1. Controlled Studies: PTSD AuthorYear # of Pts EquipmentResults Rothbaum200116 V6 Head-Mounted Display CAPS scores at 6 month follow-up showed reduction in PTSD symptoms Tarnanas200150 VPL Eye Phone 1, MR toolkit, vibrations plate Less negative thoughts toward earthquake scenarios Difede20021 Head Mounted Display 90% reduction in PTSD symptoms after VR exposure therapy Univ. Of Buffalo 20034 UB Simulator Preliminary results are promising Wiederhold20038 EEG, PC computer VR environment increased performance on task Livanou200310 Earthquake simulator, shake table (9 levels of intensity) Significant improvement (8 patients improved, 2 slightly improved) Walshe200314 3D Head Mounted Display Significant post-treatment reductions on all measures

2. PTSD Environments Virtual Earthquake Virtual Vietnam Virtual World Trade Center Driving

3. (David G. Walshe et al., 2003)  Subject Population:  14 participants who met DSM-IV criteria for specific phobia, situational type-driving or PTSD with driving phobia.  Environment:  Game Reality Environment  Midtown Madness II  Rally Championship  London Racer  Virtual Reality Driving Environment  Apparatus:  VFX-3D Head Mounted Display PTSD due to MVA

4. Walshe et al…  Method:  7 of 14 were immersed in one of driving simulations  These 7 patients went through CBT exposure program  Graded driving simulation tasks with physiological feedback Results:  Results:  - Significant reduction in Travel Distress, Travel Avoidance, and Maladaptive driving strategies.  - 92% felt sense of Presence  Conclusion:  - Virtual Reality and Game Reality may serve as a tool in treating post-accident driving phobia. PTSD due to MVA

5. Driving Study: 14 participants (Walshe, Lewis, Kim, O’Sullivan, & Wiederhold, 2003)  VGVR  VR PTSD due to MVA

6. Conclusion PTSD due to MVA  50% of the participants felt task specific anxiety and immersion caused by the combination of VR and GR tasks  7 subjects were treated; SUDs decreased throughout the treatment  Subjects’ performance in the simulation translated well into real- life driving with a decrease in anxiety  The overall decrease in heart rate at the end of the experiment signifies that “habituation on a psychological level was matched with physiological habituation”  While the experiment did not focus on the accident experiences of the victims, it did manage to decrease PTSD measures

7. Vietnam War Veterans Two environments:  Open Field  Huey Helicopter  34% decrease on clinician-rated PTSD  45% decrease on self-rated PTSD  Treatment gains maintained at 6-month follow-up

8. World Trade Center PTSD (Difede & Hoffman) Environment:  11 Graded Levels of Exposure  1 st Stage: Normal day in NYC with view of WTC towers  Final Stage: Entire re-enactment of 9/11 Results: Participant showed decrease in SUDs rating over time 83% decrease in depression levels 90% reduction PTSD symptoms Patient no longer met criteria for PTSD

10. World Trade Center Video Clip

12. “Combat experiences reported by members of the U.S. Army and Marine Corps after deployment to Iraq or Afghanistan” Taken from: New England Journal of Medicine

13. ONR Funded Project  Develop VR worlds for non-combatants  Test VR worlds for treating PTSD in non-combatants  VR will be created with off-the-shelf videogame engine  Received funding letter on Thursday (last week)  Conducting focus groups with military personnel at Camp Pendelton, Balboa Naval Hospital, and San Diego VA Hospital

14. Stress Inoculation Training

15. Simulator Adjunct Training

17. Village  Game Description:  Features:  First Person shooter Game  Game Mode: ~ With Enemies - Task: eliminate all enemies in the village ~ Without Enemies - Task: navigate through the village  Iraqi Village includes: ~ Buildings

18. D-cycloserine shows improvement compared to placebo in level of fear within the VR environment. (Ressler, Rothbaum et al., 2004) N = 30 acrophobics, 2 weekly in virtuo exposure sessions (35 to 45 minutes) 2 doses of DCS (50 / 500). From B. Rothbaum 3 Month Post-Pre Acrophobia Anxiety Questionnaire -60 -50 -40 -30 -20 -10 0 placeboDCS F(19,1)=4.36, p=.05

19. Indexed in: - MedLine - PsychInfo - Excerpta Medica - Social Sciences Citations Published by: American Psychological Association

20. Recently Indexed in PsycINFO Introducing the Journal of CyberTherapy and Rehabilitation

21. Publications Coming in 2006: Virtual Healers

22. Carl Jung Joseph Wolpe Sigmund Freud VR & videogames are tools. They do not take the place of good clinical skills or clinical judgment…

24. A few other interesting outcome studies…

25. Acrophobia (Rothbaum et al., 1995 / Hodges et al., 1995) Received VR treatment Did not receive treatment MeasureBaseline(N=12) After 8 weeks (N=10) Baseline (N=8) After 8 weeks (N=7) AcrophobiaQuest.70.920.37062.9 Attitude Toward Height 39.51835.539.4

26. Acrophobia (Kooper et al., 1994) Note : N= 20, 17 completers

27. Acrophobia (Emmelkamp et al., 2002) N=33 MANOVA : Time effect : p <.001; group and interactions were ns. Same with ANCOVAs. No changes between post and f-up.

28. Arachnophobia (Garcia-Palacios et al., 2002) N = 23

29. Arachnophobia (Bouchard et al. 2003) N = 11 Created with 3D game editor All p <.01

30. Aviophobia (Rothbaum et al., 2000, 2002) Note: N = 45, 24 at the 12-month follow-up.All p significant for the Time affects. Interactions ns.