Frontline Psych with Doc Bender: Studying Prolonged Exposure Therapy

 Doc Bender on top of the Ziggurat of Ur in Southern Iraq, in February 2009. (Photo: DCOE)

Doc Bender on top of the Ziggurat of Ur in Southern Iraq, in February 2009. (Photo: DCOE)

Dr. James Bender recently returned from Iraq after spending 12 months as the brigade psychologist for the 4-1 CAV out of Ft Hood. He served for four and a half years in the Army. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad and many spots in between. He writes a monthly post for the DCoE Blog on mental health issues related to deployment and being in the military.

In a post for DoD Live last month, I covered resilience and actions you can take to enhance your psychological fitness. This month I’m covering how technology is being used to help treat service members who have a psychological health issue.

If you’ve spent a bit of time reading the DCoE Blog or our website, you’ve heard of post traumatic stress disorder (PTSD). This anxiety disorder occurs in some people who have experienced an intense trauma, like combat. PTSD can be very debilitating and can last many years.

Prolonged Exposure therapy is a treatment for PTSD that has proved very successful in the past few years. The idea is to expose the patient to what originally caused the trauma in a controlled way where the patient is in charge of the situation. For example, say a soldier becomes very nervous when he hears gunfire because it reminds him of a sniper attack he experienced in Iraq. Part of treating him with Prolonged Exposure therapy would be exposing him to gunfire in a safe, controlled way, such as going to the rifle range and listening to the “pop” sound the rounds make.

When conducting Prolonged Exposure therapy, it is important that the exposure is both realistic and controlled. It can be difficult to accomplish this when the original trauma happened in Iraq or Afghanistan — are you going to send the soldier back to Iraq, into an ambush, just to treat his PTSD? This isn’t very practical, not to mention the complete lack of control in that situation.

Technological advances may offer a solution to the above challenge. DCoE’s National Center for Telehealth and Technology is conducting a study about Virtual Reality Exposure Therapy, VRET. In it, the warrior wears a virtual reality mask and looks into a computer-generated scene that appears very similar to an actual combat event. The scene can be controlled to match the terrain and situation that is causing the trauma. Even details like weather, time of day, and number of bystanders can be controlled.

By making the simulation more real and controllable, the service member is in a much better position to process and understand the traumatic experience. Heart rate, respiration, and other physiological functions associated with stress can also be monitored. This is a great way to measure the patient’s progress; as he becomes less stressed by the scenario, heart rate, breathing and sweating will decrease.

If you’re interested in the latest treatments for our warriors, definitely check out DCoE’s upcoming June newsletter. The issue will highlight some cutting-edge medical technology that will be used to treat service members at the National Intrepid Center of Excellence. Check out our recent post on the Computer Assisted Rehabilitation Environment (CAREN), which will be used at the center.

Thank you for your service. Stay safe, and please feel free to share your questions and thoughts with me below in comments.

This post was shared with us by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE). The DCoE Blog features information on psychological health and traumatic brain injury issues as well as personal stories and reflections from people within the military community on these topics.

  • Chandra Lloyd

    I’m glad that there are steps being taken to help those with PTSD, although it mentions that prolonged exposure has been successful, it makes me wonder how effective this treatment really is. I would like to see more information and statistics done on the effectiveness of this treatment. Question: would troops really want to go through with this treatment and relive these horrible situations?

  • Matthew Hickman

    Prolonged Exposure therapy has been used to help people overcome their fears for years. People that are afraid of snakes would be exposed to them in a safe controlled way. In the author’s example, breaking the link between the sound of gunfire and a sniper attack is critical. The virtual reality therapy is interesting, but I would guess it would be less effective than prolonged exposure.

  • Joshua Smith

    Realistic training prior to the deployment has also proven extremely effective. The Marine Corps goes to great length to effectively recreate realistic combat situations by using everything from Afghan role players to real amputees simulating casualties.

  • http://www.treuemax.com treuemax

    Realistic training prior to the deployment has also proven extremely effective. The Marine Corps goes to great length to effectively recreate realistic combat situations by using everything from Afghan role players to real amputees simulating casualties.

  • John Ohab

    Here is Dr. Bender’s response to Chandra’s question above:

    Different studies may give different statistics, but there is overwhelming evidence for prolonged exposure’s effectiveness.

    Prolonged exposure, like treatment for any illness or disorder, relies on the patient complying with treatment. Treatment for mental disorders relies on patient compliance more than most other treatments. Prolonged exposure, by design, is uncomfortable. There are some people who drop out or don’t comply with treatment. I don’t know of any hard numbers about the number of people who drop out of treatment, but based on my experience, it is an issue.

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