Stress Resilience in Virtual Environments (STRIVE)
Project Leader: John Galen Buckwalter
A New Path to Allostasis
It is universally accepted that post-traumatic stress disorder (PTSD) resulting from OEF/OIF poses an unprecedented healthcare challenge to the US. Understandably, initial efforts to address PTSD targeted treatment. The Institute for Creative Technologies (ICT) at the University of Southern California (a U.S. Army UARC) played a pivotal role in systematizing a novel method of administering exposure therapy, the most effective treatment for PTSD. Under the direction of Dr. Skip Rizzo, highly controlled yet emotionally evocative scenarios were developed in virtual reality (VR) allowing trained therapists to immerse the participant in scenes in which the therapist controls even minute details. This gives the therapist an unparalleled ability to expose the user only to environments the therapist deems the user capable of confronting and processing in a therapeutic fashion. Treatment success has been observed in open clinical trials and large controlled trials (RCTs) are underway.
The success of this treatment system led Dr. Rizzo, in conjunction with his long-term collaborator Dr. Galen Buckwalter, to explore the efficacy of VR-based immersion in preparing users for the psychological challenges of combat before combat deployment. This effort is based on two scientific principles; 1) pre-exposure to traumatic events within a safe environment provides some degree of protection for those exposed to subsequent trauma (Latent Inhibition); and 2) resilience, or the rate and effectiveness with which someone returns to normal after stress (a process termed allostasis), can be strengthened through systematic training. To provide training consistent with these principles, STRIVE has developed six VR scenarios with advanced gaming development software, cinematically designed lighting and sound and narrative that maximizes character development and emotional engagement as well as clinical appropriateness. Each scenario consists of a combat segment with a pivotal trauma, an event frequently reported to be the emotional source of PTSD ruminations such as witnessing the death of a child, or the loss of a comrade. A virtual human mentor then delivers a resilience training segment within the traumatic context. Note our openness to address the emotions surrounding death, an overt decision to allow for the use this technique in developing a suicide resilience program should the current technique to prove effective. The resilience training techniques used in STRIVE are directly developed from the dimensions of resilience identified in the Headington Institute Resilience Inventory (HIRI), the first multi-dimensional assessment of resilience. Current training focuses on Adaptability, Emotional Regulation, Behavioral Regulation, CBT Appraisal methods, Social Support, Empathy, Hardiness and Meaning in Work. These factors are used to guide curriculum given their effective summary of current theorization of resilience.
The effectiveness of these scenarios will be tested in a study to be conducted at Camp Pendleton in mid 2013. Given that resilience contains many trait components it is not appropriate to test the clinical effectiveness of STRIVE during a short-term study. Rather, we explore the effectiveness of STRIVE with a battery of psychophysiological measures obtained during exposure to STRIVE. Using EKG, EEG, GSR and respiration we will compare psychophysiological responses during high stress epochs with baseline, and with segments involving relaxation administered by the mentor. We hypothesize elevated stress markers during simulated stress and reduced stress markers (below baseline) during mentor administered resilience training. In an additional scientific component of STRIVE we are conducting one of the largest studies to date to validate the definition that resilience is equivalent to a more rapid return to allostasis. Without an efficient return to allostasis, physiologically-specific residuals remain, termed allostatic load, interfering with long-term functioning of the specific system. Given this circular pattern of causality between acute and long-term effects of stress, by assessing several physiological systems prior to stress induction we hypothesize an ability to accurately predict the effectiveness of acute stress response and resolution, solely from physiological residuals of stress, i.e., allostatic load. Such predictive ability would allow for fully individualized resilience training programs and combat placements.