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Virtual Reality in OperationalVirtual Reality in OperationalAnd Garrison Psychology And Garrison Psychology

Greg M. Greg M. RegerReger, Gregory A. , Gregory A. GahmGahm, , Albert “Skip” Rizzo, Robert A. Swanson, Albert “Skip” Rizzo, Robert A. Swanson,

Joseph Joseph EtherageEtherage, & Mark A. , & Mark A. RegerReger

14 14 June 2007June 2007

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Soldiers of Fort Lewis, WA

Army Behavioral Health Technology Office, Madigan Army Medical Center

Telemedicine and Advanced Technology Research Center

These statements do not represent the official policy or position of the U.S. Government, Department of Defense, or U.S. Army.

Acknowledgements

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Agenda

1. Equipment Deployment and Operational Applications

2. Provider Credentialing in VR Treatment

3. Soldier Technology Survey Results

4. Soldier Evaluation of the VR Iraq

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VR in Operational Contexts

• Sturdy Hardware

• Assist deployed clinician with difficult clinical decision making

• Enhance confidence in Soldier skills

• Potential for assisting in triage

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Provider Credentialing

• APA Ethics Code 2.01cPsychologists planning to provide services…involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

• Rizzo et al. (2002)“As the use of therapeutic VR expands, it will be incumbent upon clinical training programs to train future professionals in its competent and ethical use.”

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• Are Soldiers willing to use VR as part of their mental health treatment?

• Will Soldiers who will not seek traditional psychotherapy prefer VR-based treatments?

• Will Soldiers who have been to war find the cartoonish, video-gamish VR Iraq a realistic representation?

• How can the VR Iraq be improved prior to initiating VR-based treatment for PTSD?

Research Questions

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Technology SurveyParticipants

352 Fort Lewis Soldiers Surveyed

Mean Age = 25.9 (SD = 5.8)

Rank E1-E4 (58.2%)

E5-E9 (36.6%)

Officers (5.2%)

Men 91.5%

Education HS Grad or GED (48.6%)

Bachelors or Higher (8.8%)

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Technology SurveyMethod

• Convenience Sample Surveyed in the Context of Post Deployment Mental Health Assessment (SWAPP)

• 54 Item Self-Report Survey Assessing:

– Current Technology Experience/Knowledge

– Comfort Using Technology in Treatment

– Willingness to Use Specific Technologies as Augments to MH Treatment

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Technology Survey Results

• 73% Had Little-to-No Experience with VR

• 58% “Neutral” to “Very Willing” to Receive MH Treatment via VR

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Of those not interested in traditional talk therapy…

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19% “neutral” to “very willing” to receive VR Treatment

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Technology Survey Results

• Willingness to use VR in Tx related to Experience with VR (r = .23, p < .01)

• High magnitude correlations across technology augments to treatment (e.g., web-based, I-pod)

• Small relationship with completed education

(r = .14, p < .05)

• No association to age (r = .01, NS)

• No significant gender differences

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Soldier Evaluation

• 60 Fort Lewis Soldiers

• Redeployed from Iraq in the last Year

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Soldier EvaluationParticipants

Mean Age = 29.3 (SD = 6.8)

Rank E1-E4 (39.4%)

E5-E9 (56.1%)

Officers (4.5%)

Men 83.3%

Education HS Grad or GED (42.4%)

Bachelors or More (13.6%)

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Soldier EvaluationMethod

Demographic Demographic SurveySurvey

EvaluationEvaluation

18 18 likertlikert

0=poor; 5=adequate; 0=poor; 5=adequate; 10= excellent10= excellent

PTSD PTSD Screen Screen (PCL(PCL--M)M)

4 Min4 Min

5 Min5 MinConsent Consent

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Soldier EvaluationResults

Adequate to ExcellentLess Than Adequate

80%

Overall Realism

87%

City Convoy

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Soldier EvaluationResults

Adequate to ExcellentLess Than Adequate

80%

“Provided a sense of ‘being there’”

87%

City Convoy

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Technical Evaluation

0 1 2 3 4 5 6 7 8 9 10

GraphicsUpdate

HMDComfort

Ability toMove

Convoy City

0 = Poor; 5 = Adequate; 10 = Excellent

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Technical Recommendations

• Need ability to control speed (n = 11)

• “Put a weapon in my hands” (n = 10)

• Improve collision detection

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Visual Stimuli

0 1 2 3 4 5 6 7 8 9 10

Quality ofVisuals

Realism ofVisuals

Convoy City

0 = Poor; 5 = Adequate; 10 = Excellent

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Visual Stimuli Recommendations

• More pedestrians, more vehicles (n = 23)

• Put other Soldiers in the vehicle and on the patrol (n = 8)

• Explosions should be visual, not just auditory (n = 8)

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Auditory Stimuli

0 1 2 3 4 5 6 7 8 9 10

Quality ofSounds

Realism ofSounds

Convoy City

0 = Poor; 5 = Adequate; 10 = Excellent

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Discussion

1. Are Soldiers willing to use VR as part of their mental health treatment?

• The majority of surveyed Soldiers (58%) were willing to use VR as part of treatment.

2. Will Soldiers who will not seek traditional psychotherapy prefer VR-based treatments?

• Almost 1 in 5 Soldiers who stated that they were not willing to seek traditional psychotherapy were at least neutral to VR-based treatment.

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Discussion

3. Will Soldiers who have been to war find the cartoonish, video-gamish VR Iraq a realistic representation?

• Soldiers who had returned from Iraq in the last year overwhelming stated that the VR Iraq provided an adequate to excellent representation and provided a sense of “being there”.

4. How can the VR Iraq be improved prior to initiating VR-based treatment for PTSD?

• Soldiers rated ability to navigate as above “adequate” –however, it was the lowest rated aspect. Improvements to navigation, particularly in the urban environment, may enhance the VR Iraq.

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Questions?

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Army Combat Operational Stress Control

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Outcomes of VR in Iraq

1. Excellent Deployability of Current Technologies

2. IRB Challenges

3. Deployment of VR primed providers for assessing its potential

4. Shaped goals of the VR Laboratory at Madigan Army Medical Center

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1. User centered design feedback from recently redeployed Soldiers

2. Developing protocol to explore the potential for improving the assessment of PTSD

3. Exploring an integration of VR Iraq with medical simulation to enhance training of Army providers

Current VR Projects

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Of those not interested in traditional talk therapy…

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Soldier EvaluationMethod

• Demographic Survey

• PCL-M

• VR Iraq Convoy (5 Min)

• VR Iraq Dismounted Urban Patrol (4 Min)

• Evaluation/Recommendations– Realism

– Presence

– Visual & Auditory Stimuli, Hardware

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Questions?