A Violent Virtual Cure.(International Edition; TECHTONIC SHIFTS)(bombing simulation)

Byline: Christopher Werth

Imagine standing on an empty street corner when you hear the rumble of a bus coming around the corner. The breaks squeal as the vehicle stops in front of you. Its doors open; passengers begin to step off. A moment later, the bus explodes into flames, temporarily blinding you with light, and showering the street with shards of glass and burning shrapnel. The ground shakes. Body parts lie on the pavement around you. You hear screaming and the sound of sirens. And then you take off your headset--safe and sound in your therapist's office.

Survivors of suicide-bomber attacks in Israel are using this virtual-reality simulation as part of their treatment for post-traumatic stress disorder, or PTSD. In case after case, ongoing studies--which began in the 1990s with Vietnam veterans--show that virtual reality holds exciting potential for enhancing the use of "exposure therapy," in which patients are encouraged to actively and repeatedly engage difficult memories, or "hot spots." Although the research is not yet ready for widespread clinical use, the technology is proving to be a valuable tool. By establishing a context for patients to tell their stories and uncover suppressed details, it can help kick-start the therapeutic process.

Israel is a logical place to start. Dr. Tamar Weiss at the University of Haifa was a pioneer of virtual-reality therapy during the second intifada, when buses were common targets for suicide bombers who killed and injured thousands of Israelis and Palestinians. "Some have suggested that our whole country is walking around with subliminal PTSD," says Weiss. After the attacks on the World Trade Center, Dr. JoAnn Difede recognized the need to find effective treatment for survivors with PTSD, and only months later she had a simulation up and running at the Weill Medical College at Cornell University. "It was a pretty serious public-health problem," says Difede. The technique is also being tested in U.S. military medical centers, where many veterans of Iraq and Afghanistan have combat-related mental-health problems. It is especially important in work with soldiers who find therapy embarrassing but are less self-conscious when wearing a virtual-reality headset.

Exposure to simulation is generally meted out gradually. A veteran injured in an ambush or by a roadside bomb may suddenly find himself back at the steering wheel in a military convoy driving through Baghdad. "Sometimes we're finding it's all they can do to just sit in the Humvee," says Dr. Hunter Hoffman of the University of Washington. Cautiously, new elements are introduced. A car swerves into the oncoming lane; someone suddenly darts across the street. The culmination may be a windshield riddled with gunshots, or an explosion from a pile of debris. Survivors of September 11 may spend their first sessions simply looking up at ...