Skip to main content

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

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.

References

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

  2. 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 

  3. 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 

  4. 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 

  5. 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.

  6. 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 

  7. 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 

  8. 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 

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

    Google Scholar 

  10. 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 

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

    Google Scholar 

  12. 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 

  13. 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.

  14. 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 

  15. 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.

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

    Google Scholar 

  17. 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 

  18. 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 

  19. 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 

  20. 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 

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

    Google Scholar 

  22. 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 

  23. 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 

  24. 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 

  25. 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 

  26. 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 

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

  28. 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 

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

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

  31. 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

Affiliations

Authors

Corresponding author

Correspondence to Barbara Olasov Rothbaum.

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

  • PTSD
  • Vietnam
  • virtual reality
  • exposure therapy