Virtual Reality Environments for Returning Combat Veteran Social Anxiety and PTSD: Rapid Prototyping Methodologies for Intervention

Background and Purpose:  Previous research has found that combat veterans struggle with maladaptive patterns of social functioning, Social Anxiety Disorder and PTSD. Virtual Reality Exposure Therapy (VRET) has previously been used to enhance the in vivo exposure process and address vivid traumatic memories by immersion into a computer-generated combat scenario. VRET exposure to non-combat scenarios like grocery stores, college campuses, and other high-stress social situations to address social anxiety and PTSD has not been explored. Furthermore, there is a dearth in literature of established standards for developing effective VR environments for interventions.

 

Methods: This ancillary study is a mixed method nested study within a larger virtual reality study to develop interventions for social avoidance due to PTSD in returning combat veterans.  Post 9/11 active duty veterans meeting criteria for social anxiety disorder on a large university campus were recruited (N= 14) to provide qualitative feedback and quantitative biodata during exposure to a social situation: a crowded grocery store. Utilizing a Systems Development Life Cycle, including Planning, Analysis, Design, and Implementation, the study utilized a protocol for a rapid prototyping stage of 360^ovideo to collect early data from test subjects to define feature-sets of a second interactive version.  During 360^ovideo exposure (n= 6) and exposure to a virtual grocery store (n= 7), phenomenological qualitative data about personal experience with the environment were recorded.  Bio-feedback was collected using a Bio Radio Wireless Physiology Monitor. 

Results:  Veterans reported significant increases in anxiety levels within the virtual environment.  Early analysis of biometrics showed a mean increase of 25.3% in Galvanic Skin Response (GSR) and 6.3% in heart rate (HR), compared to baseline, during face-to-face interviews, and a corresponding 22.7% increase in GSR and 10.8% increase in HR during VR immersion sessions.

Furthermore, phenomenological themes emerged from rapid prototyping process.  Density of crowds in aisles, proximity to others, noises (e.g., baby crying), suspicious activity and people, and lack of a specific mission were reported as anxiety producing themes within the store.  Self-reported anxiety scores increased during both 360^ovideo and VR during exposure, indicating a potential for replication of in vivo experience.  Presence scores indicate a moderate to strong sense of presence within the VR space.

 

Implications: Scientific literature acknowledges VR as a promising therapy tool; however, the real-life applications are still limited, and potential benefits remain unexplored. Physiological measurements as well as self-reports of test subjects and researcher observations validate the initial hypothesis that immersion to VR environments causes an emotional response similar to real-life situations. Proving the effectiveness of VRET using real-time biometrics in PTSD treatment opens the gateways to a variety of applications that involve human psychology and physiology.   Finally, the development of personalized VR-based therapy protocols, combined with real-time emotional and physiological response monitoring, paves the way towards personalized mindfulness training by helping active military or veterans maintain a moment-by-moment awareness of their thoughts, emotions, bodily sensations, and surrounding environment.