"The first time they tell that story is often the hardest part of therapy. The simulator we can control. If it becomes too much, we can tone it down, make it literally a walk in the park if we need to," McLay says. "But just coming forward and deciding to face your own demons, that can be tough for people. That is one reason why we introduced the simulator. It is to try to be able to put it slightly more in control between the doctor and the patient, and introduce people to it a little gradually."
Much of the thought behind the simulators comes from the older forms of exposure therapy that were developed decades ago, and which are based on the idea that fear naturally burns itself out.
"It is physiologically difficult to maintain an amped up state for long periods of time, which definitely happens in PTSD," McLay says. "If you actually really are under threat repeatedly, the system will stay ramped up. The brain stem?what keeps the physiology amped up?learns from the upper brain, the part that thinks. We learn to be afraid of what we avoid. Our brain stem learns that 'This really is a dangerous situation and I need to back away from it.' And when you are backing away from something that is inside your own head, we can't do that effectively."
The simulator allows patients to address their fears, to relive the source of anxiety and see that they no longer have to fear for their safety. "Your brain stem learns, 'Maybe I can be safe. If something reminds me about the trauma, I'm not going to be hurt this time around,'" McLay says.
Even with the simulator, and the new advances in therapy and medication, McLay says a big stumbling block remains the negative perceptions of mental illness, despite the military's efforts to remove the stigma. "We deal with some amazing people who have gone through some very difficult things, in some cases quite horrific things. The hardest step for most folks is coming forward and saying, 'I am going to talk about this,'" McLay says. "If you can get over that hurdle, it doesn?t mean the rest is easy but it does show the person has shown a certain amount of motivation and has overcome a huge hurdle just by coming in."