David Shier came home to Warner Robins, Georgia, after serving in the military in Afghanistan from 2009 to 2010, with what would become a crippling case of post-traumatic stress disorder.
"Before it got to where I was homebound, I could go out. But there was a limit of what and how long I could take. It was like a brick wall. I would go to the grocery store, and I would be fine up until the point that I wasn't fine. And I had to get out," the former Army National Guard sergeant said.
Get out – as in put down the groceries and head for the door. PTSD made Shier hyperalert, wary of busy places and primed to flee.
His symptoms got so bad that he ended up mostly staying home, feeling anxious and depressed. As a veteran, Shier was eligible for medication and cognitive behavioral therapy through the federal government. But they didn't solve the problem.
Then, his mother spotted an ad on Facebook for a clinical trial at the Medical University of South Carolina that would change his life. "I went from not even being able to function to working two jobs, being a homeowner, having a portfolio now. I have a future, and it was because of those sessions," Shier said.
He credits his stunning transformation to a new approach to exposure therapy that uses technology called BioWare to help people with PTSD face situations they previously avoided.
Bio Ware
So what is Bio Ware? It's a new way of doing prolonged exposure therapy, where a person repeatedly goes into stressful situations with a therapist's help. The hope is that over time, the patient will feel less anxious and depressed.
Traditional prolonged exposure therapy involves talking through what caused the PTSD, during a series of appointments, according to guidelines from the American Psychiatric Association. The therapist figures out what situations the patient has trouble being in and then encourages the patient to go into those situations between appointments, a process called in vivo exposure.
What's new with Bio Ware is the use of technology that allows therapists to go into the situations with patients – virtually. Patients wear a camera that looks like a button, so it can blend into a shirt, along with devices that measure patients' stress levels through their heart rates and skin responses. A cell phone app lets patients talk with the therapists as they go into situations they'd normally avoid. Meanwhile, the therapists can see what patients see through the button camera and offer guidance.
Researchers at MUSC put Bio Ware to the test. Results will be published soon in the Journal of Psychiatric Research.
MUSC was a logical site for the trial because Bio Ware was developed by Zeriscope, a company co-founded by Robert Adams, M.D., Distinguished University Professor of Neurology at MUSC. The other founder is the entrepreneur Bill Harley. Adams and Harley were the only ones involved in the study team of 11 with a financial interest in Bio Ware.
Sudie Back, Ph.D., a professor in the Department of Psychiatry and Behavioral Sciences at MUSC, was principal investigator on the project. She said the researchers wanted to see if Bio Ware could help veterans suffering from PTSD, in an initial trial of 40 veterans. PTSD is notoriously difficult to treat, with many patients dropping out of treatment.
Their conclusion: Bio Ware was highly effective.
"This is the first study that I know of that has used a system to allow the clinician to virtually go with the patient during the in vivo exercises and also to have access to their heart rate and their skin response while they're actually doing the in vivo exposure as well as their SUDS," Back said. SUDS stands for subjective unit of distress scale, a way for the patient to describe how distressed they are feeling.
Tanya Saraiya, Ph.D. an assistant professor at Rutgers University who was one of the clinical psychologists involved in the study when she was an assistant professor in the Department of Psychiatry and Behavioral Sciences at MUSC, said it gave her new insight into what her patients were experiencing.
"If I was guiding somebody, I could see what they were seeing. I could see their physiology. I could ask them about their subjective units of distress, or SUDS, in that moment, and also help them do things that are increasingly more difficult. So, go down a crowded aisle or go to a cash register with a person there, instead of avoiding those situations," she said.
"I also learned a lot about what my patients avoided because it's a little counterintuitive as a therapist to say, 'What do you avoid in life?' They avoid it. So they don't really know. When I go with them virtually, I learn what they actually avoid."
The study involved 10 to 12 sessions of prolonged exposure therapy. Shier, the veteran who served in Afghanistan, said he started to feel better pretty quickly. "It did in 10 weeks what other treatments couldn't do in 10 years. I'm completely off medication now, and I'm happy. It was a completely night and day difference."
Next steps
The researchers said Bio Ware has the potential to help a lot of people. "The national lifetime rate of PTSD is 8% in the general population, but it's much higher, closer to 20%, among veterans." Saraiya said.
The psychologist noted that PTSD isn't just debilitating. It's expensive. "The economic cost of PTSD is No. 2 of all mental health disorders in terms of the loss of productivity and the influence on the health care system."
BioWare is undergoing further testing, including checking to see if it can help people with both PTSD and alcohol use problems. For that, the researchers added a breathalyzer and alcohol-specific counseling.
Saraiya said her experience with technology-driven prolonged exposure therapy has been rewarding for her and her patients. "It's beautiful to see people transform and do things they haven't done in a long time."
That includes Shier. "The treatment went amazing," he said.
He had some advice for others suffering from PTSD. Find something that works. Don't stay shut in. And acknowledge the problem. "You have to want to be helped. You can't just go and expect good things to happen. You have to knuckle up and put in the work. Because if you don't, it's going to be all for naught."
