Page 643 - Total War on PTSD

around, see the passenger next to them, look out the window, etc., all in the safety of the clinical office. Once a patient has gotten through an “easy” flight and has shown a reduction in anxiety, the clinician could then introduce a little turbulence or a thunderstorm and begin the process anew in order to promote further anxiety reduction or fear extinction. With repeated exposures, the effect of reduced anxiety has been shown to transfer to real world flights and thereby helping people become more functional in engaging in the relatively safe activity of commercial air travel (which is statistically safer than driving an automobile!).
Similarly, PTSD PE treatment requires emotional processing of the fear structures to modify or extinguish their pathological elements so that the stimuli no longer invoke fear, any method capable of activating the fear structure and modifying it is predicted to improve symptoms of PTSD. The key to understanding why exposure therapy works so well in treating PTSD is recognizing the instinctive human response to experiencing trauma: avoidance. As with most psychological responses to stimuli, learned avoidance of threat evolved to protect us. It is the brain's way of making sure we do everything possible to avoid a similar incident. If the last time you awoke to the smell of smoke and your house was on fire, the smell of smoke in other situations is going to trigger an instinct to flee. There is no question that trauma-focused exposure is hard medicine for a hard problem. However, while avoidance is the biggest challenge to overcome in treating trauma, it is also the thing that VR therapy is arguably the most effective in preventing. Simply put, the use of VR is just another mechanism for delivering exposure based on the
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