Tailored Immersion: Implementing Personalized Components Into Virtual Reality for Veterans With Post-Traumatic Stress Disorder

Abstract

With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment. The objectives of this article are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence. Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion. Believability of the neutral virtual environment was important for maintaining the veterans’ presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events. Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.

Case report: the addition of olfaction to virtual reality enhanced exposure therapy for PTSD

“…As with most VR enhanced therapies, the content of the VR scenarios was similar to the narrative of the patients but does not correspond exactly. Although it has been suggested that individualized VR scenarios are important (see (Van Veelen et al, 2021), both very realistic although generic scenarios (Skip et al, 2010) as well as abstract scenarios (Botella et al, 2015) have been found to be effective and at the theory underlying exposure based treatment for PTSD places importance on the ability of the patient to emotionally process the traumatic memory (Foa and Kozak, 1986) and employs techniques to enhance this, for instance asking the patient to retell the narrative using first person, present tense. Since this process can be challenging for patients, methods to enhance prolonged exposure have been examined (e.g., (Flanagan et al, 2018).…”

“…It has been suggested that adding odors that are related to the traumatic event will improve treatment outcomes, and this has been carried out both in hypnotherapy (Abramowitz and Lichtenberg, 2010) as well as in the context of Virtual Reality enhanced Exposure Therapy (Van Veelen et al, 2021;Lo and Hurley, 2022), This case study describes the treatment of combat related PTSD using VR enhanced exposure therapy with the addition of olfaction.…”