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Virtual reality helps ease trauma for patients at Tampa veterans hospital

Headsets can deliver calming scenarios or return veterans to the place where the stress began.

TAMPA — Kenneth Stewart, an Army veteran getting treatment at the James A. Haley Veterans’ Hospital, walked into a meditation therapy session with a heart rate of 89 and shoulder pain he couldn’t ignore.

Recreation therapist James Kaplan sat Stewart down in a comfortable chair and handed him a virtual reality headset. Stewart, 59, had heard about virtual reality as therapy for veterans like him with chronic pain and post traumatic stress disorder. But he was skeptical.

That changed after a few minutes with the headset.

The room transformed into a digitized forest and Stewart’s heart rate fell to 77. He stopped thinking about his pain.

“It’s so realistic,” Stewart said. “I wish I could go there.”

Virtual reality, where headsets and the feeds they deliver make the real world disappear, has lagged as a consumer product. But there have been significant strides during the past few years in its clinical use, especially among military service members.

To help manage chronic pain, U.S. Army veteran Kenneth Stewart, 59, of Montgomery, Ala., explores a virtual landscape at the James A. Haley Veterans Hospital in Tampa. Stewart, a field artillery chief during Operation Desert Storm, suffers from chronic shoulder pain and post-traumatic stress disorder. [ DOUGLAS R. CLIFFORD | TImes ]

Kaplan started the virtual reality therapy program at James Haley a little over a year ago and has led more than 600 sessions with patients.

On average, they report pain reduction of 1½ to 2½ points on a scale of 10 after using a guided virtual reality meditation app. The app can be adapted to display a variety of environments, including caves, cliffs and underwater reefs.

In this case, the virtual reality experience works by distracting patients from physical or mental stressors, having them focus instead on relaxing digital settings.

It’s a method tested as far back as the 1990s when virtual reality first underwent research as a therapy tool.

It’s also been applied to a method known as exposure therapy.

In the low-tech version of this method, patients with post traumatic stress disorder close their eyes and imagine scenarios that trigger their panic to identify cues that set them off and how to avoid them.

But with exposure therapy, the therapist can’t determine whether the patient is actually trying to recreate a scene or pinpoint what the patient is imagining.

That’s why Deborah Beidel, director of the University of Central Florida RESTORES clinic and a therapist with 30 years experience in exposure therapy, is now using virtual reality in her clinic.

“In VR I have more control,” Beidel said. “It allows me to make experiences more powerful.”

To help manage chronic pain, U.S. Army veteran Kenneth Stewart, 59, of Montgomery, Ala., explores a virtual landscape at the James A. Haley Veterans Hospital in Tampa. Guiding him is Jamie Kaplan, recreational therapist at the hospital. [ DOUGLAS R. CLIFFORD | TImes ]

The RESTORES clinic treats active duty service members, veterans and first responders in a three-week intensive program where stress-inducing scenarios are virtually recreated using headsets.

Say a patient who’s a combat veteran distinctly remembers seeing a bag of trash on the side of the road moments before an improvised explosive device went off under a Humvee. Post traumatic stress disorder might be triggered whenever the patient spots trash on the side of the road.

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At Beidel’s clinics, the patient would be transported through virtual reality to the scene of the explosion, complete with the trash bag. Only this time, there’s no explosion. Repeated sessions of this altered scenario might help the trigger go away.

Since 2011, Beidel’s clinic has treated more than 450 veterans and active duty personnel this way, and nearly 215 first-responders and survivors of mass shootings.

Her team is now developing software to help survivors of military sexual trauma.

Debate has arisen over the length of virtual reality sessions at the clinic, about two hours for some patients, and whether it can cause overstimulation. But Beidel has said none of these concerns come from patients. She also said that after completing the program, most patients no longer meet the criteria of a post-traumatic stress disorder diagnosis.

Currently, her lab uses the Bravemind software developed at the University of Southern California. For years, Albert Rizzo at USC has studied the technology’s use in treating people with military backgrounds.

Rizzo is associate director of the medical virtual reality group at the school’s Institute for Creative Technologies. He said the stigma against seeking mental health treatments is strong in the military community, where seeking therapy can be seen as a sign of weakness.

Many service members associate virtual reality technology with video games and find it easier to undergo this kind of therapy, Rizzo said. Virtual reality in clinical settings allows both patient and clinician to do things they can’t in the real world.

“The technology caught up with the vision,” Rizzo said.

More work is needed, though, before the technology can spread to every clinic and hospital. For one, a large controlled study is needed comparing patients treated with virtual reality and those who aren’t, said Jeremy Bailenson, founding director of the Virtual Human Interaction Lab at Stanford University.

Kaplan at James Haley already is getting questions about his program from veterans’ therapists across the country eager to set up their own virtual reality therapy.

For his part, patient Stewart, a field artillery chief during Operation Desert Storm who lives in Montgomery, Ala., is sold on the technology.

He’d like to get his own virtual reality headset — so he can continue his meditation at home.