Virtual Backgammon

Yes, I admit it. I am a Luddite, but not a Troglodyte. Until last Sunday I regarded computer games [especially the one which spends electricity, merely to spare the player the Therbligs it would take to shuffle and lay out an actual deck of cards] as a waste of time and resources. Not any more.

I direct your attention to a BBC on-line [see, I do use my MacBook for more than word processing] article, posted on 18 Oct 09: Virtual Reality Tackles “Shell Shock.” In it, the Beeb’s medical correspondent, Fergus Walsh, describes the successful treatment of 30 [out of a group of 40] US military personnel diagnosed with Post-traumatic Stress Disorder, following several tours of duty in Iraq. Alas, the 30 who responded well to the treatment were thereafter sent back to Iraq, or on to Afghanistan. But I digress…

The [non-radioactive, non-pharmaceutical] treatment was developed by Albert Rizzo, of the Institute for Creative Technologies at the University of Southern California, and is based on the X-Box game, Full Spectrum Warrior. We’ll get to the [literally] whiz-bang features of the current treatment soon, but first, back to Vienna.

If you recall my original “Backgammon” post, Freud used that game metaphor to describe the capture and imprisonment of one’s “soldiers” at the scene(s) of particularly harrowing “battles” in the course of one’s life. Lose too many troops [which he conceptualized as psychic energy], and you become unable to “soldier on.” His therapeutic model encouraged the traumatized individual to revisit the distressing events, recalling them in as much detail as s/he could manage, with the goal of “liberating the hostage soldiers” [regaining psychic energy]. In the actual game of backgammon, one has to throw a specific dice score, to move a “soldier” off the bar, and allow him to complete his journey home to safety [“bearing off”]. Why did this psychotherapeutic treatment take so long [or not work at all]? Resistance. Having survived [sometimes, just barely] a traumatic event, who would want to “go there” again? The Jack Nicholson censor in the mind tells the would-be recollector of a trauma, “You can’t handle the truth! I’m not going to let you remember what really happened back there.”

Let’s use the wolf [up-your-nose] model to explain the same thing. By definition, the traumatic event was frightening. If a major injury was sustained, there was pain & suffering. Often, the trauma involved the sudden intrusion of hostile individuals or their devices of destruction. Less obviously, but saliently, there may have been humiliating circumstances [such as a momentary loss of nerve, or loss of continence]. When the amygdala is thus aroused, the hippocampus is deprived of blood. Therefore, the brain’s most direct information-processing site is “off-line” during the traumatic event. Victims of violent crime are notoriously bad at picking their assailant out of a line-up. Back in college, I was a very weak witness during my deposition for my roommate’s totalled car lawsuit: unable to remember the make of the car that hit us, or even the make of the car we were in! [Luckily, the guy settled out of court, just as our case was called.]

Guthrie’s One-Trial Learning model is also relevant here. The complex stimuli of a traumatic event [the cue] may be followed by an evasive movement [as is my case], or by an aggressive movement, or by a catatonic freeze. When I was a VA Psychology Trainee in 1973, working with veterans “fresh out of the jungle” [of Vietnam], the most commonly cued movement in our clientele was aggression. Assaulting a stranger who accidentally brushed up against you from behind would get you arrested in a New York minute, back in the day. The best explanation the assailant could offer the judge was the non-specific, “All-of-a-sudden, I was back in Nam.” [Just like, all-of-a-sudden, in that shotgun seat, I am back in Durham.]

In 1999, Rothbaum et al. modified an X-Box wargame to treat a 50-year-old Vietnam vet, who had been suffering flashbacks and other PTSD symptoms since that war. Their hope was that Virtual Reality Exposure Therapy would overcome the patient’s resistance [or limbically-induced amnesia], allowing him to re-experience, in a safe and controlled setting, the traumatic events that had held him hostage for 3 decades. Once the memories were recovered, the conventional therapeutic work of processing the information and assisting the patient to “handle the truth” could begin.

As the lead clinician in the current San Diego study says, “Our different senses are very powerful cues to our memory.” Therefore, as well as tailoring the sights and sounds to re-enact the individual soldier’s traumatic event(s), the Virtual Reality program adds realistic motion [such as vibrations and sudden impacts] and smells: burning rubber, cordite, garbage, smoke, diesel fuel, Iraqui spices and what is euphemized as “body odor” [but was more likely ordure]. The subject’s heart rate and galvanic skin response [both measures of anxiety] are constantly monitored during the 30-minute VR sessions, to “keep it real,” but not so real that the original [fight/flight/freeze] movement is triggered. Then an hour of debriefing and talk-therapy ensues. The entire treatment consists of only 4 once-weekly sessions.

Just think of all the Therbligs such a treatment method could save the government! More importantly, just think of all the “hostage soldiers” it could “liberate” from their traumatic war experiences.

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Filed under catharsis, gets right up my nose, limbic system, post-traumatic stress

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