Skip to main content

Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study

Journal of Traumatic Stress volume 12, pages 263–271 (1999)Cite this article

Abstract

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). This report presents the results of the first Vietnam combat veteran with PTSD to have been treated with VRE. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-month follow-up.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th Edition. Washington, D.C.

  • Beck, A. T., Ward, C. H., Mendelsohn, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    Google Scholar 

  • Blake, D. D., Weathers, F., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney D. S., & Keane, T. M. (1992). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 13, 187–188.

    Google Scholar 

  • Boudewyns, P. A., & Hyer, L. (1990). Physiological response to combat memories and preliminary treatment outcome in Vietnam veteran PTSD patients treated with direct therapeutic exposure, Behavior Therapy, 20, 381–391.

    Google Scholar 

  • Carlin, A. S., Hoffman, H. G., & Weghorst, S. (1996). Virtual reality and tactile augmentation in the treatment of spider phobia: A case report. Behaviour Research and Therapy, 1–8.

  • Chemtob, C. M., Novaco, R. W., Hamada, R. S., & Gross, D. M. (1997). Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65, 184–189.

    Google Scholar 

  • Cooper, N. A., & Clum, G. A. (1989). Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behavior Therapy, 20, 381–391.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders—Patient edition (SCID). Biometrics Research Dept., New York: New York State Psychiatric Institute, Biometrics Research.

    Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.

    Google Scholar 

  • Foa, E., Rothbaum, B. O., Riggs, D., & Murdock, T. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715–723.

    Google Scholar 

  • Foa, E. B., Steketee, G., & Rothbaum, B. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176.

    Google Scholar 

  • Fontana A., Rosenheck, R., & Spencer, H. (1993). The Long Journey Home III: The third progress report on the Department of Veterans Affairs specialized PTSD programs. Northeast Program Evaluation Center, Evaluation Division of the National Center for PTSD, Department of Veterans Affairs Medical Center, West Haven, Connecticut.

    Google Scholar 

  • Foy, D. W., Glynn, S. M., Friedman, M. J., Schnurr, P. P., Neilson, N., Howard, A., Schapiro, J. A., Knight, C. P., Morland, L. A., & Gusman, F. D. (1998). Trauma focus group treatment for combatrelated PTSD: Implementation data from a 10 site pilot study. Presented at the Lake George Research conference on Posttraumatic Stress Disorder. March.

  • Foy, D. W., Sipprelle R. C., Rueger, D. B., & Carroll, E. M. (1984). Etiology of posttraumatic stress disorder in Vietnam veterans: Analysis of premilitary, military, and combat exposure influences. Journal of Consulting and Clinical Psychology, 52, 79–87.

    Google Scholar 

  • Hodges, L. F., Rothbaum, B. O., Kooper, R., Opdyke, D., Meyer T., North, M., de Graff, J. J., & Williford, J. (1995). Virtual environments for exposure therapy. IEEE Computer Journal, July, 27–34.

  • Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective distress. Psychosomatic Medicine, 41, 207–218.

    Google Scholar 

  • Keane, T. M., Fairbank, J. A., Caddell, J. M., & Zimering, R. T. (1989). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245–260.

    Google Scholar 

  • Pitman, R. K., Altman, B., Greenwald, E, Longpre, R. E., Macklin, M. L., Poire, R. E., Steketee, G. S. (1991). Psychiatric complications during flooding therapy for posttraumatic stress disorder. Journal of Clinical Psychiatry, 52, 17–20.

    Google Scholar 

  • Pitman, R. K., Orr, S. P., Forgue, D. F., Altman, B., de Jong, J. B., & Herz, L. R. (1990). Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders. Journal of Abnormal Psychology, 99, 49–54.

    Google Scholar 

  • Pitman, R. K., Orr, S. P., Forgue, D. F., de Jong, J. B., & Claiborn, J. M., (1987). Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Archives of General Psychiatry, 44, 970–975.

    Google Scholar 

  • Rothbaum, B. O., & Foa, E. B. (1992). Exposure therapy for rape victims with posttraumatic stress disorder. The Behavior Therapist, 15, 219–222.

    Google Scholar 

  • Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J., & North, M. M. (1995a). Effectiveness of virtual reality graded exposure in the treatment of acrophobia. American Journal of Psychiatry, 152, 626–628.

    Google Scholar 

  • Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., & Williford, J. (1995b). Virtual reality graded exposure in the treatment of acrophobia: A case study. Behavior Therapy, 26, 547–554.

    Google Scholar 

  • Rothbaum, B. O., Hodges, L., Watson, B. A., Kessler, G. D., & Opdyke, D. (1996). Virtual reality exposure therapy in the treatment of fear of flying: A case report. Behaviour Research and Therapy, 34, 477–481.

    Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory (self-evaluation questionnaire). Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Spielberger, C. D., Jacobs, G. A., Russell, S. F., & Crane, R. (1983). Assessment of anger: The State-Trait Anger Scale. In J. N. Butcher & C. D. Spielberger (Eds.), Advances in Personality Assessment (Vol. 2). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Spielberger, C. D. (1996). State-Trait Anger Expression Inventory. STAXI Professional Manual. Psychological Assessment Resources.

  • Steer, R. A., & Beck, A. T. (1988). Beck Depression Inventory. In M. Hersen and A. S. Bellack (Eds.), Dictionarey of Behavioral Assessment Techniques. Pergamon Press: New York.

    Google Scholar 

  • Van Etten, M. L., & Taylor, S. (in press). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology & Psychotherapy.

  • Weathers, F. (1998). CAPS Clinical Cutoffs. Unpublished data.

  • Weiss, D. S., Marmar, C. R., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Hough, R. L., & Kulka, R. A. (1992). The prevalence of lifetime and partial posttraumatic stress disorder in Vietnam theater veterans. Journal of Traumatic Stress, 5, 365–376.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, 30322

    Barbara Olasov Rothbaum & Fran Shahar

  2. College of Computing, Georgia Institute of Technology, Atlanta, Georgia, 30332

    Larry Hodges, Jarrel Pair, Philip Hebert, Dave Gotz & Brian Wills

  3. Department of Psychiatry, Atlanta VAMC, Atlanta, Georgia, 30322

    Renato Alarcon, David Ready & David Baltzell

  4. Department of Psychology, Emory University, Atlanta, Georgia, 30322

    Ken Graap

Authors
  1. Barbara Olasov Rothbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry Hodges
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renato Alarcon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Ready
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fran Shahar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ken Graap
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jarrel Pair
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philip Hebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dave Gotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Brian Wills
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. David Baltzell
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Rothbaum, B.O., Hodges, L., Alarcon, R. et al. Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study. J Trauma Stress 12, 263–271 (1999). https://doi.org/10.1023/A:1024772308758

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1024772308758

  • PTSD
  • Vietnam
  • virtual reality
  • exposure therapy