Virtual Reality for Veterans

Introduction

On VR Voyaging, we typically focus on VR as entertainment or as an interactive gateway to exploring cultural heritage. In this post, I decided to take a look at yet another way that VR can be used in a non-gaming context. As my wife works at a Veterans Administration facility (USA healthcare for veterans), I became aware of ways they have used virtual reality for veterans suffering from post-traumatic stress disorder (PTSD) and other trauma, along with opportunities for therapy and relaxation.

Most people know of PTSD (Post Traumatic Stress Disorder) as a mental health condition that can develop after experiencing or witnessing a traumatic event, such as combat, sexual assault, natural disaster, or terrorism (it’s not limited to veterans specifically). PTSD can cause symptoms such as flashbacks, nightmares, anxiety, depression, anger, guilt, and avoidance of reminders of the trauma. PTSD can interfere with daily functioning and quality of life for veterans and their families. These effects are often thought of as either inescapable, requiring drugs to cope, or at least lots of mental health therapy.

VR therapy for PTSD

One of the most effective treatments for PTSD is exposure therapy, which involves gradually confronting the traumatic memories in a safe and controlled environment. Exposure therapy helps individuals reduce their fear and distress associated with the trauma and learn to cope with their emotions, however it can often be too challenging or uncomfortable for many people.

VR works differently from traditional exposure therapy in that it can be used to create realistic and user-specific scenarios that resemble the original traumatic events. VR therapy allows people to face their fears in a virtual world, while being guided by a therapist who monitors their physiological and psychological responses. VR therapy can provide several advantages over traditional exposure therapy, such as:

Increased sense of presence and immersion in the virtual environment
Enhanced control and flexibility over the intensity and duration of the exposure
Reduced stigma and embarrassment associated with disclosing traumatic details
Increased motivation and engagement in the treatment
Reduced cost and accessibility barriers

Several studies have shown that VR therapy is effective in reducing PTSD symptoms and improving functioning and well-being for veterans. For example, a randomized controlled trial conducted by the Veterans Administration (VA) found that VR therapy was superior to imaginal exposure therapy (where veterans verbally describe their trauma rather than confronting it directly) in reducing PTSD severity and improving quality of life for Iraq and Afghanistan war veterans. Another study found that VR therapy was equally effective as prolonged exposure therapy (a gold-standard treatment for PTSD) in reducing PTSD symptoms and improving functioning for Vietnam war veterans.

VR relaxation for veterans

Besides exposure therapy, VR can also be used for relaxation and stress management for veterans. The variety of custom soothing and calming environments can help veterans cope with negative emotions, such as anger, sadness, or anxiety. VR can also provide positive experiences that can enhance veterans’ mood, self-esteem, and well-being.

Stress can have negative effects on their physical and mental health, such as high blood pressure, heart disease, diabetes, depression or substance abuse. Relaxation sessions in VR can help veterans reduce their stress levels, improve their mood, increase their mindfulness skills, and promote their mental health. A study by the VA found that VR relaxation was effective in reducing pain intensity and unpleasantness for chronic pain patients.

Some examples of VR relaxation applications for veterans are:

Guided meditation: VR can provide guided meditation sessions that combine relaxing visuals, sounds, and instructions to help veterans focus on their breathing, body sensations, and thoughts.
Nature scenes: VR can transport veterans to natural settings, such as forests, beaches, mountains, or gardens, where they can enjoy the beauty and tranquility of nature.
Music therapy: VR can offer music therapy sessions that use music to elicit positive emotions, memories, and associations for veterans.
Biofeedback: VR can provide biofeedback training that uses sensors to measure veterans’ physiological signals, such as heart rate, skin conductance, or brain activity. The signals are then displayed in the virtual environment as visual or auditory feedback that helps veterans learn to regulate their stress response.

Opportunities for VR at the VA

The VA is a leader in using VR for veteran health care and has helped over 1,000 veterans already. The VA has established the VHA Innovation Ecosystem Extended Reality Network (VHA IE XR Network), which is a network of over 1,700 engaged staff including clinicians, researchers, innovators, and industry partners who collaborate to advance the use of VR for veteran care. The VHA IE XR Network provides resources such as funding, training, equipment, evaluation tools, best practices guidelines, and technical support to facilitate the implementation of VR projects across the VA system. Over 160 VA facilities are involved in this effort.

A woman wearing a VR headset and holding two controllers is being assisted by a man — *photo credit: US Veterans Administration*

A woman holds a VR headset in place on a man's head — *photo credit: US Veterans Administration*

Current VR projects target physical and occupational therapy, recreational therapy, PTSD, anxiety, loneliness, isolation, depression, and much more. Specific programs include:

Bravemind: A VR exposure therapy system developed by the University of Southern California Institute for Creative Technologies that treats PTSD for combat veterans.
STRIVE: Stress Resilience in Virtual Environments is a pre-deployment VR system for training emotional coping skills and assessing chronic and acute stress responses.
VR for Pain and Anxiety Management: Utilizes distraction to improve outcomes with pain and anxiety management, promote relaxation, and make health care experiences more positive.

VR for socialization

Another benefit of VR for veterans is that it can allow them to socialize easier with other people who share similar experiences or interests. Social isolation and loneliness are common problems among veterans, especially those who have PTSD or other mental health issues. Social isolation can worsen their symptoms and increase their risk of negative outcomes.

VR can provide a platform for veterans to connect with others in a virtual space, where they can chat, play games, watch movies or attend events together. VR can also create a sense of community and belonging among veterans who may feel alienated or misunderstood in the real world. While there aren’t any veteran-specific VR social networks yet, Meta Horizon Worlds and other similar products can be used to facilitate social interactions between veterans.

Summary

Virtual Reality is much more than just games and virtual travel for fun. Being able to explore scenarios and locations in a safe way can provide critical opportunities for combat veterans to face and process situations that cause them pain. Research and established programs are already taking advantage of this using virtual reality for veterans’ care. If you or someone you know is a veteran who could take advantage of any of these programs, be sure to inquire at your nearest VA hospital or clinic, visit the VA Immersive site, or contact vaimmersive@va.gov.

Acknowledgements

VR Voyaging would like to thank the VA and specifically Dr. Anne Bailey of the Office of Healthcare Innovation and Learning for their assistance in putting together this article. No final review was done by the VA, and all errors or omissions are our own.