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Helping veterans face their fears Therapists combine smells, combat scenes to treat PTSD

It's not quite smell-o-vision, but University of Central Florida researchers are kicking off a study that will combine a virtual reality simulation of wartime scenes along with the "smells" of Middle East combat zones to help veterans overcome post-traumatic stress disorder (PTSD).

Because smells are so acutely tied to memories, researchers hope that the combination of reliving painful experiences -- along with the smells of war -- will help Iraq and Afghanistan veterans overcome their anxieties. Known as exposure therapy, the technique teaches people to face their fears by confronting them gradually.

"If you're afraid of a dog, how do you get over it? By being around a dog," said Dr. Deborah Beidel, a University of Central Florida psychology professor who is leading the study.

In the program, Beidel and a team of therapists will use software programs known as Virtual Iraq and Virtual Afghanistan -- which look like a video game but simulate the experience of being in those countries -- to duplicate the traumatic experiences the soldier witnessed.

Gradually, the teams will take the soldier back through the experience, talking about it and reliving it until he or she overcomes the fear. And though researchers have been using Virtual Iraq for several years, the smells, Beidel said, may be a key part of reliving the experience. The computer that runs the virtual reality program is hooked up to a scent machine with 13 scents, ranging from burned rubber to gunpowder to Middle Eastern spices.

By pushing a button, therapists running the program can send off a puff of air that contains those scents -- and have it travel right under the vet's nose.

Adding scents to the Virtual Iraq package, said creator Skip Rizzo, a psychology professor at the University of Southern California, was designed to make the experience more realistic.

"Smell is a real primordial. You walk by a bakery, and it reminds you of being 5 years old and your grandmother baking bread. It has an incredible capacity to activate old memories," he said.

For Vietnam veterans, he said, the smell of swamps or even the scent of Asian food triggered wartime memories.

If results from the UCF study are promising, they may become part of Veterans Affairs treatment programs throughout the country. Rates of PTSD and traumatic brain injury among troops deployed to Iraq and Afghanistan have been disproportionately high, according to a study by the RAND Corp. A third of returning troops have reported mental problems, and 18.5 percent of all returning service members battle either post-traumatic stress or depression.

Like Vietnam veterans -- who said they dropped to the ground every time a helicopter flew overhead because that was how they were trained -- many of today's veterans find that the stresses they endured overseas have followed them home and are interfering with civilian life.

Some find themselves checking the sides of the road for IEDs while driving down the interstate. Although they know that the chance of a roadside bomb on a local interstate is remote, they can't stop themselves.

The first step in treating vets for PTSD, say therapists, is getting them to talk about their traumatic experiences, such as being attacked or ambushed, seeing dead bodies, being shot at or knowing someone who was killed or seriously hurt.

When asked about the events that may have sparked their stress, many vets provide only the basic details -- a "just the facts" recitation of the events -- Rizzo said. But in time, he said, therapists can help them open up and provide more detail. Using that information, therapists can set up a virtual scenario that helps the vet walk through the experience again. In Virtual Iraq, the soldier can be placed in a Humvee, either driving, as a passenger or in the gun turret. He or she can go on street patrol through a city market or walk into a mosque.

The therapist then can add pieces to the scenario, including people running into the street, a roadside bomb exploding or a helicopter flying overhead. A car may explode in the marketplace or the passenger in the Humvee may get shot and slump over.

Though veterans experience many stressful encounters, Beidel said most can pinpoint one event that was the most traumatic -- and it's often the subject of their nightmares. Reliving it, she said, can gradually reduce their anxiety.

The challenge for researchers and mental health professionals has been getting vets to stick with treatment without dropping out. But Beidel and Rizzo think that this type of treatment -- using a virtual reality scenario that looks a lot like a video game -- may appeal to this generation of vets, who grew up digitally, more than traditional therapy.