Staying on the Cutting Edge: The VA's New Move to Implement Immersive Virtual Reality Treatments

BY Anne L. Bailey

Through immersive technologies such as virtual reality, mixed reality, and augmented reality, the Department of Veterans Affairs is defining a new reality in how it delivers care. According to an assessment by the International Virtual Reality in Healthcare Association, the VA is the global, peerless leader in implementing immersive technology.

The VA recognizes that immersive technology can transform its care delivery. Since 2017, the VA has used more than 3,500 VR headsets to treat a variety of health conditions in more than 170 VA Medical Centers and outpatient clinics in all fifty states, as well as in Puerto Rico, Guam, and American Samoa.

Immersive technology offers veterans an engaging, non-pharmaceutical approach to care, while also advancing VA’s commitment to connecting veterans to the newest and best care.

Given that the current demand for quality health care far exceeds the resources in clinical care, VA is leveraging the portability of immersive technology to expand the footprint of our healthcare system, while also working to improve staff training and help reduce burnout.

By using this technology, the VA aims to increase access to care and decrease the overall cost of care by offering veterans additional opportunities to receive evidence-based virtual care, including from their homes. It is important to point out that immersive technology is not intended to replace traditional therapy or treatment by a provider.

Additionally, this technology is not meant to be used as a stand-alone treatment for any condition. It can be used where available, and if clinically appropriate, to help deliver treatments performed by qualified providers.

The VA has long been a pioneer in innovation and the use of technology. “Today we are leaders in integrated immersive technologies to expand and improve veteran care,” said SME . “Just as the VA has normalized liver transplants, cardiac pacemakers, and other transformational health care interventions, it hopes to see radical transformation to the benefit of veterans and healthcare more broadly by increasing access to a technology that veterans are increasingly asking to incorporate into their care delivery.”

The VA is evaluating—or has implemented—Virtual Reality for more than 40 different uses, including managing chronic and phantom limb pain, anxiety, treatment-resistant depression, social isolation, suicide prevention, insomnia, and physical rehabilitation.

Early outcomes have shown decreases in pain intensity and anxiety and increases in engagement in care for chronic pain patients and others, as well as increases in patients’ perceptions of happiness. Most importantly, veterans have said they would recommend VR to former servicemembers and would prefer more VR in other healthcare treatments.

A good example is the use of VR as an additional tool to deliver exposure therapies to veterans with Post-Traumatic Stress Disorder. Exposure therapies are recognized among the most successful, evidence-based treatments available for PTSD and are offered at every VA mental health clinic.

Part of an evidence-based approach to helping veterans with trauma-related disorders includes practicing deliberate exposure to different situations, sights, sounds, smells, and people linked to patients’ emotional reactions during a traumatic event or events. By repeatedly encountering these stimuli in a situation that triggers emotional reactions, but which is not dangerous, new learning is acquired and patients are eventually able to better manage their reactions when they encounter these stimuli in daily life.

Photo Courtesy VA

VR technologies allow increased access to repeatable practice with common trauma-associated stimuli (triggers) that would otherwise be impossible, expensive, or time-consuming for some veterans, including those living in rural areas. Examples include dealing with large crowds, heavy traffic, air travel, fireworks, and other unexpected, loud noises, as well as people from different cultural backgrounds.

Veterans may find that starting with a virtual simulation of these triggers can help them anticipate what to expect as they go about their daily lives. VR is also used to increase emotional engagement and processing while reviewing memories of traumatic events for veterans who may have difficulty expressing emotions.

Some veterans may also find it easier to begin exposure practice with an increased sense of safety that can come from engaging with a virtual simulation before experiencing a trigger in real life.

With immersive technology, therapists and veterans can more accurately predict emotional intensity levels in different situations or stimuli and be able to plan an appropriate exposure sequence for everyone. Some of these technologies allow for real-time adjustment of emotional intensity levels by adding or subtracting different elements of the situation (the number of other people, time of day, weather conditions, traffic conditions, noise intensity, and so on) as the veteran engages with the virtual experience. This level of real-time customization is not usually possible with traditional real-life exposure practices.

Additionally, there are efforts to incorporate the capabilities of generative artificial intelligence to customize the creation of unique exposure environments for each individual. However, these emerging features haven’t been evaluated in VA pilot programs.

Some immersive technologies also provide virtual reality exposure practices remotely, during which the therapist and the veteran can be anywhere in the country and still work together in a real-time therapeutic exposure session.

Over the past few years, veterans in at least 100 VA clinics around the country have begun to include virtual reality tools to implement some of their exposure practices through pilot programs. The Hershel “Woody” Williams VA Medical Center Post-Traumatic Stress Disorder Clinical team in Huntington, West Virginia, for example, recently participated in a program that used a web-based platform to enable access to a range of common exposure scenarios from a mix of computer graphic and video environments.

“I saw several veterans make great strides in overcoming fear of flying and public places in the safety and comfort of the office setting,” said Dr. Lauren Davidson. “Virtual reality was a very effective way for each veteran to approach these situations without additional travel or cost. One veteran was even able to travel by airplane after working on it in VR.”

The team at Huntington also used another program that included a series of veteran-specific environments to capture some of the most-reported situations veterans needed to practice to cope with traumatic experiences. These environments, which were created from feedback of a group of VA psychology subject-matter experts, included a supermarket, diner, outdoor concert, outdoor classic car show, multicultural food festival and fair, and an outdoor fireworks display.

After using the environments with veterans, Dr. Billy Rutherford said he received feedback “that these tools were largely seen as easy to use and acceptable forms of exposure practice. One veteran discussed how he was able to begin going into shopping malls with his family again.”

After using the same program at the VA Puget Sound Health Care System, Dr. Greg Reger said that one “rural veteran was able to use the virtual reality system to practice exposure to a virtual restaurant before attending an event in a bigger city. After the event, he said he was able to enjoy his meal in a crowded venue because he had already practiced with the virtual reality system.”

A Kansas City VA Medical Center team has used virtual reality for exposure practice to triggering scenarios, as well as to increase emotional engagement while processing memories. Dr. Jamie Kratky of the Kansas City VA said that she and her colleagues have used virtual reality “as strategy for helping veterans learn to approach, rather than avoid, stressful memories from the past. Additionally, some veterans I worked with used virtual reality to begin reconnecting with life around them through driving exposures and public spaces.”

Additional clinical research may lead to more widespread use of these tools for veterans and may provide additional insights and individualized options for treating veterans’ trauma-related disorders.

Disclaimer: The VA does not endorse, and has not approved, any product or company.

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