Software

How the VA Is Using VR for Veterans’ Therapy

The Department of Veterans Affairs has embraced virtual reality technology to help veterans heal.

Carolyn Shapiro is a freelance journalist based in Burlington, Vt., with expertise in covering business and technology, health and science, consumer issues and the food industry.

At Department of Veterans Affairs medical centers, some military veterans undergo “prolonged exposure” therapy to treat post-traumatic stress disorder. In those sessions, a therapist asks them to return to the pivotal experiences that caused the trauma and talk about them.

For many veterans, it’s a struggle to conjure those events and their exact details. However, now PTSD patients at the VA facility can put on virtual reality headsets that take them to the setting where the events happened. They can see the landscape, hear the noises — all via VR software loaded into the headset — “to help them feel like they’re actually in the place,” explains Anne Lord Bailey, a pharmacist and director of clinical tech innovation at the VA. “You can hear the battle going on and you can see it before your eyes.”

The therapist, in the room on a different headset, can listen and respond to patients and even add sensory cues to the virtual scene as veterans describe them: a cluster of vehicles, an explosion, an injured comrade. As patients confront the fear and other feelings stirred up by those recollections, prolonged exposure helps them soften the sense of danger within the safety of the therapy room.

“Immersing them in this environment has really helped clinicians walk with them through that experience,” Bailey says.

Virtual reality is one of the “extended reality” tools that the VA has deployed to about 100 of its medical centers and 500 of its frontline workers for different purposes, Bailey says. Extended reality includes augmented reality, mixed reality and virtual reality technologies, all using computer-generated imagery and sound. The VA has applied the technology in those various forms to more than 20 areas of treatment for veterans.

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How Does VR for Therapy Work?

Virtual reality immerses the user in a three-dimensional, interactive environment that’s traditionally found in video gaming but increasingly has applications in healthcare, particularly in mental health treatment. Across the VA, VR is aiding treatment of veterans struggling with depression, anxiety and isolation, as well as PTSD. These immersive tools also are enhancing physical, occupational and recreational therapies.

“We’re learning a lot in this space,” Bailey says. “The thing that we have been really excited to find is that veterans of all ages, all races, all ethnicities, all categories seem to really appreciate the experience of virtual reality.”

VA staff have embraced the technology too. In a pilot program at several medical centers, clinicians don headsets for “empathy training” to better understand the experiences of those in their care, specifically veterans with dementia and older LGBTQ veterans.

“Now what you hear and what you see in front of your eyes is the same thing as a patient who’s experiencing dementia or an LGBTQ veteran who’s aging,” Bailey said.

“All of a sudden, people start talking to you and what you hear is muddled, or your vision doesn’t see what you should be seeing. It looks distorted, or I can’t hear things because they’re not clear, even though I can tell that people are talking to me. Or, I get disoriented: I try to turn to the right, and things are shifty or crooked.”

How Can VR Therapy Treat PTSD and Mental Health Issues?

The immersive aspect of VR has led to improved care for veterans. For some struggling with PTSD, no other methods of treatment may have worked, Bailey says. “It helps to rewire that memory,” she says.

Currently, 15 VA medical centers have put the VR headsets to work for prolonged exposure therapy, incorporating software called Bravemind, created at the University of Southern California Institute for Creative Technologies. With support from the SoldierStrong Foundation, the VA can expand the technology to any sites that have interest in it, Bailey says.

The thing that we have been really excited to find is that veterans of all ages, all races, all ethnicities, all categories seem to really appreciate the experience of virtual reality.”

Anne Lord Bailey Director of Clinical Tech Innovation, Department of Veterans Affairs

Verizon is working with VA to build out a 5G superfast network around and inside its medical centers to enable the extended reality tools. It takes a high-bandwidth, low-latency wireless connection to deliver the detailed imagery of an immersive therapy session, says Bryan Schromsky, a Verizon managing partner in 5G solution architecture for the public sector. The prolonged exposure therapy, for example, depends on the ability to push out new information or images into the simulated environment in real time to match what the veteran recalls.

“We see that as a huge opportunity for 5G,” he says of the VA’s extended reality use cases. “The reason being is you want that immersive training or that immersive experience. It’s going to require a lot of bandwidth.”

EXPLORE: How is the Department of Veterans Affairs using 5G in hospitals?

How Is the VA Using VR for Treatment

VR tools also enhance mental health treatment in other areas, including palliative care, pain management and helping with feelings of isolation in long-term care facilities. In the VA’s community living centers, patients may be suffering from depression due to separation from loved ones during the coronavirus pandemic. The technology can transport them away from discomfort and anxiety.

“Instead of sitting in their beds by themselves, they’re walking through the mountains of western North Carolina or they’re sitting by a campfire,” Bailey says.

The headsets have similar benefits for patients undergoing chemotherapy infusions or dialysis, situations “where you’re captive and you can’t go anywhere, but you also don’t want to just sit there and think about what you’re going through in that moment,” Bailey says.

Caitlin Rawlins, BSN, RN, assists a veteran with using VR therapy following a total knee arthroplasty. Source: Department of Veterans Affairs

One VR pilot program involves 12 sites led by the Asheville Veterans Affairs Medical Center in partnership with Waya Health, which develops VR platforms for patient care. The program primarily focuses on use of the technology to assess veterans’ risks for falls or neurological problems. While wearing the headsets, patients work through a series of questions that help clinicians evaluate their risk.

Another piece of that program addresses procedures for veterans who need surgery, for example, but cannot undergo anesthesia. Instead, they receive a nerve block and remain conscious during the operation.

“The veteran’s awake, but rather than lying there and thinking about the surgery, if we can give them a virtual reality headset, they’re on the beach in Fiji or somewhere different throughout the procedure,” Bailey says. “They’re not thinking about it, so the anxiety level comes down.”

Is VR Therapy Effective?

The crucial aspect of extended reality technology for VA therapy is the continued oversight of real-life clinicians. Health experts not only guide and monitor the use of the equipment to ensure that it is effective for the patient but also add a personal aspect to care.

“It’s to augment the experience,” Bailey says of the extended reality tools. “We don’t want to replace human touch. We don’t want to replace that necessary and very important human connection. But what we want to do is leverage this technology to augment the care that we are able to provide and enhance the experience of the veteran.”

In some cases, extended reality tools can bridge the physical distance between clinician and patient while the patient is stationed in the field or working remotely during the pandemic. Augmented or virtual reality does more than simply replace videoconferencing, which leaves the veteran in front of a computer within a home or field office. The headset brings the veteran into the room with the clinician, allowing personal, focused, one-on-one care.

“There are times that we can put headsets on and be in physically different places, but then suddenly, virtually, we’re very close together,” Bailey says.

Though the technology isn’t necessary beneficial or relevant for every patient or every treatment, the VA envisions building an extended reality network across its system to apply immersive technology wherever it’s needed, Bailey says. “Our ultimate goal is to make this available to every VA clinician and veteran who’s interested in immersive technology.”

The VA typically procures headsets with specific modules for specific purposes, selecting among vendors that provide those platforms. The headsets come with content preloaded.

To make the technology more adaptable and customizable for patients, the VA has rallied its IT team to develop a menu of modules that can be loaded onto empty headsets, which would connect to the VA network — like an “app store” for VR headsets, Bailey says. The VA expects to roll out that platform by the end of 2022, according to Bailey.

“In order to provide that personalized medicine with immersive technology,” she says, “we’re going to need to keep our options open and available.”

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