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Healing the Invisible Wounds of War

Reliving War's Horrors

WASHINGTON, Sept. 25, 2008 — The aroma of roasted lamb rubbed with saffron wafts from a bazaar that begins to empty as the sun sinks between a pair of minarets. A soldier walks past a veiled woman, her eyes peering through a thin slit in an ink-black headscarf. The call to prayer beckons from a lone mosque in the parched, desert town.

Graffiti on a nearby wall catches the soldier's eye and he moves closer, recognizing the mustached face of Saddam Hussein. The iconic image is what remains after a cardboard stencil was dusted with a cloud of red spray paint and peeled off the sandstone.

Just then the undulating notes of the prayer call are shattered by far-off shouting: "Get out of my country you imperialist American!" The soldier cranes his neck and traces the gruff voice to a rooftop. He finds the silhouette of a man shouldering a rocket-propelled grenade launcher and senses the weapon's crosshairs on his camouflaged body.

Army Col. Michael J. Roy, who oversees the 'Virtual Iraq' exposure therapy at Walter Reed Army Medical Center, conducts a demonstration of a life-like simulator that represents a new form of PTSD treatment with Army Sgt. Lenearo Ashford, Technical Services Branch, Uniformed Services University, on Sept. 16, 2008, in Washington, D.C. Defense Dept. photo by John J. Kruzel

Thousands of miles from Iraq, this war scene unfolds in a windowless room in the psychiatric wing of Walter Reed Army Medical Center. In the corner sit three computers, one with cords linking it to a pair of goggles, a set of stereo headphones, and machines that generate motion and scent. Using this equipment, doctors are morphing the hellish memories of troops afflicted with post-traumatic stress disorder into an interactive experience called "Virtual Iraq."

A study released in April found that nearly 20 percent of Iraq and Afghanistan veterans report PTSD symptoms, which cover a range of emotional and behavioral changes aimed at blunting the effects of trauma. Now some medical experts believe troops can learn to release the grip of their demons by confronting them face-to-face through this cutting-edge form of exposure therapy.

"You feel like you're going to die: Your heart's beating out of your chest, your blood pressure's going up and you want to just get away from it all," Army Col. Michael J. Roy, a medical internist and director of Military Internal Medicine who oversees Virtual Iraq, said of the treatment. "But you can make it through it. And you realize you're going to be OK."

The traditional form of PTSD treatment is known as "imaginal" therapy. In an average session, patients may be asked to close their eyes and provide a first-person account of their traumatic recollection as thoroughly as memory allows: what they saw, smelled, and heard. But instincts often bar subjects from willingly revisiting these terrifying moments in vivid detail.

"It works well for those who can do that, but one of the cardinal features of PTSD is avoiding the trauma," Roy said. "So you're asking somebody who wants to avoid any reminder, 'Tell me everything you can about what happened.'

"If you can do that, great -- there's a good chance you're going to be cured. But are you going to be able to do it? Are you going to put up with it and keep coming back? A lot of people don't."

Though it's still in the early test phases, Roy and a team of therapists at Walter Reed hope to show the medical community that virtual reality exposure therapy can be more effective than its
classic counterpart.

So what is the starkest contrast between the methodologies of imaginal therapy and Virtual Iraq?

"We're deliberately creating some anxiety," Roy said. "To once again witness a battle buddy getting shot, or smell the residue of a roadside bomb dredges up memories more quickly and in greater detail than merely talking.

"You really do need to create some degree of stress or anxiety for this approach to work," Roy said. "It basically helps to remind the subject of what they felt, and then they remember all kinds of elements that were either suppressed or hard for them
to describe."

Virtual Iraq works somewhat like a backhoe, pulling buried memories to the surface by their roots. But the therapy is far from an instrument of penetrating force. On the contrary, one of the computers acts as a physiological feedback loop, safeguarding against experiences that are too emotionally high-charged.

From the back of this machine runs cables that stick to the patient, monitoring blood pressure, heart rate, and levels of perspiration and respiration. The virtual landscape builds piecemeal,

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