You walk through a crowded marketplace in Iraq and pass a colorful fruit stand and a butcher selling meat. Cars are parked along the street. You hear a call to prayer and, suddenly, the people vanish. You look around and realize you are now alone, the street eerily quiet. A moment later, a bomb goes off.
In reality, you are in an office with a virtual reality headset over your eyes, and a trained psychologist who sits beside you has triggered the simulated explosion — which you feel vibrate — as part of virtual reality exposure therapy to help you recover from post-traumatic stress disorder (PTSD).
The office of JoAnn Difede, Ph.D., serves as a virtual reality lab where active-duty military and veterans of the wars in Iraq and Afghanistan, as well as 9/11 first responders and survivors, can put on a headset and be transported back to the desert, a marketplace in Iraq, or to the Twin Towers. Dr. Difede, director of the Program for Anxiety and Traumatic Stress Studies at NewYork-Presbyterian and Weill Cornell Medicine, has spent the last 20 years trying to ease the pain of people who have PTSD, whose traumatic memories manifest as nightmares, causing flashbacks, irritability, difficulty sleeping, hypervigilance, and more.
“They may startle easily to loud noises,” says Dr. Difede, who is also an attending psychologist at NewYork-Presbyterian/Weill Cornell Medical Center and a professor of psychology in psychiatry at Weill Cornell Medicine. “People who have been through trauma may tell you they can’t sit with their back to the door — they are just tense all the time. It interferes with relationships, school, and work.”
Dr. Difede, a pioneer in virtual reality exposure therapy, immerses people in detailed scenarios based on their experiences to help them face and move past their trauma. To date, she and her team have treated hundreds of patients at NewYork-Presbyterian and Weill Cornell Medicine.
“The idea is that by going over and over it again as it if it were happening, your brain learns that it actually happened in the past, and that you’re safe now. Your brain is learning, ‘Oh, this is in the past. I can file it away now in the memory drawer,’” says Dr. Difede. “By going over the trauma, the person can gain a sense of control over it. We’re helping them walk through a horrifically difficult situation to help them find a way out.”
While some patients with PTSD can lessen their symptoms by recounting their trauma to a trained psychologist (prolonged exposure therapy), others may be too numb to fully engage with the memory, which holds them back from healing. This is where virtual reality and all the sensory details from memories come in, says Dr. Difede.
“Humans don’t live by the word alone,” says Dr. Difede. “We’re not just verbal creatures, which is the way psychotherapy’s typically done. In the virtual environment, you can use sensory stimuli to help emotionally engage the person.”
Inside Dr. Difede’s office, patients put on the mounted headset and can see the computer-generated environment. Using toggles, like in a video game, they maneuver through the environment — walking through the marketplace or a mountain terrain, or driving a convoy through the desert, hearing and feeling the truck rumbling beneath them. While doing so, the patient describes the traumatic experience to Dr. Difede (or a trained psychologist on her team) sitting nearby. Dr. Difede, who can see the virtual images on a computer screen, manipulates details to make them more specific to the individual. For example, if the person was alone at the time of the traumatic event, Dr. Difede can remove the other characters from the environment. She can summon a sandstorm or create an explosion (the patient feels the vibration) or introduce the sound of shooting. Or in the barracks, she can set off an “incoming” alert. She might even incorporate smells, like Iraqi spices, into the treatment.