BusWorld: an analog pilot test of a virtual environment designed to treat posttraumatic stress disorder originating from a terrorist suicide bomb attack.

Exposure therapy treatment can lead to large reductions in posttraumatic stress disorder (PTSD) symptoms. Virtual reality exposure (VRE) therapy is designed to facilitate cognitive behavioral therapy for PTSD. During VRE therapy, patients go into an immersive computer-generated environment (go back to the scene of the traumatic event) to help them gain access to their memories of the traumatic event, change unhealthy thought patterns, gradually habituate to their anxiety, and reduce the intensity of associated emotions. The therapist's ability to manipulate the amount of anxiety experienced by the client during therapy is an important element of successful exposure therapy. Using a within-subjects design, 30 asymptomatic volunteers each experienced four levels of a virtual world depicting a terrorist bus bombing, designed to be increasingly distressful. There was a statistically significant difference between the mean subjective units of discomfort scores (SUDS) of the four levels, and several planned paired comparisons showed significantly higher SUDS ratings with higher simulation levels. Results suggest that sound may play an important role in successful elicitation of emotional responses during VRE. The results of this analog study provide initial validation of the potential of BusWorld to provide graded exposure for individuals suffering from PTSD originating from suicide bus bombings. Future research exploring whether VR exposure therapy with BusWorld can reduce PTSD in clinical patients is warranted.

BusWorld: designing a virtual environment for post-traumatic stress disorder in Israel: a protocol.

A number of carefully controlled studies have documented the effectiveness of traditional imaginal exposure for the treatment of post-traumatic stress disorder (PTSD). Virtual reality (VR) exposure therapy is based on a similar logic but rather than self-generating imagery, patients wear a VR helmet and go into a three-dimensional (3-D) computer generated virtual world to help them gain access to their memory of the traumatic event. Recent preliminary research has shown that some patients who fail to respond to traditional therapy benefit from virtual reality exposure therapy, presumably because VR helps the patient become emotionally engaged while recollecting/recounting/re-interpreting/emotionally processing what happened during the traumatic event. The present paper presents a brief overview of a new VR World we developed to provide virtual reality therapy for terrorist bus bombing victims in Israel, and a brief description of our research protocol and measures (for details, see www.vrpain.com).