"It's a hard treatment for a very hard problem," said Albert Rizzo, the director of the Virtual Environments Lab at the University of Southern California.
Rizzo first created a simulation for Iraq veterans with the disorder in 2003, by modifying the Xbox game Full Spectrum Warrior. In 2004, he and Ken Graap, president and chief executive of Virtually Better in Decatur, Georgia, received financing from the Office of Naval Research to develop the current simulation, with extensive feedback from veterans and active-duty members of the military.
Virtually Better also offers a Virtual Vietnam, as well as programs to address fears of heights and flying, social phobias and addictive behaviors.
Exposure therapy may not be enough for veterans with complicated symptoms resulting from chronic stress and multiple traumatic episodes, said Rachel Yehuda, director of the post-traumatic stress disorder program at the James Peters Department of Veterans Affairs Medical Center in the Bronx.
"I don't believe," she said, "that any study of exposure therapy for combat-related PTSD has shown a clinically significant improvement" in more than half the patients.
"While I would offer it to a veteran in a heartbeat, I would be prepared for the fact that it might have to be supplemented with other forms of assistance" like medication and social services, she said.
"If we're too enthusiastic," Yehuda added, "then people may expect veterans to be cured after 12 weeks, and it just doesn't work that way."
Hunter Hoffman, a cognitive psychologist at the University of Washington in Seattle, said: "With the growing ranks of Iraq War veterans who have developed PTSD, now is the time for them to receive effective treatment, not 20 years from now.
"We know from Vietnam that for most patients diagnosed with PTSD, these problems don't just go away over time."
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