Tomah VA therapists use combat simulator to help veterans with PTSD
Exposure therapy confronts traumatic memories in safe space
FORT McCOY – Zach Nelson texted his mother and brother goodbye in March and then swallowed what he hoped was a lethal amount of pills.
A friend of Nelson’s had recently committed suicide and the 30-year-old Iraq veteran figured “if he can’t make it, neither can I.” But his family notified police in New Auburn, where Nelson lived, and they found him before it was too late.
Nelson ended up at the Tomah VA Medical Center where, as part of his mental health therapy, he returned to the dangerous sands of Iraq on foot patrols and route clearance missions, just like the ones he experienced overseas.
This time, though, instead of battling real roadside bombs and terrorists, Nelson confronted his
memories through the wonders of technology. The same technique is being practiced on other veterans suffering from post-traumatic stress disorder as well.
Tomah VA mental health therapists are treating veterans with PTSD, depression and anxiety in a state-of-theart combat simulator at nearby Fort McCoy. The multimillion-dollar simulator features full size Humvees and weapons surrounded by a 360-degree video and audio system.
Last year, Tomah VA therapists began using the combat training simulator to effectively return veterans to the circumstances at the root of their problems. The idea behind prolonged exposure therapy is to lessen PTSD symptoms by confronting rather than ignoring trauma-related memories.
“It’s almost like a small time machine and you get to go back, but you’re in a safe place,” said Samuel Hipp, 32, who spent seven years in the Army including a deployment to Iraq in 2009’10. “You get to process a traumatic event in a different way.”
For Nelson, a combat engineer, it was memories of going to the motor pool shortly after he arrived in Iraq and seeing the aftermath of an improvised roadside bomb. He felt pain and sadness even though he didn’t know if the American soldiers were killed or wounded.
“I never really knew what happened in that truck. I just saw all the blood,” said Nelson.
He was further traumatized when the route clearance vehicle he was driving hit an IED.
Since the Tomah VA started using Fort McCoy’s simulator last year, 75 people have gone through exposure therapy. About two-thirds are Iraq and Afghanistan veterans, said Robert Campbell, director of the residential rehabilitation treatment program at Tomah.
The 65-day program includes nine sessions in the combat simulator as well as other group and individual therapy. Tomah VA therapists work with Fort McCoy to tailor scenarios, which can feature desert, jungle and city landscapes. Veterans are placed in four-person teams and a therapist is always with them in the simulator.
The first time Nelson went through the combat simulator, the scenario involved an IED explosion with bloody mannequins. Memories of the
anonymous blood he saw in the Humvee flooded back.
Exposure therapy is not for everyone and some veterans do not respond well or decide to leave the program early, Campbell said. But most who have gone through the combat simulator have responded well to treatment.
“Almost everybody who comes here has to have problems functioning. I’ve had people who couldn’t shop for their kids for Christmas because there was too much stimulation,” Campbell said. “We’re trying to take these symptoms down one at a time.”
‘An innovative addition’
Statistics show 20 veterans in the U.S. commit suicide each day. Tomah VA Medical Center Director Victoria Brahm noted that of those 20 suicides, on average only three were getting mental health care when they ended their lives. While PTSD is treated in many different ways, exposure therapy in the Fort McCoy combat simulator is “an innovative addition to PTSD therapy programming,” Brahm said.
At a mental health summit Thursday at Fort McCoy, mental health and veterans officials had a chance to see the combat simulator in action before talking to a half-dozen veterans who had been treated through exposure therapy.
Inside one of four rooms outfitted with a full-size Humvee surrounded by video screens, participants sat inside the vehicle or on chairs and watched as therapist Bo Pearson, standing in the gunner’s turret, explained what they were seeing. The Humvee pulled out of a forward operating base as helicopters whirred overhead and sand dunes loomed in the distance.
The Humvee sped into a town, passing cows and goats, burqa-clad women and vehicles.
“There’s a guy over here with a tarp over his truck. He could have a bomb in there (or) it could be harmless,” said Pearson, as the Humvee turned a corner and gunfire exploded nearby.
Two people inside the Humvee pointed M-4 air rifles toward a guy armed with a grenade launcher, fired and watched the man fall to the ground. Pearson fired the machine gun and a car exploded in flames, black smoke billowing up. As the Humvee headed back to base, mortars landed all around it, puffs of sand blowing up into small clouds.
Veterans going through exposure therapy are never told in advance what they will do and see in the simulator, though when they get on their bus from the VA and head toward Fort McCoy, the scenario begins when they hear the muezzin call to prayer, sounds they routinely heard while stationed in Iraq and Afghanistan.
Adrenaline rush
Some combat veterans turn to risky behavior when they return home, vainly trying to re-create the feelings of exhilaration from being in a war zone. They may drive too fast or drink too much.
For Hipp, who traveled around Iraq working a security detail in the 1st Cavalry Division, it was alcohol.
“I wasn’t a drunk driver. I was a ‘sit in the basement and drink’ person,” said Hipp, wearing a ball cap adorned with an American flag patch and an “I Fought in Stuff ” T-shirt. Until one day when he got pulled over for drunken driving, something he believes saved his life because it brought him to the VA for help.
In his first combat simulator session, Hipp was on a foot patrol with other veterans when mortars began exploding 75 feet away. A doctor participating in the scenario as an embedded journalist ran away in fright and Hipp was told to bring him to safety. Within seconds, the group began working as a team and the fear Hipp felt at hearing and seeing the first mortar blast melted away as he concentrated on his task.
“There’s this adrenaline rush and spike that comes in combat situations,” said Hipp. “At the end of my first time here I was emotionally drained but I sat back and said ‘I haven’t felt this rush in eight years.’ ”