“Is there blood and guts, as well?” one of the four psych clinicians asks during the virtual-reality demo, as a simulated explosion on an Iraqi street wreathes his convoy in dust and flames.
“We’ve got blood and guts,” confirms Albert “Skip” Rizzo, swiveling his head around, a graying ponytail yo-yoing behind him. “It’s something we try not to use. But we have it.”
The VR images on Rizzo’s proprietary headsets aren’t meant for the Call of Duty crowd. Rizzo runs Bravemind, an academia-Pentagon venture that makes VR hardware and software for veterans of Iraq and Afghanistan. “It’s about confronting your past and moving past it,” says the 62-year-old, motorcycle-riding, Uggs-wearing Ph.D. “A medical VR version of prolonged exposure therapy.”
Rizzo’s subjects are soldiers whom traditional therapy has failed. About 1 in 5 of the 2.7 million veterans of Operations Iraqi Freedom and Enduring Freedom remain psychologically scarred by roadside bombs, surprise attacks, the guilt of taking a life or failing to save one. It’s a group plagued by post-traumatic stress disorder (PTSD), often hidden because it still carries a stigma in the military’s macho culture. VR is becoming a lifeline for some of the veterans struggling to readjust to civilian life.
Bravemind uses computer-generated imagery accompanied by realistic sensory stimuli—sounds, vibrations, even smells provided by a machine loaded with vials of scents—to approximate the circumstances of a veteran’s traumatic memories. The software’s 14 environments, ranging from remote Afghan villages to crowded Baghdad markets, include attackers, bombs, and innocent bystanders. They’re “filled with so much stimuli that it’s difficult to avoid engagement,” Rizzo says, and the exposure helps force patients to confront and deal with their trauma. Clinicians can tweak the intensity of a scene by toggling details like smoke, fire, and violence.
Unlike those in some high-end VR, the scenes aren’t quite photorealistic. That’s by design: The software is lifelike enough to force patients to relive and come to terms with troubling moments, but it retains enough of a video game-style look to protect them from further trauma. “Your mind fills in the details for you,” says Chris Merkle, a former Marine and Bravemind patient. “Think about the worst day of your life. Every time you describe it, it normalizes it.”
Merkle spent 14 years overseas on seven tours and says he’d go back today if he hadn’t aged out of service. Once home, he was angry, explosive, eventually desperate. His Department of Veterans Affairs therapist suggested he apply for the Bravemind program. “It’s almost like a confessional,” says Merkle, now working in mental health outreach at the VA while studying to become a therapist. “I got it off my chest, and now I can work on it.”
Bravemind’s synthesis of clinical psychology and VR dates to the early days of the Iraq War in 2003. At the University of Southern California, Rizzo had built a fledgling VR lab to treat brain injuries and attention-deficit hyperactivity disorder, and he pitched the PTSD applications to USC’s Institute for Creative Technologies. The institute, funded by the U.S. Army Research Laboratory, is home to Light Stage, a setup used to create the visual effects for Avatar.
The government committed about $5 million to initial development, with which Rizzo’s team finished a prototype in 2007. They built a second model in 2013, around the time Oculus VR LLC founder Palmer Luckey interned at Bravemind. (He duct-taped an early Oculus Rift together there.) About 100 U.S. military facilities now use Bravemind’s equipment, making it one of the widest-ranging programs in the nascent field of VR health care, used to treat thousands of vets. “We teach them coping skills,” says Rizzo.
The process isn’t easy, says Todd Adamson, Bravemind’s lead therapist at the Long Beach, Calif., VA. “You have to build rapport and trust fast, because we get into exposure in Session 3,” he says. “Those first two meetings, I’ve got to do my best to connect with this person. I have to be real and honest.”
A typical course of treatment runs for 10 weekly sessions, with a follow-up three months later. A more intense version runs twice a week for five weeks. Either way, the results suggest that participants’ stress symptoms, including depression, decrease by as much as 80 percent. In cases where it doesn’t work, veterans are referred back to conventional therapy.
The Pentagon has committed $12 million to a six-year clinical study comparing Bravemind’s effectiveness with other treatments, a key hurdle to wider adoption. The Canadian military recently bought a handful of Bravemind systems with Canada-customized software for about $400,000, and Rizzo says he’s in talks with the Danish military to buy the U.S.-standard systems for about $5,000 each.
Bravemind has found favor among tech companies, too. In December, Advanced Micro Devices, Dell, Valve Corp., and Intel paid to donate 10 sets of Rizzo’s gear to 10 VAs in need. That kind of help may cushion the USC lab if it’s targeted by the Trump administration, which has signaled plans to slash federal science research. Rizzo says he’s pursuing other sponsorships.
He’s also interested in trying to broaden the medical uses of VR, which some hospitals are testing to help patients manage pain. Bravemind’s model is also being used to treat military victims of sexual trauma, and Rizzo has experimented with fear reduction for phobias and therapies for addiction, autism, Parkinson’s, and more. “There’s something about immersion that matters,” he says.
The bottom line: Bravemind’s veteran-focused VR hardware and software are used at more than 100 military bases, hospitals, and other sites.
(Updated 10th paragraph to correct spelling of Adamson's name.)