New Prescriptions for War Trauma
By Tim Starks, CQ Staff
Source: CQ Weekly
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2005 Congressional Quarterly Inc. All Rights Reserved
CQ WEEKLY – COVER STORY
May 23, 2005 – Page 1367
Every war relies on advances in medicine to treat injured soldiers. Already the Iraq War has utilized revolutionary treatments, such as vacuum-assisted bandages that clean wounds and stanch bleeding, and computer-powered prosthetics that can mimic the movements of a natural limb.
But psychological wounds are another matter. Perhaps the most prevalent health problem of soldiers returning from Iraq is post-traumatic stress disorder (PTSD), the mental baggage from the battlefield – flashbacks, anxiety and depression – that can destroy a veterans ability to lead a normal life.
The treatment for PTSD, which was only taken seriously as a psychological condition after the Vietnam War, includes a variety of forms of psychotherapy and drug therapy. And although there is still no definitive treatment for the disorder, researchers believe two new and unusual treatments appear to be quite promising: recreational drugs and video games.
In South Carolina, a psychiatrist has received permission from the Food and Drug Administration (FDA) to use MDMA – an illegal drug commonly known as Ecstacy – to treat returning soldiers suffering from PTSD. And at the University of Southern California (USC), a team of researchers is using virtual reality simulations of the Iraq War to help veterans drop their guard and open up to therapy.
Dr. Michael Mithoefer, the South Carolina psychiatrist leading a team of Ecstacy researchers, says the goal of both treatments is to pierce the defensive shell that PTSD sufferers erect around themselves to begin meaningful psychotherapy. Its about removing obstacles, he said. Theres a level of fear and defensiveness that blocks people from doing the therapeutic work they need to do.
Until now, doctors have used anti-depressants such as Prozac and Zoloft to treat the symptoms associated with PTSD. Mithoefer, who has successfully used Ecstacy with FDA approval to treat crime victims suffering from PTSD, received the agencys nod this year to expand his trials to veterans after learning about high rates of psychological disorder in soldiers who fought in Iraq. The study also won the approval of the Drug Enforcement Administration.
Though Mithoefer says conclusive results of his Ecstacy treatment on veterans will not be ready for some time, he notes that in his experiments with the drug on crime victims, Ecstacy has been helpful in breaking down the psychological barriers that impede successful psychotherapy. We do have a lot of difficult emotions coming up, he said. Weve had subjects comment that it didnt seem like an ecstatic experience to them. Its hard work and painful.
Meanwhile, at USC, researchers have found that virtual reality games that simulate the ferocity of urban warfare in Iraq also can help PTSD-suffering veterans open up after psychological trauma. Psychiatrists have used virtual reality games to treat civilian PTSD patients since the early 1990s.
Like with treatment for the fear of flying, the basic premise is graduated exposure to the feared stimuli, said Albert Rizzo, a USC professor and a researcher who developed the Iraq game. But this is all done in the imagination.
With $4 million from the Navy to fund his research, Rizzo turned to experts at USCs Institute for Creative Technologies, who had developed a military training simulator that was the basis for Pandemic Studios X-Box game called Full Spectrum Warrior. To make a game relevant to soldiers suffering from battlefield PTSD, the researchers combined their original simulator with elements from another video game designed to treat PTSD in Vietnam veterans, as well as virtual reality treatments for survivors of the Sept. 11 terrorist attacks.
A version of the game transports a PTSD patient back to Iraq, where he takes a virtual ride in a military convoy along a desert road and patrols urban streets alone or with an infantry squad. The game simulates the sounds of mortar fire or verbal orders from a commanding officer. Rizzo says more advanced editions will include encounters with dead and wounded soldiers and civilians.
So far, Rizzo says, the game has produced good results in tests with soldiers who suffer from mild PTSD. Even in its limited form, these guys were experiencing things like increases in heart rates, Rizzo said. They were talking about what they went through with their therapists. Thats a great first step.
Mithoefers Ecstacy research is more unnerving for some military officials, since it involves an illegal drug. For his research, he can use only veterans – not active duty soldiers – because of the Pentagons ban on illegal drugs.
Mithoefer also had to rely on a private nonprofit foundation, the Multidisciplinary Association for Psychedelic Studies, for $343,788 to fund his study. He said he has been careful to ensure his research follows strict scientific procedures in order to dispel concerns about the studys use of Ecstacy. There has been resistance. Some people are concerned it might send the wrong message, he said. Were not giving anyone MDMA to take home.
The CQ (Congressional Quarterly) Weekly published an excellent cover story by Tim Starks, entitled “New Prescriptions for War Trauma.” The article interviews Dr. Michael Mithoefer and discusses the MAPS-sponsored study of MDMA-assisted psychotherapy in the treatment of PTSD.