Scientists at the USC Institute for Creative Technologies are converting content from a game designed to teach soldiers about leadership and tactics into a therapy tool to treat Post-Traumatic Stress Disorder in soldiers returning from war in Iraq.

The project is headed by ICT Research Scientists Albert "Skip" Rizzo and Jarrell Pair and is funded by the Office of Naval Research.

The virtual-reality PTSD assessment and treatment system has adapted assets from virtual scenarios originally developed for the game Full Spectrum Warrior (Xbox), in combination with newly created next-generation graphic content developed at the ICT.

The first prototype from this effort is now in place with collaborators at Camp Pendleton and at the San Diego Naval Hospital, who will use it to treat PTSD in Iraq War veterans with symptoms ranging from flashbacks to depression.

The project is part of a three-year clinical trial that partners USC with Virtually Better, the Atlanta-based group that had previously developed the Virtual Vietnam PTSD application in 1997. Plans are also in place to have a version of the application set up in Iraq to solicit feedback on its features from actual soldiers on the ground via a partnership with Ft. Lewis Army psychologists Col. Greg Gahm and Capt. Greg Reger.

"We're taking something that was already developed at USC and retooling it for a different purpose," said Rizzo, also a research assistant professor in the USC Leonard Davis School of Gerontology. "It just makes sense to see the application go full circle like this."

The commercially successful Full Spectrum Warrior is a combat simulator developed in conjunction with personnel from the Army's Infantry School at Ft. Benning, Ga. The game, billed as "the authentic Army experience," puts the player in an urban fighting environment.

The new project will adapt and add to those virtual environments, transform them into combat areas in the Middle East and, under the watchful eye of a trained psychologist, gradually expose the soldiers to stimuli that resemble the traumatic events that created their disorder.

The most efficacious approach to treating anxiety disorders such as PTSD has been cognitive behavioral therapy, Rizzo said, where the patient is gradually exposed to what he or she fears. This is the classic approach used to treat common anxiety disorders such as fear of heights, fear of flying or fear of public speaking.

But post-traumatic stress disorder is both more complicated and more generalized.

"With PTSD, you have a more intense anxiety response based on traumatic events that are typically outside the sphere of normal human experience," he said.

The challenge comes in exposing the soldiers to stimuli that bring them back to a traumatic event – such as seeing someone getting shot or shooting someone – while not traumatizing them all over again.

One way to address this challenge is to gradually expose the patient to stimuli that resemble the traumatizing event, but within the safety of a supportive clinical setting. In this project, the clinician will have control over every aspect of the virtual-reality environment, changing scenarios, sounds, weather and the intensity of the experience.

One goal of the treatment will be to create an emotional response in the patient that he or she can then work through with the therapist in a supportive environment.

"Our aim here is not to re-traumatize people, but rather to re-expose them to relevant traumatic events in a graduated way that they can handle." Rizzo said.

"You want to help people manage their emotional responses in a way that makes them more functional in their day-to-day lives and relationships.

"For example, when a car backfires, you want to help a patient get to the point where he doesn't have a flashback of a gun going off, " Rizzo said.

This is not the first time patients have been immersed in a virtual environment to help them cope with traumatic events. The approach was first used in 1997, to treat Vietnam veterans with PTSD and later to treat survivors – such as firefighters – of the 2001 World Trade Center attacks. VR is also being tested as a treatment for PTSD in survivors of terrorist bus bombings in Israel.

The difference may be the highly advanced technology now being used.

Because of the groundwork laid by the USC developers of Full Spectrum Warrior, Iraq War vets will be stepping into a virtual world that took millions of dollars to create. Due to the urgent need for such innovative PTSD treatment tools – and since the ICT scientists were able to recycle many of these assets – the prototype version currently at Camp Pendleton will be the first of its kind to be tested with returning soldiers from the Iraq War. The testing will occur in collaboration with Brenda Wiederhold from the Virtual Reality Medical Center.

Eventually, Rizzo said, he envisions a scenario in which every returning soldier, sailor, airman and Marine is screened for PTSD using this new tool.

"It's a nice merger between game development, computer graphics, psychology and all of the engineering technology that goes into creating virtual environments," Rizzo said.

"Our goal," he said, "is to help military personnel begin to manage the difficult emotions that are sometimes the byproduct of combat-related experiences. And with recent reports coming out suggesting Vietnam-levels of PTSD in returning Iraq War soldiers, we are working on this project with great urgency.”

The ICT partnered with the U.S. Army in 1999 to create virtual reality tools that would train troops to be better leaders and decision makers in the field. In November 2004, the Army extended its previous contract by five years and awarded ICT $100 million – the largest research contract ever received by USC.

The union has proven to be a successful one, with ICT standing squarely at the intersection of the U.S. military's desire for more sophisticated training tools and the multibillion gaming industry's desire for more realistic combat scenarios.

Rizzo presented the project March 16 at a conference, “Wounds of War Rehabilitation: Strategies for Recovery,” sponsored by the Dept. of Veterans Affairs.