Virtual Reality Exposure Therapy for Combat-Related PTSD

War is one of the most challenging environments that a human can experience. The cognitive, emotional, and physical demands of a combat environment place enormous stress on even the best-prepared military personnel. The OEF-OIF (Operation Enduring Freedom-Operation Iraqi Freedom) combat theatre, with its ubiquitous battlefronts, ambiguous enemy identification, and repeated extended deployments, was anticipated to produce significant numbers of military personnel with post-traumatic stress disorder (PTSD) and other mental disorders. Recent studies are now confirming this expectation. Among the many approaches that have been used to treat PTSD, exposure therapy appears to have the best-documented therapeutic efficacy. Such treatment typically involves the graded and repeated imaginal reliving of the traumatic event within the therapeutic setting and is believed to provide a low-threat context in which the patient can begin to therapeutically process trauma-relevant emotions as well as decondition the learning cycle of the disorder via a habituation/extinction process. While the efficacy of imaginal exposure has been established in multiple studies with diverse trauma populations, many patients are unwilling or unable to effectively visualize the traumatic event. To address this problem, researchers have recently turned to the use of virtual reality (VR) to deliver exposure therapy by immersing patients in simulations of trauma-relevant environments that allow for precise control of stimulus conditions. This chapter presents an overview of PTSD exposure therapy, a description of VR, and the rationale for how this technology has been applied as a tool to deliver exposure therapy along with a brief review of current research. We then provide a description of the current Virtual Iraq exposure therapy system and treatment protocol and present initial results from an open clinical trial with active duty military personnel and a brief case study. The chapter concludes with a summary of future directions in which VR technology can be further applied to more comprehensively address a range of PTSD-relevant issues.