9/11 PTSD Therapy

"We ask the patient to imagine the event as if it were occurring again in their own imagination," she explains. "You want the person to relive the experience and process the memories. If they can't access their memories then they really can't process it and get better." That's what happened to King. He felt he made some initial progress, then "hit a plateau."

"He was giving a flat response," Difede says. "The problem is many people with PTSD are numb, emotionally numb. In other words they don't feel anything. It's like there's a mask they can't break through. And they're avoidant, which means they're avoiding people, places, things or emotions, anything that reminds them of their trauma— in this case, the World Trade Center. So in order to do imaginal exposure therapy, there's a sort of a dilemma there. The very thing that you need to do, you're avoiding, and it's inherent in the nature of the disorder to avoid it."

To help such patients "break through," Difede asked virtual reality (VR) researchers at the University of Washington to design a 9-11 simulation. "We had to design such that the therapist would be able to use it even if she's not a VR expert," says Hunter Hoffman, director of the VR Analgesia Research Center at the University of Washington's Human Interface Technology Laboratory, University of Washington College of Engineering. "So it's designed so she can just push buttons and it doesn't require great computer sophistication." The programmers used existing military simulation software to create explosions and other visual and sound effects, and delivered the first version of the software to Difede by January of 2002, Hoffman says.

image: Hunter Hoffman, University of Washington

The software allows Difede to expose patients to their memories at a tolerable pace controlled by the therapist. "So you start out just looking at the World Trade Center towers as it was that day, blue sky, sunny September day, that's it," says Difede. "And only when they're able to tolerate their experience, if you will, in the processing of their memories do you move on to the next sequence. We ask them to rate on a scale of zero to 100 how distressed are you? How terrified? Usually it goes up, but by the end of the treatment it goes back down to zero or thereabouts."

King was initially skeptical about the VR therapy. "I couldn't imagine how doing that would improve or work at all," he says. "It did, though...it brought back a lot of things that I had actually forgotten or blocked out of my mind, so it caused me, I think, to open up at a different level, and the bottom line is it made quite a difference."

While Difede's research is preliminary, she says she's successfully treated ten stubborn cases, including King, as part of an ongoing clinical trial she thinks will establish VR therapy as an effective "second-line" therapy for "those patients who can't engage in imaginal therapy."

King says it gave him his life back. "I think a lot of the guilt has passed…like, 'Why did I make it?'" he says. "I don't think about that anymore. I just realize it was a bad day and somehow I'm one of the lucky ones that walked out. I'm sleeping better. I feel like I'm well on my way now to getting back to the person I was before 9-11."

King hopes other 9-11 survivors who are still suffering will benefit from his experience, especially first-responders who might not be accustomed to asking for help. "There's something about being a first-responder that you're never weak, you know, you're in charge of everything, you can take care of any situation," he says. "I think it's important that they know that it is out there and it can work...it's there for them and if they need it they should absolutely seek the treatment."

Next, Hoffman will collaborate with a team of researchers preparing to use VR exposure therapy to treat U.S. soldiers returning from Iraq with PTSD. This research appears in the August, 2004 issue of Scientific American, and the first case report was published in the journal CyberPsychology & Behavior in 2002 . It was funded by Paul Allen, the co-founder of Microsoft, and the National Institutes of Health.