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Virtual Reality to the Rescue at Hadassah University Medical Center for Victims of Post-Traumatic Stress


Dr. Amal Bishara, left, Director of Hadassah's Arab Bone Marrow Registry Outreach Project, and Dr. Shoshana Israel, head of Hadassah's Tissue Typing Unit

With an expertise in diagnosing and treating Post-Traumatic Stress Disorder (PTSD), the Hadassah University Medical Center is now combining the results of its research with the latest cyberspace technology to help victims of bus bombings who are suffering from PTSD.

Israeli therapists are using a virtual reality therapy program entitled "BusWorld," which gradually presents a realistic simulation of a bus bombing in Israel. "The effective way to release their stress is to have people tell their story," explains Dr. Sara Freedman of Hadassah's Cognitive Behavioral Therapy Center, "but some people with PTSD simply can't or don't. It can be difficult to get people to come in and relive their nightmare, but when they do, BusWorld facilitates the process of dealing with the trauma, especially where conventional interventional therapy has not been effective."

Although it resembles a sophisticated computer game, Dr. Freedman cautions that BusWorld is a potent tool that must be introduced and directed by a trained therapist. During conventional PTSD therapy, patients retell the story of the traumatic experience in the first person and the present tense. In virtual reality therapy, patients follow the same protocol, but tell their story while they are inside a computer-generated virtual world, which replicates the trauma experience. Before PTSD patients actually don the special goggles through which they view the trauma reminders, they meet with their therapist to prepare them for the experience.

The therapy brings patients right into the environment of the event, where the patient is cautiously encouraged to recount what happened next. As treatment progresses, the therapist decides which of BusWorld's 12 levels of difficulty is most appropriate--going from just seeing a bus stop to watching the bus explode, with the accompanying sounds of screams and sirens.

At each stage, the patient must retell the experience for an entire 60 minutes. Sometimes patients only manage to tell their story twice; sometimes they repeat it 20 times.

During the years of the Intifada, when Hadassah's beds were filled with victims of terror, the Medical Center became a world leader in diagnosing and treating PTSD patients. Due to its expertise, Hadassah was asked to help the survivors of the tsunami in Sri Lanka and people traumatized by the World Trade Center bombings in the United States.

It was during those years that Prof. Arieh Shalev, then head of the Department of Psychiatry, and his team of researchers identified genetic markers for PTSD, which can be detected with a simple blood test. This discovery enables psychiatrists to predict which victims will develop PTSD and to provide immediate therapeutic intervention--the most effective method of reducing or eliminating the manifestations of PTSD.

Psychiatric Services published some of the results of Hadassah's more recent research, which evaluated current interventional and follow-up procedures for PTSD victims, identified weak spots in the system, and recommended how treatment could be improved. (See "Barriers to Receiving Early Care for PTSD: Results From the Jerusalem Trauma Outreach and Prevention Study," in the July 2011 issue of Psychiatric Services.")

The Archives of General Psychiatry will be publishing a follow-up paper on "The Prevention of PTSD by Early Treatment," which discusses the findings of the second part of Hadassah's study.

Date: 9/13/2011


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