us army aeromedical research laboratory, usamrmc virtual ... · 3 5 us army aeromedical research...

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US Army Aeromedical Research Laboratory, USAMRMC

Virtual Reality Stress Inoculation Training

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MAJ Melba Stetz, Ph.D. Army Research Psychologist

Virtual Reality Medical Center Telemedicine and Advanced Technology Research Center

TATRC

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• Combat Stress– Definitions– Assessment– Treatments– Prevention

• Virtual Reality- Stress Inoculation Training– Our Study



Agenda

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Warfighters’ Stressors • Sleep deprivation• Information overload• Exposure to injuries/dead bodies• Anxiety for the welfare of fellow

Warfighters/ family left behind• Work overload from timed-demands• Organizational constraints• Unpredictability

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Stetz’s, et al., (2005) study of 5,671 patient movement records on MedEvac-ed Warfighters (Apr- Dec, 2003) showed 7% (OEF) and 6% (OIF) were MedEvac-ed due to psychiatric illnesses.

Mental Health MedEvacs

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Stetz’s et al., (2006) follow-up analysis of that sample showed that 21% of those MedEvac-edWarfighters had psychiatric histories prior to deployment.

72 (66%)

3 (3%)

33 (31%)

Depression-Related Stress-Related Unspecified

Mental Health Related MedEvacs

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• Pre-Deployment Health Assessment (DD Form 2795)

• Post-Deployment Health Assessment (DD Form 2796)

DoD Screening

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Acute Stress Disorder/ Post Traumatic SD (PTSD)

• Stress can range from acute to traumatic.

• PTSD = Severe reaction to combat stress/ “post” traumatic experiences.

• PTSD symptoms must be present for > 1 month and include:– a persistent, re-experience of the event– avoidance of stimuli associated with the event– increased arousal (difficulty sleeping, anger)

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Warfighters with Stress Problems

– 1 in 10 US Iraq veterans suffer some type of stress disorder.

• PTSD:– 18% of those that return from Iraq– 11% of those that return from Afghanistan

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PTSD Gender Differences• No statistically significant PTSD symptom

difference between gender• Females might be exposed less to traumatic

events, but if exposed, are more likely to develop PTSD

• Females have a longer course of illness than males

• Females are more likely to express their emotions and to seek help

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We are protecting Warfightersagainst physical but not psychological stressors.

“The Problem”

–“I think we ought to encourage every innovation…to make some of this stuff come to life in the minds of the trainees.”- - GEN Wallace, TRADOC CDR

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• Psychopharmacology– Selective Serotonin Reuptake

Inhibitors• Side-effects, dependence,

interference

• Psychotherapy– Critical incident stress debriefing– Antidepressant medications– Cognitive-Behavioral

• Exposure– In-vivo– Imaginal– Virtual Reality (VR)

Stress Management

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SIT

Stressors Strains

SIT moderates this stress-strain relationship by preparing individuals for stressful experiences. Coping strategies may be incorporated.

Moderators

Performance

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Virtual Reality (VR-SIT)“Virtual Reality-Stress Inoculation Training for Medical Personnel”

USAARL Participant during a VR-SIT

“The Usefulness of VR-SIT for

Military Medical Females: A Pilot Study”

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Stetz, Wildzunas, & Wiederhold

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Self-Report Subjective Information • Biographical Data• Simulator Sickness Questionnaire• PTSD Checklist- Military Version• Multiple Affect Adjective Check List-

Revised• Presence Questionnaire

Subjective Stress Appraisal

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Physiological Stress Appraisal• Monitoring of heart/respiration rate and skin

conductance/ temperature • Pre-positioned cameras

Nonin Medical Onyx II, Model 9550 pulse oximeter.

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Bio-chemical Stress Appraisal• ARL/NWU report a positive correlation between

cortisol and amylase• Amylase = enzyme that hydrolyzes starch to

oligosaccharides, and then slowly to maltose and glucose

• Salivary amylase concentrations are predictive of plasma catecholamine level

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VR Scenarios• Combat Medic• Convoy Patrol• Convoy Under Fire• Friendly Locals• Market Place• Street Battle

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12345678

Females Males

Gender

12345678

Caucasian African-American

Hispanic

Race

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20-30 31-40

Age

12345678

Enlisted Officer

Rank

Demographics

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Previous Deployment

3 / 38%

5 / 63%

Yes

No

Demographics- cont.

Virtual Experience

3 / 38%

2 / 25%

3 / 38%

Much

Some

None

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• Females– Combat Medic– Convoy under Fire– Street Battle

• Males– Combat Medic– Convoy under Fire– Convoy Patrol

Most Stressful Scenario

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MAACL-R

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Anxiety Depression Hostility

FemaleMale

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Researcher-Participant Process

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• 3 groups of medics (SEP 06; JAN/ APR 07) from the AMEDD School of Aviation Medicine– Group # 1 will not be exposed to any inoculation

(VR-SIT).– Group #2 will receive 1 VR-SIT. – Group #3 will receive 2 VR-SIT.– Group #4 will receive 4 VR-SIT.

• Process to be tested during Simulated TNG Exercise using a Score Card

Research Design

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• Validate VR training vs. STX

• Test main Hypothesis:– Those with more inoculations will show

• Lower stress• Higher performance level

Study Main Objectives

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• Many Warfighters are evacuated/returning from theater due to combat stress

• Screening/diagnostic instruments are available but administration is not systematic

• Few alternative therapies are available for care• VR-SIT seems to be a tool that is:

• prophylactic against stress, and• good for training needed job tasks

Summary

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U.S. Army Aeromedical Research LaboratoryFort Rucker, AL, 36362

www.usaarl.org

MAJ Melba Stetz, Ph.D.Principal Investigator Aeromedical Research Psychologist344-255-6899; [email protected]

MAJ Robert Wildzunas, Ph.D.Research Director Warfighter Performance Division344-255-6847; [email protected]

us army aeromedical research laboratory, usamrmc virtual ... · 3 5 us army aeromedical research...

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