Virtual Reality Exposure for Trauma and Stress-Related Disorders for City Violence Crime Victims

IntroductionIn Mexico crime rates are extremely high: 21.3% of the population over 18 years has suffered from a crime and 86.3% of the population feels unsafe. In recent years, Mexico experienced a dramatic increase in violence. The number of homicides, assaults, kidnappings, threats, disappearances, extortions, and attacks on civilians, journalists, public officials, human rights advocates, and deaths of bystanders increased substantially. The National Survey of Urban Public Safety (1) reported that in the month of September, 2013, 68% of the population over the age of 18 considered that living in their own town is highly unsafe, because in the last three months they have witnessed and/or heard of alcohol consumption on the streets (70%), victims of theft or robbery (66.2%) and urban vandalism (56.1%); on the other hand, there is a wide variety of factors that children, youth and adults are exposed to, which are highly dangerous, and need to be taken into account in order to create preventive or intervention strategies.Accordingly, Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) rates caused by criminal violence such as assault, kidnapping or express kidnapping, are quite high and continue to increase. The violent situation that exists in the country has generated among survivors fear and insecurity, thus increasing the chances of developing acute stress disorder or posttraumatic stress disorder. This has increased the need for intervention programs for this population. Problems and related consequences, lead the population to a hopeless sense of fear and insecurity and their repercussions are associated with the PTSD and ASD. Traditional exposure therapies are often difficult to conduct and financially unavailable to most Mexicans; so this new exposure technique using virtual reality environments (VRE) seems be a potential tool, which permits both patients and therapists more control and yields better results. Based on the effectiveness of participants' preference and acceptance for this innovative intervention in a previous controlled study using virtual reality for the treatment of victims, we conduct a study offering treatment at the School of Psychology in Mexico City (2, 3). The prevalence of PTSD and ASD requires attention because those who suffer from these disorders have elevated degrees of anxiety, fear and avoidance, thereby interfering in personal development and everyday life. Nowadays there are effective cognitive-behavior therapy (CBT) treatments for PTSD and ASD (4). These treatments employ exposure techniques that help patients to overcome the presence of feared objects or situations related to the traumatic event. Prolonged exposure (PE) is the preferred exposure technique for treating PTSD (5). However this technique is poorly used in clinic treatments (6). The low use of these treatments is due to cognitive avoidance of patients to recall traumatic memories and the difficulty for some patients to engage in imaginal exposure.Virtual reality exposure techniques (VRET) can help to overcome some restrictions of traditional exposure therapy (in-vivo or imagined) (7). VRET can simulate the traumatic situation with a high sense of reality; therefore this can help patients regardless of their ability for imaginal engagement. Another benefit is that therapists can control the characteristics of the situation presented to the patient. These aspects could reduce cognitive avoidance in order to increase the emotional engagement during exposure (8). There are several studies supporting the effectiveness of VR for the treatment of PTSD in different populations (9, 10), e.g., survivors of war, active soldiers and victims of terrorism attacks. In Mexico, the development of such systems is non-existent, and its empirical validation is emerging, which gives evidence of the relevance of this study in our socio-cultural context.Based on this socially relevant problem and centered on the efficacy of previous studies for war violence, our research team initiated a project supported by the National Science and Technology Council, and the municipal government of Ciudad Juarez in Mexico, the purpose of which was to evaluate the efficacy of a treatment program for PTSD through virtual reality exposure in criminal violence victims and eyewitnesses in Ciudad Juarez. …