The Atlanta Journal-Constitution
