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Virtual tour, real cure
9/11 post-traumatic stress therapy breaks ground

By Samantha Marshall
Published on December 01, 2003

Tears streamed out from under bulky virtual reality goggles as Charlice Noble-Jones recounted the day she emerged from a downtown subway station and saw a plane crash into the World Trade Center.

After conventional therapy for post-traumatic stress disorder failed to relieve the numbness she experienced following Sept. 11, three-dimensional digital re-enactments of the attack enabled the former Wall Street trader to confront her emotions.

"Virtual reality therapy helped me to deal with the demons of that day," says Ms. Noble-Jones, who has since gotten married, had a baby and moved to Georgia. "It helped me make a normal memory."

Virtual reality therapy for post-traumatic stress is the latest mental health breakthrough to come out of millions of dollars worth of research in the aftermath of Sept. 11. At New York-Presbyterian Hospital's Weill Cornell Medical Center, the therapy has proved so successful in curing some of the toughest cases that it will be used to treat several other kinds of mental health problems, including alcohol and drug addiction.

"This is really a new vista in mental health," says Dr. Joanne Difede, an assistant professor of psychiatry at Weill Cornell. Dr. Difede, a leading expert on PTSD, set up the virtual reality program with Hunter Hoffman, a psychologist who developed the software at the University of Washington. The National Institute of Mental Health and private donors backed the project with about $110,000 in grants.

The technology, which has been used for the past five years to treat phobias such as fear of heights and fear of flying, was first tested on PTSD in a clinical program launched at Weill Cornell early in 2002. The first case study, released this summer, reported a 90% reduction in symptoms of PTSD and an 83% reduction in symptoms of depression in the first six weeks of therapy. Traditional therapy takes 16 weeks to achieve a 50% reduction in symptoms.

Mental health experts who specialize in trauma say one of the lessons of Sept. 11 is that a small but significant proportion of WTC workers and volunteers--about 20%--have persistent trauma symptoms. So it's necessary to find accessible treatment alternatives for these patients over the long term.

6,500 people screened

"We are seeing persistent rates of post-traumatic emotional sequelae two-plus years out," says Dr. Craig Katz, a psychiatrist at Mount Sinai Medical Center. In his work at one of the large-scale mental health studies taking place across the city, Dr. Katz has screened close to 6,500 people who worked at Ground Zero or participated in the rescue and cleanup.

Dr. Difede is running separate projects to screen and treat firefighters and Con Edison workers who were on the scene. She has encountered several patients like Ms. Noble-Jones, who were so deeply traumatized by the terrorist attack that traditional therapy was not working. The doctor set up the groundbreaking virtual reality program to provide a second line of treatment for tough cases.

Virtual reality therapy works like traditional exposure therapy-the current standard of care for PTSD, in which patients retell the details of their trauma to their therapists, in the present tense, over and over again. By doing so, they relive the emotions of the past until those feelings no longer cause flashbacks, anxiety attacks, sleeplessness or any other debilitating symptoms.

But avoidance of reminders of trauma is a common symptom of PTSD. Some patients refuse to participate in traditional treatment or, though they profess willingness, are unable to engage their emotions or senses.

Virtual reality therapy gives them images that can open the floodgates. They wear virtual reality helmets with two miniature monitor screens inside a pair of goggles. The scenery changes as patients move their heads, effectively putting them inside a virtual space. Therapists can stop the program anytime patients feel overwhelmed.

"In the beginning I thought it was a joke, but I was in tears within two minutes," says Ms. Noble-Jones.

The high cost of the equipment and software means that not everyone will have access to the new treatment. A single virtual reality helmet costs $20,000. The software costs $12,000, and each additional detail written into the software costs $5,000.

As the technology comes down in price, which Dr. Difede estimates will take about three years, the treatment will become a more viable alternative. It's already more practical than traditional therapy, because mental health professionals can control the level of exposure within the secure surroundings of their offices. They don't have to accompany patients to the site of a trauma or the source of a phobia, as they may be required to do in traditional therapy.

Virtual reality is the first new development in PTSD treatment in recent years, but progress in research is being made across the city.

Hormone levels, kids studied

A New York Academy of Medicine study released last month documents the severity of PTSD among children who lost a parent on Sept. 11, and the impact that traumatized surviving parents have on their recovery. Researchers at Cornell are studying hormone levels in such children. At Mount Sinai Medical School, researchers are investigating how hormonal levels change in people with PTSD before and after treatment.

The new information suggests that mental health professionals need to take a more flexible, long-term approach to treatment.

"We have to ask ourselves if there is a one-size-fits-all therapy for people who have been traumatized," says Dr. Rachel Yehuda, a professor of psychiatry at Mount Sinai who has treated Holocaust survivors.

Much of the progress in virtual reality technology is expected to have broader applications. Researchers are already looking into ways the treatment can be used to help drug addicts and alcoholics. Last month, Weill Cornell launched a virtual reality therapy program to help burn victims better handle their pain during recovery.

"This is definitely a silver lining," says Dr. Difede.

Reprinted with permission from Crain's New York Business, 2003 copyright Crain Communications, Inc
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