June is Post-Traumatic Stress Disorder (PTSD) Awareness Month and Emory Healthcare Veterans Program would like to share how it uses Prolonged Exposure therapy and Virtual Reality Exposure therapy to heal invisible wounds. Our highly skilled team of professionals is led by world-renowned Emory clinical psychologist Barbara Rothbaum, Ph.D., who has been working in the PTSD field since 1986 and pioneered Virtual Reality Exposure therapy as a treatment for PTSD in veterans and service members. In exposure therapy, we help people confront reminders of the traumatic event, but in a therapeutic manner so that their distress decreases.
Prolonged Exposure Therapy
There are many approaches to treating PTSD, and after several decades of research, our program has determined Prolonged Exposure therapy to be the most successful in healing invisible wounds. This process treats PTSD by asking the patient to recall the memory repeatedly, and in a therapeutic manner, so that he/she will feel more comfortable with the memory and gain a sense of mastery over the experience, rather than experiencing anxiety and avoidance. Avoidance is a common behavior for those suffering from PTSD, and although facing the memory head-on appears intimidating, revisiting the wound is the only way to heal it.
“This form of treatment is successful because the trauma needs to be emotionally processed so it can become less painful. The process is similar to the grief process. When a loved one dies, it is extremely distressing, but by expressing that hurt (say, through crying), it gradually becomes less upsetting. Eventually, we can think about that person without crying, although the loss will always be sad. Those with PTSD devote much effort to avoiding thinking about the trauma because they mistakenly view the process of remembering as too agonizing to tolerate,” said Dr. Rothbaum.
Virtual Reality Exposure Therapy
Sometimes recalling the memory is difficult because it has been locked away for so long. Virtual Reality Exposure therapy is an extension of Prolonged Exposure therapy, which immerses the patient in a virtual world that is reminiscent of his or her traumatic memory. As the patient describes the memory to the therapist, the therapist is able to recreate scenes of the memory, complete with smells, vibrations, and landscapes.
“VR is a tool that helps to extend what we already do effectively, which is exposure therapy for PTSD and anxiety disorders. It helps to resolve some of the barriers we can sometimes encounter, like if a person is unable to connect fully with their traumatic memory, we can use VR to help strengthen that connection,” said Dr. Liza Zwiebach, a clinical psychologist with Emory Healthcare Veterans Program.
Dr. Rothbaum first used Virtual Reality Exposure therapy to help people overcome their fear of heights, then in helping her patients gain control over their fear of flying in airplanes. This innovative process proved just as effective as the standard practice of using an actual airport and airplane in treatment. In follow-ups months after therapy ended, 93 percent of treated patients reported flying in real airplanes. She then used Virtual Reality Exposure therapy to treat Vietnam veterans suffering from PTSD and developed the program Braveheart, which later became the Emory Healthcare Veterans Program.
“We wanted to see if the Virtual Reality Exposure therapy would have anything to offer them—as another treatment alternative. And it did. They got better,” said Dr. Rothbaum. “They’ve reported that it didn’t bother them anymore, these experiences that have been haunting them for decades.”
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