As post-traumatic stress disorder -- the scourge of battle-weary warriors -- reaches epidemic proportions, the nation's fascination with video games is about to propel PTSD therapy into an entirely new dimension.
Researchers at the University of California and a Pasadena counseling center for first-responders have hit upon the idea of using virtual reality -- computer simulations -- not only to treat the emotional ravages of war and catastrophe, but also to try to prevent them.
The new approach points to a time in the not-so-distant future when new recruits facing front-line assignments may be able to inoculate themselves against the psychological effects of potential real-life nightmares.
At an experimental center near Playa del Rey, a prototype for the new therapy evokes images of a video war game on steroids.
A programmer is able to control the simulation via a super-computer, keying up a rapid-fire barrage of visuals, sounds and even smells designed to create the hellish experiences of a US military convoy making its way through a no-man's land in Iraq or Afghanistan.
On a raised platform next to the screen, the user wears wraparound goggles and grips a joystick, controlling the virtual driver's point-of-view and his reactions as if he were actually in the hot seat trying to negotiate the hazards that keep whipping at him from every azimuth of the virtual free-fire zone.
On a large video screen next to the computer, the point-of-view of the driver inside the lead vehicle sweeps the horizon, whipping left as a sniper opens up on the convoy, then jerking right as a comrade riding shotgun takes shrapnel in his face and arms.
The smells of cordite, burning gasoline and scorched flesh waft from hidden air vents.
Though it's all make-believe courtesy of VR, research assistant Brady Helds, who's experienced the simulation, suffered gut wrenching physical reactions -- monitored by electrodes -- during a recent demonstration exercise.
"My hands definitely began sweating when the combat kicks in," he told NBC4.
"It was loud and intense," Helds added. "I wanted to get out of that area."
This unique approach to immersion therapy, VR-style, is being tested and applied at 20 military PTSD clinics around the country. An offshoot program is being developed for civilian first-responders and emergency workers.
Rizzo is associate director of USC's Institute for Creative Technologies. Buckwalter is resident researcher at the Headington Institute in Pasadena, a one-of-a-kind psychiatric counseling center for first-responders who perform high-stress rescue work in natural and man-made disasters around the world.
"We try to create an environment where someone feels the stress, and give them the tools to emotionally cope with it," Rizzo said. "Being in such an environment, we believe, can activate emotions that sometimes are repressed."
Headington's research has focused, in part, on dissecting the physiological causes and symptoms of post-traumatic stress, using sophisticated monitoring devices to track changes in body chemistry and the effectiveness of coping strategies.
"People in high stress will report, 'You see your vision go down into a tunnel -- fight or flight, get out of there and do something,'" Buckwalter said.
"The electrodes we attach to our subjects give us a look at how the body is reacting to acute stress and then how quickly it comes down when people engage in breathing and thought-focusing exercises," he said.
Part of the program is a repair effort, to help victims of PTSD get over it by putting them back into terrifying situations -- only this time in a safe "virtual" environment where they can learn to rein in their emotions without the crushing pressure of actual threat.
"We are not trying to eliminate someone's emotional response," Rizzo explained. "We are trying to help them cope with hard events better."
On a more experimental level, the program is also designed to ward off trauma in advance by exposing potential victims to what might happen to them, and easing them into it -- without the risk and terror.
"If we know how people hurt themselves mentally, we can start developing ways to teach them to cope with the situations better and to make the emotions that come from them more manageable," Rizzo said.
Rizzo and fellow researchers have developed a narrative approach to the prevention scenario. It puts the trainee in an evolving war story with a virtual foxhole buddy to answer questions and provide guidance.
"We are trying to put the person in the story by drawing on cinematic techniques," Rizzo said. "We may use narration like it was used in 'Platoon' or 'Saving Private Ryan.' We may actually give them a fake gun so they can actually hold the weapon and walk around in a virtual environment, and hopefully we can guide them when they are coming to a key point in the story."
As part of this preventative effort, Buckwalter and his Headington colleagues have identified key psychological attitudes that seem to increase resilience to stress and therefore need strengthening.
"People who are most resilient have an inner life that shows strength and is filled with meaning and pleasure," he said of his findings. "If they develop these three aspects in their lives, they are going to be prepared when they get into the traumatic situation."
This would suggest that the warrior best equipped to roll with the punches is one with a strong sense of purpose and pride in the mission and an ability to draw gratification from it. Soldiers or first-responders with these traits, said Buckwalter, can "control the tendency to let their hormones go out of control" as they confront crisis or danger.
Initial research has also persuaded Buckwalter's team that there is a correlation between the body's inflammatory system and a propensity for stress.
"People who have more inflammatory elements in their bodies report having consistently more stress in their relationships," Buckwalter said. "They are ready for things not to go well in their engagements with others."
In practical terms, this could mean that people who get physically hot and bothered in social situations may need more stress training before going into combat or intense emergencies.
"Those people may be more prone to the negative effects of stress," said Buckwalter.
Four years of hands-on experimentation and testing have gone into this new PTSD therapy, but much more work needs to be done.
What's more, both Rizzo and Buckwalter caution that VR technology alone can't do the job. It takes trained counselors working with patients to maximize the potential of this new treatment regimen.
But if the research does prove out, they said, US troops going off to war or coming home from it may eventually be better equipped to defeat the enemy that threatens them from within.
The need could not be more apparent. Twenty percent of the GI's returning from Iraq and Afghanistan may be suffering from post-traumatic stress, according to official estimates. But the gestation period for PTSD, and the embarrassment it causes some victims, may have led to underreporting.
And since warriors of the current generation are doing two or three tours of duty in quick succession, the intensity of the emotional fallout from their experiences may be far more intense than anything faced by their recent predecessors.