stetz cybertherapy 07 [read-only]€¦ · • pre- screening: – ptsd checklist ... females)...

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“Virtual Reality Stress Inoculation Training for Combat Medical Personnel”

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MAJ Melba Stetz, Ph.D. Research Psychologist

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Warfighters’ Stressors • Unpredictability• Sleep deprivation• Information overload• Work overload • Organizational constraints• Exposure to injuries/deaths (friend/foe)

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We are mainly protecting warfighters against physical stressors.

“The Operational 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;

Antidepressants• Dependence, interference

• Psychotherapy– Critical incident stress debriefing– Cognitive-Behavioral

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

Stress Management

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Stress Inoculation Training (SIT)

Stressors(e.g., attend wounded while under fire)

Strains(e.g., anxiety)

•SIT can moderate stress-strain relationships by preparing individuals for stressful experiences.

•Coping techniques can be incorporated to enhance SIT.

Moderators(e.g., Coping Techniques)

Performance

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Pilot Study

“The Usefulness of VR-SIT for

Military Medical Females:

A Pilot Study” USAARL Participant during a VR-SIT session

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Obtained Sample-to-date

54TOTAL-TO-DATE:

3MAY-JUN ‘07 @ USASAM = FM

11APR-MAY ‘07 @ Fort Drum = Mountain Medics

9APR ‘07 @ USASAM = FM

12MAR ‘07 @ Lyster, Fort Rucker = Medical Personnel

6FEB ‘07 @ Fort Benning, GA = Ranger First Responders

13JAN ‘07 @ USASAM, Fort Rucker, AL = Flight Medics (FM)

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• Budget from the Telemedicine and Advanced Technologies Research Center = $100K.

• Date that it actually started (due to $ getting to USAARL, games being developed, participants’ class dates, available personnel, etc.) = JAN 07.

• Date to be completed: JUN 07.

Study Information TATRC

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•Main Hypothesis: Those with more inoculations will show:

• Lower strain

• Higher performance

Study Main Objectives

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DesignParticipants = Medical personnel (e.g., medics, nurses).• Targeted sample size: 63; criterion for significance

(alpha) set at .05 and an effect size (f) of .40 to yield a power of .80.

– Control Group- 9 participants that will neither receive either virtual reality (VR) or coping training (CT).

– VR Group: 18 participants that will receive either 2 or 4 sessions.

– CT Group: 18 participants that will receive either 2 or 4 sessions.

– VR + CT Group: 18 participants that will receive either 2 or 4 sessions.

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Psychological Assessment

• Pre- Screening:– PTSD Checklist- Military Version

• Bio-survey• Multiple Affect Adjective Check List-Revised• Presence Questionnaire

• Post- Screening:– Simulator Sickness Questionnaire

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Bio-chemical Assessment• Salivary Amylase Kit-

– predict plasma catecholamine levels– self-contained

• amylase levels are quantified using tabled values of time for color change and ambient temperature recording

• Cortisol– saliva and sweat– polypropylene fiber material

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Physiological Assessment• Devices to monitor heart/respiration rate and skin

conductance/ temperature

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VR Scenarios

Combat Medic Flight MedicVirtual Reality Medical Center

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Virtual Data Collection @ USAARL

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VR Data Collection in other posts

Coping Session

Game Session

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Hands-On Data Collection (indoors)

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Hands-On Data Collection (outdoors)

Fort Benning, Georgia

Fort Drum, New York

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Demographics- (1st sub-sample)

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E3 E4 E5 E6 E7Ranks

The first sub-sample (JAN 07, n = 13/30) was composed of Medics attending the Flight Medic’s Course at the US Army School of Aviation Medicine, Fort Rucker, AL.

•Caucasian- “American?” (10,77%)•Single (11, 85%)•Reservists (10,77%)•< 5 years of service (7, 54%)•21-29 years old (7, 54%)

PRELIMINARY DATA…

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3, 23%

2, 15%

8, 62%

Deploying Soon Not Soon… Don't Know

Demographics- cont.

3, 23%

10, 77%

Previously Deployed Not yet…

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2 10

2

4

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8

OIF

OIF

&O

EF

Bos

nia

Where?

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012345

OIF

Pana

ma

Unk

Where?

PRELIMINARY DATA…

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Presence- (1st sub-sample)

Presence Questionnaire (Witmer & Singer, 1994)

PRELIMINARY DATA…

0123456

How Much

Presence

#1 #2 #3 #4 #5 #6

Participant's Number

VR Presence while in the Study

How involved were you in the VR experience?How responsive was the virtual environment?

Previous VR Experience

0123

Nin

tend

o

PC/R

PG

PS2/

Xbox

RPG

TWG

olf

Wof

W

Xbox

Xbox

360/

PC

Xbox

/PS2

/PC

Non

e

Type of Games

# of

Par

ticip

ants

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Psychological Stress (1st sub-sample)

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50

55

60

65

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75

Anxiety Depression Hostility

VRVR + CT

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4550

55

6065

7075

Anxiety Depression Hostility

VRVR + CT

Pre-Inoculation

Post-Inoculation

Multiple Affect Adjective Check List-Revised (Zuckerman & Lubin, 1985)

PRELIMINARY DATA…

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40

30

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10

0

-10

-20

-30

More Stress(faster reaction)

Less Stress(slower reaction)

VR Only Coping Only VR + Coping

Diff

eren

ce fr

om P

re-In

ocul

atio

n (S

ec.)

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Bio-chemical Stress (1st sub-sample)(time for reaction with amylase reagent)

PRELIMINARY DATA…

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From 2 of the samples (n = 25)

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55

60

65

Inoc. 1 Inoc. 2

CT Only VR Only CTVR

Estimated Marginal Means of Anxiety

PRELIMINARY DATA…

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GoGoGoGoNo GoCTVR-4

GoGoGoNo GoNo GoCTVR-4

GoGoNo GoNo GoNo GoVR-4

No GoN/AN/ANo GoGoVR-2

HandsHands--OnOnVRVRGroup

APR’s Data Collection

Performance Measures

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• Last data collection?

• Beginning of the Coping VR Study?

More to come…

PI’s Deployment?

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Lessons Learned• Schools are appreciative of the instructional “games.”

• Participants have reported none-to-low prior PTSD symptoms.

• Most participants (i.e., males) seem to like playing the “games.”– In fact, most (e.g., those previously deployed, including

females) wanted to come back 3 and 4 times to quickly “save the casualty” and kill the “bad guys.”

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Lessons Learned- cont.• Some liked the breathing/relaxing TNG

– Immediate physiological biofeedback tends to be well received by the VR + CT group.

– Many CT and VR + CT participants mentioned practicing these techniques throughout the day.

• “Go’s/No-Go’s” can be reproduced from the lab portion of the study. However, study sites tend to "pass" all Soldiers by the end of the STXs (hands-on) portion.

• Due to technological and field data collection variables…there will be some missing data.

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• Many Warfighters are returning from theater due to combat stress.

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

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

– Preliminary/ongoing USAARL data suggest that VR-SIT and coping strategies are promising for hardening warfighters (i.e., medical personnel) against combat stress.

Summary

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Contact Information

MAJ Melba Stetz, Ph.D.Principal Investigator

[email protected]

LTC Robert Wildzunas, Ph.D.Research Director,Warfighter Performance and Health [email protected]

stetz cybertherapy 07 [read-only]€¦ · • pre- screening: – ptsd checklist ... females)...

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