STRIVE: Stress Resilience in Virtual Environments J. Galen Buckwalter* Albert Rizzo Bruce John Brad Newman Josh Williams Thomas Parsons University of Southern California, Institute for Creative Technologies ABSTRACT The Stress Resilience In Virtual Environments (STRIVE) project aims to create a set of combat simulations (adapted from existing Virtual Iraq/Afghanistan exposure therapy system) that are part of a multi-episode narrative experience. Users can be immersed within challenging combat contexts and interact with virtual characters within these episodes as part of an experiential learning approach. Such approaches, often referred to as Stress Inoculation Training, have been found to reduce the neuroendocrine response, increase coping competence and reduce cortisol response. STRIVE is currently developing three combat modules with a narrative arc that includes increasingly intense combat situations, relational development, stress and loss, and emotional trauma. The goal is to raise the service member’s threshold for the stress of combat. Keywords: Virtual Reality, stress inoculation training, resilience, virtual environment, psychoeducation, allostatic load. Index Terms: J.3 [Computer Applications: Life and Medical Sciences]: Health; J.7 [Computer Applications: Computers in other systems]: Military. 1 OVERVIEW The incidence of posttraumatic stress disorder (PTSD) in returning OEF/OIF military personnel is creating a significant healthcare challenge. This has served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. One emerging form of treatment for combat-related PTSD that has shown promise involves the delivery of exposure therapy using immersive Virtual Reality (VR). Initial outcomes from open clinical trials have been positive and fully randomized controlled trials are currently in progress to further validate this approach. Based on our research group’s initial positive outcomes using VR to emotionally engage and successfully treat persons undergoing exposure therapy for PTSD, we have begun development of a similar VR-based approach to deliver stress resilience training with military service members prior to their initial deployment. STRIVE consists of three combat scenarios (Fig. 1), each followed by a session with a virtual mentor (Fig. 2) who employs a variety of cognitive behavioral techniques to further enhance the service member’s ability to undergo a stress response without long-term negative consequences. The techniques include psychoeducation, anxiety management, mindfulness and cognitive restructuring. By understanding the stress response and the tools available to resolve stress effectively we hypothesize that service members will be able to reappraise enemy threats as challenges, maintain composure, view the entire battlefield to choose the most effective actions and to process the emotional, psychological and spiritual consequences of combat. The STRIVE project aims to present this approach to service members prior to deployment as part of a program designed to better prepare military personnel for the types of emotional challenges that are inherent in the combat environment. During these virtual training experiences users are monitored physiologically as part of a larger investigation into the biomarkers of the stress response. One such construct, allostatic load, is being directly investigated via physiological and hormonal analysis from specimen collections taken immediately before and after engagement in the STRIVE virtual experience. In addition, the user’s acute response to stress is measured during virtual training with EEG, EKG and GSR. Overall goals of STRIVE include building resilience to combat as well as identifying allostatic load profiles that are associated with the most effective stress responses. Figure 1. Initial STRIVE combat scenario in a HUMVEE Figure 2. Psychoeducation module between combat scenarios USC Institute for Creative Technologies 12015 Waterfront Drive Playa Vista, CA, 90094 *Email: jgbuckwalter@ict.usc.edu 173 IEEE Virtual Reality 2012 4-8 March, Orange County, CA, USA 978-1-4673-1246-2/12/$31.00 ©2012 IEEE