Video Game Therapy for Veterans

Supriya Venkatesan, Veteran

Supriya Venkatesan, Veteran

When veterans return home from war they are left with physical and mental scars that hinder life significantly. PTSD and TBI are a string of letters that need no introduction in the acronym overdose of military jargon – and these have unfortunately creeped into civilian speak because of the large scale of these issues. And sadly suicide, amputees, flashbacks are words that have become all too common in our post 9/11 world. Every day 20 veterans take their life and 28% of veterans are diagnosed with clinical distress according to an Air Force study conducted in 2010.

There is a plethora of treatment out there for these issues but one of these is highly unconventional—video games. Most members of the military will attest to their love of video games while in the military and out, perhaps that is why this familiar format is easy to grasp for treatment.

“There’s no limit to the potential use of games as a therapeutic tool,” says Major Erik Johnson, Chief of Occupational Therapy for the Burn Center at the U.S. Army Institute of Surgical Research. He also happens to be the Chief Medical Office for Operation Supply Drop, a non-profit that supplies video games to soldiers. Operation Supply Drop has raised more than $8 million in donations, which have served over 30,000+ veterans and active duty military worldwide to outfit hospitals with consoles and shipped games to active-duty members in the military.

The game consoles and games themselves are used for a wide range of treatments that improve range of motion and balance, even if the patient has suffered a brain injury. Johnson finds the Wii especially helpful for patients with physical disabilities because it helps with dexterity, cardiovascular health, creating stronger connections in the brain and depression.

"If you have an amputee who’s trying to learn how to stand and he’s working on balance, he’s going to have an easier time if he’s engaged in some kind of fun activity. His mind won’t be on the balancing action so much as playing the game,” comments Johnson. Often veterans play the video games without even realizing they have engaged in therapy. For instance, a veteran can be bowling on the Wii and for him or her it’s just about playing a sport. But for a therapist, they see that the patient is working on balance, on weight shifting, on standing tolerance and endurance.

And it’s not just millennial veterans of the Nintendo generation that experience benefits from playing the games. Vietnam veterans are often surprised when first propositioned with the idea but begin to enjoy it immensely once they begin playing. Its a lot more fun than going on the stationary bike or going outside in the cold weather, and playing video games is often a novelty experience for them. Maj. Johnson says, “Perhaps the biggest benefit I’ve observed, however, is that when we engage patients in this type of therapy it significantly boosts their emotional state. And anything we can do to provide them positive emotional feedback is a huge deal for us.”

Dr. Michael Valdovinos, an Air Force veteran and clinical leader in the field of virtual reality exposure therapy (VRET) has provided relief to thousands of veterans who suffer from PTSD. VRET is the same as the classic exposure therapy where the idea is to have a patient repeat the mental and emotional experience of the traumatic event while in talk-therapy. The idea is that with enough exposure the patient would learn how to manage the memories. But now with technology, the imagination can lend way to immersive experiences. Dr. Valdovinos doesn’t think this form of treatment is for everyone though because it can be escapist for some. “When people come back from war, it’s hard to turn off that mechanism,” he says. “We have a very cognitive and behavioral response to gaming, so it can create this reality where you don’t have to address the underlying emotional things that happen when you suffer a trauma. That’s a problem.” However video games have been effective for many.

Bryant Chambers a former platoon leader that deployed to Iraq in 2003 discusses the value of video games on his YouTube channel.  He talks about emotional numbness and the feeling of listlessness upon coming home. He believes video games are beneficial not because they resemble war but because they provide challenging tasks in a group setting. He says, “Video games use a lot of the same operant conditioning that soldiers see. Obviously, soldiers are doing it for real, but with the stimulants and the response that's happening on screen, [the avatar] still behaves very much like a real live human being when they get hit.”

Skip Rizzo, a psychologist at the University of Southern California's Institute for Creative Technologies in Los Angeles, is another leader in the gaming space who has created customized virtual reality games for veterans with titles like "Virtual Iraq" and "Virtual Afghanistan," that have been adapted from first person shooter games and released on the Xbox. Patients playing the games underwent functional magnetic resonance imaging (fMRI) where changes in their brain were tracked and the research showed that patients had less active amygdala, the region of the brain responsible for emotional reactions. Simultaneously, they had more activity in the frontal lobe, the region of the brain responsible for executive function and emotional control.

Rizzo’s group is also researching how virtual reality systems can be used as a preventive measure by being utilized prior to deployment. Additionally, they are launching a project for victims of military sexual trauma. "We're not creating digital rapes," Rizzo said. Instead, the team is creating scenarios where the victim is able to relive feelings of being trapped or losing control.

Stephen Cotta was another veteran who had untreated PTSD symptoms for years and decided to try the virtual reality program at the University of Central Florida. He said the experience was “both harrowing and life-changing.” For years the memories of a grenade hitting his best friend’s truck and killing him festered in his psyche. He had been standing just a few yards away on that fateful day and the experience left a permanent mark that shook him with every unconscious and conscious remembrance. Cotta recalls his first few virtual reality sessions, “I’d be crying and shaking. I got pretty close to walking away.”

The scene that was stimulated had all the details of the bombings. “You’d be able to visually see the landscape while holding a rifle. And they have this little machine that blows out smells of truck exhaust and burning flesh. It completely envelops you.” But after multiple sessions, Cotta was able to handle each simulation a little easier and by the end of his treatment he was able to be completely calm. By having the repeated exposure he was able to develop tools to control his anxiety and emotions. “The end game is that it teaches you that it’s something that’s not going away,” Cotta says. “So what the virtual reality does is it helps you to go back there and cope with it.” Mission accomplished.