The Usefulness of Virtual Reality Stress Inoculation Training for Military Medical Females: A Pilot Study

Warfighters face stressors such as sleep deprivation, information overload, exposure to injuries/dead bodies, and anxiety for the welfare of fellow Warfighters and family left behind. Consequently, we are continuously losing Warfighters due to psychological stress. Researchers have recently reported that approximately 18% of Warfighters returning from Iraq and 11% returning from Afghanistan (n = 6, 201) screened positive for Post Traumatic Stress Disorder (PTSD). PTSD is a debilitating condition resulting from experiencing trauma, characterized by continuous memories of the traumatic experience. Military medical personnel are not immune to stress since they have a challenging and demanding dual role — that of a Warfighter and a first responder. In fact, it has been reported that many first responders report serious psychological distress, including PTSD. Even though many researchers are studying Warfighters’ stress, there is still a gap in the literature on studies with support personnel (i.e., medics) and females. During a recent interview, a researcher reported finding no statistically significant PTSD symptoms difference between males (11%, n = 300) and females (12%, n = 50) in a sample of Warfighters holding violence-prone support jobs (i.e., medics). However, other researchers had previously reported that approximately 20% of females and 8% of males who had been exposed to traumatic events did develop PTSD symptoms. Furthermore, some researchers suggest that females might be less likely to be exposed to adverse stressful events but more likely to develop PTSD if exposed. Thus, an overall increased prevalence of PTSD in females (10% vs. 5% in males) can be accounted for by a significantly greater vulnerability to develop PTSD after exposure. Females also seem to have a longer course of illness than males with a median time to remission being 35 months for females compared to 9 months for males. The purpose of this study is not to identify which gender is more prone to PTSD. However, given the premise that males typically grow-up being exposed to more stressful situations than females (i.e., teasing each other, playing rough sports), and the lack of studies on female Warfighters (especially, in the medical field), we propose to test the effectiveness of Stress Inoculation Training (SIT) for female military medical personnel. SIT proposes that repeated exposure in stressful, but controlled conditions (i.e., via virtual reality) enables individuals to gradually adapt to stressors and learn how to cope. By conducting virtual reality SIT, or “VR-SIT”, the stressors can be applied systematically and paced appropriately for each individual. Our VR-SIT pilot study is currently underway and preliminary findings will be presented at the 2006 CyberTherapy Conference in Canada. ANNUAL REVIEW OF CYBERTHERAPY AND TELEMEDICINE 52 (i.e., PTSD, n = 33, 31%) or to depression (n = 72, 66%). PTSD is a psychiatric disorder that follows traumatic events. It can occur after exposure to extreme traumatic stressors during combat deployment such as coming under fire, suffering injuries that require medical attention, seeing casualties (Nisenbaum, Barrett, Reyes, & Reeves, 2000), or handling human remains (McCarroll, Ursano, & Fullerton, 1993). To be considered PTSD, symptoms must be present for more than one month (to rule out Acute Stress Disorder), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Major symptoms of PTSD consist of a persistent reexperience of the traumatic event, avoidance of stimuli associated with the trauma, numbing of general responsiveness, and increased arousal (i.e., difficulty sleeping, anger, irritability). Danckwerts and Leathem's (2003) PTSD review shows that the severity of PTSD symptomatology is influenced by the extent or gravity of the actual exposure to the stressful event (e.g., the sudden unexpected death of a loved one carries a risk of 14% for triggering PTSD, while combat, bombing, or mass violence has a risk factor as high as 20–40%). Individuals with PTSD report symptoms related to cognitive impairment such as an inability to think, concentrate, or make decisions. They may appear easily distracted or complain of memory difficulties (Amer. Psych. Assoc., 2002). In addition to deployment and battlefield stress, Warfighters experience job-related stressors such as work overload, time demands, uncertainty, and poor leadership that can decompensate in sub-clinical emotional states of anxiety and fear. For example, under conditions of high workload, individuals tend to experience anxiety because of an inability to cope with work requirements (Bliese & Stetz, in press) and individual performance declines. Unpredictability at work has also been shown to lead to low performance. Warfighters tend to report higher performance and well-being when predictability/ certainty at work is high (Fleming, O’Keeffe, & Baum, 1991). Organizational constraints (i.e., lack of equipment) have also been associated with lower satisfaction (Spector & Jex, 1998; Stetz, Stetz, & Castro, in press), lower wellbeing, and decreased reenlistment intentions. VIRTUAL REALITY’S ROLE IN STRESS DETECTION, MEASUREMENT, TREATMENT,