Virtual reality as therapeutic modality
Interview with Francesco Strand Franchi
Virtual reality is one of the recent treatment modalities in the work with traumatized persons. The Danish Veteran Center is one institution that has experiences with this approach.
When did the Veteran Center start using virtual reality?
At the Danish Veteran Center, we participated about 5 years ago in a conference where the US experiences with virtual reality in the work with traumatized veterans were presented. We saw various steering systems that could develop into different scenarios. We decided on a system named “BraveMind” which offered virtual representation of a wide range of experiences from the Afghan and Iraq wars describing characteristic high-risk situations e.g. terrain driving, fly-overs, bombings and battle.
Could you describe in practice how it works?
The person in question is provided with virtual reality glasses and joystick that will allow him so to speak to walk around in the scenario. The therapist on the other hand is in contact with the client via microphones while simultaneously being in charge of and controlling all stimuli in the scenario. The therapist is thus steering the whole process and selecting the intensity and what are the exposure the client should experience. In this way the client will reexperience the traumatic event.
The Veteran Center is already using Prolonged Exposure Therapy, but the VRET (virtual reality exposure therapy) includes various sensory modalities, apart from vision also hearing, smell, movement (e.g. by standing on a vibrating plate).
So, all in all it is a quite extensive set-up that is required.
What were your intentions when starting this at the Veteran Center?
We had a hypothesis that some of the veterans who did not benefit sufficiently from the Prolonged Exposure Therapy might benefit from Virtual Reality treatment modality. One reason being that the group – who is aged around 25-40- has a profile of being very fond of gadgets and may feel more inclined to this virtual reality approach.
So, you started on a small scale?
Yes, we began with a pilot study including 10 clients suffering from military PTSD. Nine of the group completed the therapy that comprised about 10 sessions each lasting 1½ hour. The project was led by the psychologist Nikolai Roitmann and researcher Sofie Folke. I joined the project after Roitmann left his position at the Danish Veteran Center.
Subsequently we carried out qualitative interviews with the veterans included in the pilot phase focusing on their experiences.
What was the outcome of the pilot study?
We are right now finalizing a paper about the results, but the overall result was that the outcome of VRET and treatment as usual were fairly similar. The clients who completed the VRET experienced a significant relief of their symptoms both at the end of the sessions as well as in a 3 month follow up. So, our conclusion is that using virtual reality therapy is both acceptable, safe and possible seen from the client perspective.
Having said that from the perspective of the therapists this treatment is extremely demanding. It requires technical expertise in handling all the equipment simultaneously with having a therapeutic interaction with the client. Furthermore, it requires a great deal of work to adjust the virtual scenario to the individual traumatic experiences of the client. Finally, the equipment is only available in one setting in Denmark.
So our conclusion is that presently it is too demanding a set-up to be used routinely in the treatment. To be included routinely in the treatment offered ongoing training, technical and professional maintenance are required. We have not quite found a foothold and are not there yet.
Presently we prioritize the more established treatment methods in the psychotherapeutic trauma treatment.