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Review
. 2017 Jan 16;8(sup5):1414560.
doi: 10.1080/20008198.2017.1414560. eCollection 2017.

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Albert 'Skip' Rizzo  1 , Russell Shilling  2
Affiliations
Review

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Albert 'Skip' Rizzo et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.

Numerosos informes indican que la incidencia del trastorno por estrés postraumático (TEPT) en el personal militar de Operación Libertad Duradera/Operación Libertad Iraquí/Operación Nuevo Amanecer (OEF/OIF/OND, por sus siglas en inglés) ha generado un reto significativo en la atención de la salud conductual. Estos hallazgos han servido para fomentar la investigación sobre cómo desarrollar y difundir mejor los tratamientos basados en la evidencia para el TEPT. El presente artículo presenta el uso de la Realidad Virtual (RV) como herramienta clínica para abordar la evaluación, la prevención y el tratamiento del TEPT, basado en los proyectos de realidad virtual que se han desarrollado en el Instituto de Tecnologías Creativas de la Universidad del Sur de California desde 2004. Una breve discusión de la definición y la justificación para el uso clínico de la RV va seguida de una descripción de una aplicación de RV diseñada para suministrar exposición prolongada (EP) para el tratamiento de miembros de servicio (MS) y veteranos con TEPT relacionado con el combate y la agresión sexual. A continuación, se presenta la expansión de las simulaciones virtuales de tratamiento de Iraq y Afganistán para la evaluación y la prevención del TEPT. Esto es seguido por una discusión prospectiva que detalla los primeros esfuerzos para desarrollar sistemas virtuales de agentes humanos que cumplen la función de pacientes virtuales para formar a la próxima generación de proveedores clínicos, como guías de atención médica que pueden utilizarse para respaldar el acceso anónimo a información de salud conductual relevante en relación al trauma, y como entrevistadores clínicos capaces de realizar un análisis del comportamiento automatizado de los usuarios para inferir el estado psicológico. El documento concluirá con una discusión sobre la realidad virtual como herramienta para eliminar las barreras a la atención médica, además de su aplicación directa en la evaluación y la intervención.

大量报道指出创伤后应激障碍（PTSD）在‘持久自由据军事行动/伊拉克自由军事行动/新曙光军事行动（OEF/OIF/OND）’的军队人员中的发生率已经给行为医疗护理带来了不容忽视的的挑战。这些发现有助于鼓励对如何更好发展和推广 PTSD 治疗进行研究。这篇文章基于南加里佛利亚大学创造性技术研究所从2004年开始 VR 项目，展示了使用虚拟现实（VR）作为临床工具来解决评估、干预和 PTSD 治疗的问题。首先是关于 VR 临床使用的定义和原理的简短讨论，然后描述VR 在延长暴露治疗（PE）的应用。这个治疗用于患有战争和性侵犯相关的 PTSD 的服务人员（SMs）和老兵。之后呈现了对这项技术扩展应用：使用虚拟治疗模拟伊拉克和阿富汗场景进行 PTSD评估和干预。这之后，有一个前瞻性的讨论详细描述了早期开发虚拟代理系统为虚拟病人服务的努力。这个系统旨在为下一代临床工作者提供训练，并可以用于可匿名获取的创伤相关行为健康护理信息的健康护理指导，同时扮演临床访谈者对使用者进行自动行为分析来推断其心理状态。在结束部分，这篇文章将讨论直接使用VR进行评估和干预以及将它作为打破获取护理帮助障碍的工具。.

Keywords: BRAVEMIND; PTSD; SimCoach; Veterans; Virtual Reality; exposure therapy; resilience; service members; virtual humans; virtual patients; • The article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of posttraumatic stress disorder (PTSD).• A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members and Veterans with combat- and sexual assault-related PTSD.• Virtual human applications relevant to PTSD are also discussed.• The clinical use of VR is discussed in a larger context, particularly regarding its capability to break down barriers to care..

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No potential conflict of interest was reported by the authors.

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