VFX and Development of PTSD Treatment

Intro:

I think it's best to start off this article with both a disclaimer, and an introduction to why I am writing about this topic. If you struggle with mental health, and your mood or behavior is easily affected by sensitive topics, this article isn't for you. Please feel free to explore some of the other articles on my site.

For the rest of you, we're going to be talking about how our industry is improving one section of mental illness. Personally, this topic resonates with me very heavily. As I've struggled with post traumatic stress, and dissociation for a large chunk of my life. But to say that the VFX industry, particularly Houdini saved my life, would be a bit of an understatement. Still to this day, I can point to the exact moment where visual effects gave me the momentum and ability to survive some of my worst years. Perhaps I'll talk about it one day, but for now all you need to know is that this blog was spawned out of those incidents. :) Good things sometimes come out of a lot of pain.


So let's explore how our burnout industry is saving lives.

What is PTSD?

 

Posttraumatic Stress Disorder is a mental illness that is caused in people who have experienced or witnessed traumatic events. this can range from anything from watching a scary television show at a young age, to being involved in the death or trauma of another human being or to yourself.

In World War One, it was originally called shell shock or combat fatigue. However, PTSD doesn't just happen in veterans. it can occur in all people, regardless of their background or heritage.  Women are twice as likely to have PTSD over men, and according to certain U.S statistics; one in 11 people will be diagnosed with PTSD in their life. Certain ethic groups such as Latinos, African Americans, and native north Americans also have higher rates of PTSD than other ethnic groups. 

But what does it feel like?

People with PTSD have feelings and thoughts that last long after the traumatic event has happened. This can be sudden bursts of sadness, anger, happiness, or fear. As well as feelings of detachments to others around them. Speaking from personal experience, this can evolve from nightmares, to months living at high levels of anxiety. For example: I think the closest version of fear for someone who hasn't experienced it can relate to is exam stress. Imagine living in a state where you are reliving the same exam week in college, again and again. You have the anxiety of preparing for something that is never going to happen, and you don't know what to prepare for.  And when the week is finally over, your body doesn't know how to decompress. So you just continue to stress out over the unknown. It does an undeniable amount of damage to your body.

It also leaves you with an insane amount of detachment. Imagine going out to dinner with your friends in a loud restaurant, and the entire time wearing bad quality noise cancelling headphones. You can see everyone laughing and talking around you, but the tones and context fades in and out. Suddenly, there are barriers between you trying to interact with everyone else.  Even hugging your parents can be a challenge. Loud noises and music can also trigger flashbacks and intense moments of fear.

Usually the symptoms of PTSD can be placed into four categories.

Intrusion: Thoughts are repeated, disturbing memories never leave, and you can't think of anything else. Flashbacks might occur. These can be so realistic that your mind  can convince you that you are re-living the same experience.

Avoidance:  People with PTSD might refuse to talk about the event, or refuse to interact with others in specific environments. Or even avoid objects or places that might make them upset.

Mood Alteration: The previous experiences someone might have had can make them feel detached, or unable to feel positive emotions. Or even satisfied with their current life. They might wrongfully blame themselves for the vents that have happened to them. Or lose interests in activities, and be distrustful of others.

Reactivity Alteration: People with PTSD might also have random angry outbursts and overreact to simple situations. As well as have issues sleeping or concentrating. Or even bursts of hyper concentration where they need to focus on one particular task.

Sometimes these symptoms don't start right after the person has gone through their trauma. They can sometimes manifest months or years afterwards. And then last for the rest of that person's natural life. It can be treated, but only with a lot of personal reflection, therapy, and support.

PTSD symptoms can also vary in intensity over someone's life. There might be good days. Other times there might be bad ones.

 

There are also four different stages that someone with PTSD will go through after a traumatic event.

The Emergency Stage: This first stage happens right after the event has occurred. The individual is in shock, and should be treated for it. They might be struggling to process what just happened to them, and feelings of guilt, hyperventilation, anxiety, and fear.

Denial Stage:  At this stage the survivor will probably avoid talking about the situation, and thinking about it. They might be experiencing strong feelings regarding the event, and might only talk about it while intoxicated.

Short Term Recovery: At this stage. Individuals might start to experience nightmares centered around the event, and refuse to continue to go to therapy.  They might think that they have completely recovered and try to return to normal life and view their support systems differently.

Long Term Recovery: In this stage, the person might continue to deal with the effects of PTSD in their normal life. As well as nightmares. However, as long as they are seeking treatment , these symptoms should slowly start going away.

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Current Treatment Methods

There are some important and modern treatments for PTSD. So let's go over them.

In the Psychotherapy field there is a commonly used practice called Cognitive Behavior Therapy(CGT).

CBT has been found to be the most successful treatment of PTSD for both short term and long term recovery. CBT for PTSD is mainly geared towards talking and focusing on the traumatic event. It focuses on changing a person's thinking and behavior patterns. It also makes sure the person uses the skills they learned in therapy in their everyday lives. There are two main practices used in CBT to help survivors face their fears.

Exposure Therapy: This type of CBT helps people control their fears by repeatedly exposing them to the memories of their trauma in a controlled environment. Exposure can involve the use of mental imagery, writing, visits to certain places, or other methods to make the person revisit their trauma. Therapists can also create virtual environments for patents to explore, but we'll touch more on this later. By exposing someone to their trauma again, and again, they will become less sensitive to it over time.

Cognitive Restructuring: This type of treatment helps others make sense of bad memories. Often people remember their trauma differently overtime, and the event might have happened differently than they remembered it. By helping them to restructure their thoughts, it removes feelings of guilt or shame around the event.

This therapy should only be performed by trained mental health professionals. 

There are also more specific and unique forms of CBT used in  therapy. 

Cognitive Processing Therapy(CPT): This form of therapy is a modified form of CBT, that aims to make patients reevaluate their trauma-related thinking. It focuses on the way people view themselves, others, and the world around them. Often a person's thinking will keep them stuck inside an event and prevent a recovery. It is one of the fastest and successful types of mental health treatments. Usually, it takes about 12 sessions before the patient is satisfied with the results. Dropout rates for CPT are around 26.8%. Which makes it fairly low for this type of therapy. 

Prolonged Exposure(PE): This form of therapy relies heavily on behavioral therapy techniques. It slowly helps heavily affected individuals start talking about their trauma. It again stops people from avoiding their pain, and things in their environment that might remind them of events. This can lead to a faster recovery from PTSD as their suddenly is no excuses for the individual to address their problems. It is one of the best recommended paths for PTSD treatment. Dropout rates for this type of therapy is 27.3%. 

Stress Inoculation Training (SIT): This is another type of CBT that aims to reduce anxiety in patients. It teaches coping skills to help deal with stress. It can be used as a stand alone treatment or with other therapies. It again teaches others to react differently to their symptoms. It has also been shown to help cancer patients focus better while progressing through their therapy.

There are also some completely different treatments for PTSD that do not involve the use of CBT.

Eye Movement Desensitization and Reprocessing (EMDR): This is a form of psychotherapy. During this form of therapy the patient will be told to listen to a particular sound or movement while thinking about their trauma. This both exposes the patient to their memories and puts them in a trance-like state to experience it. However, some methods of this therapy are up for debate. However, it has been show to help on average 77 percent of individuals with psychotic disorder and PTSD.

Present Centered Therapy (PCT): This is a non-trauma focused treatment. It centers around the present issues a patient might have, than the past ones. It also teaches problem solving so people can combat their future issues. There is a moderate level of research that suggests that PCT helps people with PTSD. However, in some control groups it has been shown to be ineffective. 

Traumatic Incident Reduction (TIR): This is a newer version of exposure therapy. It identifies the biggest frightening factor for someone with PTSD, and then aims to reduce the person's feelings around the memory.  It also aims to get the patient to talk about their memories and trauma calmly. TIR has also been shown to be more effective than standard direct therapeutic exposures.

Imagery rehearsal therapy (IRT):  This is a cognitive-behavioral treatment for reducing the  intensity of nightmares. It has been shown to be effective in short term treatment, but not in the long term. It also has to be further studied because veterans do not seem to respond to the treatment. As well as only 23% of patients showing a full recovery rate.

Guided Therapeutic Imagery: This is a technique that mental mental health workers use to help people in therapy focus on mental images and make them relax. It is almost the "yoga" version of PTSD therapy. It very much focuses on maintaining the person's physical health and mental health at the same time. It can also help treat general anxiety, grief ,and depression. Guided meditation for PTSD can come in two types. One focuses more on visualization, and leads the patient through a series of images. The other type focuses on mindfulness and helps people focus on their own thoughts.

Narrative Therapy: This is one of the more popular forms of therapy . In this treatment, it allows for people to retell their stories to process their memories. Basically, it is a storytelling form of therapy. It works well in children, but less so in adults. 

Sometimes therapy is not enough for specific cases, and medication becomes an option for controlling behavior. In this case, it is often at the discretion of the medical professional to decide. The majority of medications used to treat PTSD are either selective serotonin reuptake inhibitors (SSRIs), (which are antidepressants), or  Benzodiazepines.

PTSD in Film

There have been many depictions of PTSD in film. Some of them have been circled around characters, events, or war. Either way, let's take a look at some of them.

Iron Man:

The most popular depiction of a character with PTSD would probably be Iron Man. In the third Iron Man movie, as well as in the later Avengers movies, it's quite clear that Tony  Stark is traumatized by the events of the first avengers film. Fighting an alien army and watching New York be destroyed certainly did a toll on the superhero. He has constant flashbacks, hyperventilates, and is constantly anxious. However is this a proper depiction of someone with the disorder?

Placing Robert Downey Jr's acting aside, we can be somewhat confident that the character does have some level of PTSD. However, Tony seems to be exhibiting constant symptoms of the first stage of his traumatic stress, as well as the second stage of the disorder. Though, I'll be honest his recovery does seem a bit speedy to me in the context of the films.

T2 Trainspotting:

This film came out in 2017, and is based off the novel of the same name. This film is very unique because it focuses  on the flashbacks of it's characters. The VFX crew (Union VFX) had to really focus on developing the flashbacks for their intensity, and the character's previous environments. Depending on where the story was in the film, the edits also had to be concise and transition with emotion.  

The Hurt Locker:

This film came out in 2009, and focuses around a soldier played by Jeremy Renner and his team of explosive disposal experts. During the film, it slowly shows their psychological reactions to combat stress and how it affects their day to day lives. This film is probably one of most accurate depictions of war and its impacts on soldiers.

 

This film also won six academy awards. It was so culturally and historically significant that it was selected for preservation in 2020 by the National Film Registry. 

The Room:

This film came out in 2015. It is probably one of the hardest films to sit through. It follows a young mother and her son trapped in captivity and being held against their will. After their escape, it focuses on them trying to fit back into normal life and regaining their freedom. The acting in this film is spot on for actors portraying people would have been subjected to imprisonment and sexual violence. 

Brie Larson won an academy award for her portrayal as the mother, and also worked with a trauma specialist to understand exactly what the character was going through.

Virtual Reality for Mental Health

So as you might have guessed by now, visualization and imagery is an important part in healing a mind. So it's not surprising that technology could and will help mental health treatments. Already there are a few amazing examples of people putting technology to good use. So let's take a look at them. 

One of the biggest technologies on the mental health playing field is VR. (Virtual Reality) 

Zooming over to SIGGRAPH....In 2020, SIGGRAPH Asia was able to showcase some amazing work. Professor Skip Rizzo. who is a Director of the University of Southern California Institute, (Creative Technologies Medical VR Lab), was able to show something unique. Professor Rizzo has created a simulated environment for a virtual Iraq/Afghanistan VR exposure therapy project. This project is aimed at helping people with combat-related Post-Traumatic-Stress-Disorder. He has been working on simulated environments for PTSD assessment since 2004.  He has also developed VR game-based apps to help patients with CNS dysfunction who need physical and cognitive rehabilitation.

 

Rizzo describes his therapy as Extinction Learning.  But the VR exposure Rizzo is working with is based around traditional prolonged exposure therapy. However with VR, patients don't need a doctor to guide them through a flashback or treatment. This time they have a controlled story and game application.

The development of VR for mental health can be somewhat traced back to 1961. Even though VR was first developed in 1957, it wasn't used to simulate environments for people until years later. The first simulated "VR" experience was called the "Headsight" and was first used to train military personnel for dangerous situations.  It was first developed by the Philco Corporation.

Another VR treatment for PTSD is called Power Dreaming. It was developed by a few researchers from Virtual Reality Medical Center in San Diego California. It mainly is for patients suffering from nightmares related to Post-Traumatic Stress Disorder or traumatic brain injury (TBI). It integrates behavioral health and computer technology to change current behavioral health of patients. However, it doesn't follow a standard exposure therapy treatment, rather it focuses on building adaptive coping behaviors. It's researchers are also developing a mobile app for the game so treatment can be affordable and self-administered.

Mental Health Downsides in Visual Effects

In-between all these achievements, I do have to talk about the downside the visual effects industry can have on your mental health. As this is primarily something that most people are now warned about before they enter the VFX industry. Which is Burnout. 

Burnout is a state of emotional, physical, and mental exhaustion caused by  prolonged stress. It is quite common for artists in our industry to go through a phase of this. It also sometimes never goes away, and can have a lasting impact on them for the rest of their life. So is burnout a form of PTSD? The answer is yes.

There are a a lot of factors in our industry that increase the risks of burnout. For example, one of them being overtime.

Overtime plays a big factor in causing burnout. When you are working 55+ a week trying to get shots done, not seeing your family , waking up before sunrise and coming home after dusk, commuting, and so much more....It is incredibly hard to have energy to do other things.  And when you feel like you have to stay until the job is done, sometimes artists don't even head home. They just sleep at the studio. This leads a lot of people who are placed under a lot of pressure to snap.

Unfortunately, we have seen burnout go too far and cost people their lives. Just this past year in Montreal , Canada we saw a incredibly talented  producer get snuffed out by burnout. And that was not fair.

So it's our responsibility to look after ourselves. And if we can't, then know that you aren't alone. You can push through, and it will get better. Be open with your struggle and speak up when you need help. 

Closing Notes

So I've mentioned a lot through this article that virtual reality and other visualization techniques are being used to improve PTSD treatment. But is there anything else in visual effects that could be used to treat people?

Well, I would argue yes. Simply from personal experience. We know that a mix between visual treatment and active participation in therapy goes a million miles for someone's mental state. I would slightly argue that any activity that involves a person actively creating art or images and problem solving at the same time can have similar effects. it's one of the reasons why art is so therapeutic.  It quite literally helps people paint out their pain. 

So could training someone in a visual effects software have a similar effect on it's users as a mental health application?

As VFX artists, we constantly have to problem solve and create things beyond our imaginations. As well as mimic everything in our surroundings. So could this count as a form of image related therapy? As our jobs force us to relive basic human actions and events in a software. As well as model items from our imagination. And at the same time make us actively participate in a different narratives with those structures.

Maybe. I'm not entirely sure. I would love to see a university grad do a deep dive on this. Or maybe write a paper about it. I'm not qualified to do so, but as someone who finds working in Houdini rather calming, I think it's worth looking into.  

Mental Health Resources:

Canada-wide Mental health Resources:

Kids Help Phone: Text Services: Text "CONNECT" to 686868 (also serving adults)
Chat Services: https://kidshelpphone.ca/live-chat/

Youthspace.ca (NEED2 Suicide Prevention, Education and Support): Youth Text (6pm-12am PT): (778) 783-0177

Youth Chat (6pm-12am PT): www.youthspace.ca

Crisis Services Canada: Toll Free (24/7): 1 (833) 456-4566

Text support (4pm-12am ET daily): 45645

Canadian Crisis Hotline:1 (888) 353-2273

World-wide Menth Health Resources:

Checkpoint Mental Health Services: HERE

World Health Organization: HERE

References:


Power Dreaming: A protocol for decreasing PTSD-related nightmares using virtual reality: https://www.icf.com/insights/health/power-dreaming

The 4 Arms of Adaptive Technology: https://blog.siggraph.org/2018/09/the-4-arms-of-adaptive-technology.html/

DR. SKIP RIZZO AND THE RISE OF MEDICAL VR THERAPY: https://www.vfxvoice.com/dr-skip-rizzo-and-the-rise-of-medical-vr-therapy/

Explore Digital Humans, VR for Mental Health, and In-Camera VFX at SIGGRAPH Asia 2020: https://www.awn.com/news/explore-digital-humans-vr-mental-health-and-camera-vfx-siggraph-asia-2020

Combat Stress Reveals How Trauma Traps Soldiers on the Battlefield: https://www.lbbonline.com/news/combat-stress-reveals-how-trauma-traps-soldiers-on-the-battlefield

VR FOR GOOD: https://vfxscience.com/2020/12/13/vr-for-good/

VFX Artist Needed LA: https://filmlocal.com/job/vfx-artist-needed-la/

'Iron Man 3': Does Tony Stark Have PTSD? (Guest Column): https://www.hollywoodreporter.com/heat-vision/iron-man-3-does-tony-520868

Understanding mental health: https://www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/understanding-mental-health?utm_campaign=vac-acc-mentalhealthservices-20-21&utm_medium=sem&utm_source=ggl&utm_content=ad-text-en&utm_term=ptsd&adv=2021-0058&id_campaign=11855189917&id_source=115371580076&id_content=486568459399

‘Hacksaw Ridge’ Sound Mixer Kevin O’Connell On Producing A PTSD-Triggering Soundscape: https://deadline.com/2016/12/hacksaw-ridge-mel-gibson-kevin-oconnell-lionsgate-oscars-sound-mixer-interview-1201856277/

COMBAT STRESS: EXPERIENCE LONG-TERM PTSD. THE FILM THAT MAKES IT STAY IN YOUR HEAD TOO: https://www.thestable.com.au/combat-stress-experience-ptsd-the-film-that-makes-it-stay-in-your-head-too/

How Virtual Reality Can Help The Global Mental Health Crisis: https://www.forbes.com/sites/solrogers/2019/05/15/how-virtual-reality-can-help-the-global-mental-health-crisis/?sh=2523747128f7

Dr. Mark Wheeler reflects on the PTSD work recorded in Lifted: https://screeninnovation.co.uk/lifted/

Miami VA Treating PTSD With VR: https://www.creativeplanetnetwork.com/government-video/miami-va-treating-ptsd-with-vr

Imagery Rehearsal Therapy to Treat Nightmares With PTSD: https://www.verywellmind.com/imagery-rehearsal-therapy-2797304

NightWare is a prescription-only Apple Watch app for PTSD: https://9to5mac.com/2020/11/09/nightware/

THAT WHICH I LOVE DESTROYS ME: https://vashivisuals.com/that-which-i-love-destroys-me-ptsd-4632/

Guided Therapeutic Imagery: https://www.goodtherapy.org/learn-about-therapy/types/guided-therapeutic-imagery

Guided Meditation for PTSD: https://declutterthemind.com/guided-meditation/ptsd/

Mental Imagery and Post-Traumatic Stress Disorder: A Neuroimaging and Experimental Psychopathology Approach to Intrusive Memories of Trauma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510312/


PTSD: why some techniques for treating it work so fast: https://www.hgi.org.uk/resources/delve-our-extensive-library/anxiety-ptsd-and-trauma/ptsd-why-some-techniques-treating-it

Guided Imagery and PTSD: A Different Approach to Treatment: https://www.nicabm.com/trauma-guided-imagery-and-ptsd-a-different-approach-to-treatment/

EXPOSURE AND VISUALIZATION THERAPIES: https://www.gulfbend.org/poc/view_doc.php?type=doc&id=55770&cn=109

Union VFX Catches the Last Train for ‘T2 Trainspotting’: https://www.digitalmediaworld.tv/in-depth/1391-union-vfx-catches-the-last-train-for-t2-trainspotting

What Are the Stages of PTSD?: https://pyramidfbh.com/what-are-the-stages-of-ptsd/

PTSD Facts & Treatment: https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/treatment#:~:text=Cognitive%20Behavior%20Therapy%20(CBT)%3A,the%20center%20of%20the%20treatment.

8 Movies About PTSD (Post-Traumatic Stress Disorder: https://alorecovery.com/8-movies-about-ptsd-post-traumatic-stress-disorder/

Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans: https://pubmed.ncbi.nlm.nih.gov/20412888/#:~:text=Imagery%20Rehearsal%20Therapy%20(IRT)%20has,been%20well%2Dstudied%20in%20veterans.&text=Insomnia%20and%20PTSD%20symptoms%2C%20on,%3D1%20nightmare%2Fweek).