three-dimensional space with the organ that requires surgical treatment, view it from any desired angle and able to switch between 3d view and the real ct images. efficacy randomized, tightly controlled, acrophobia treatment trials at kaiser permanente provided >90% effectiveness, conducted in 1993–94. (ext. ref. 2, pg. 71) of 40 patients treated, 38 showed marked reduction in phobic reaction to heights and self-reported reaching their goals. research found that vrt allows patients to achieve victory over virtual height situations they could not confront in real life, and that gradually increasing the height and danger in a virtual environment produced increasing victories and greater self-confidence in the patient that they could actually confront the situation in real life. "virtual therapy interventions empower people. the simulation technology of virtual reality lends itself to mastery oriented treatment ... rather than coping with threats, phobics manage progressively more threatening aspects in a computer-generated environment ... the range of applications can be extended by enhancing the realness and interactivity so that actions elicit reactions from the environments in which individuals immerse themselves" (ext. ref. 3, pg. 331–332). another study examined the effectiveness of virtual reality therapy in treating military combat personnel recently returning from the current conflicts in iraq and afghanistan. rauch, eftekhari and ruzek conducted a study with a sample of 42 combat servicemen who were already diagnosed with chronic ptsd (post-traumatic stress disorder). these combat servicemen were pre-screened using several different diagnostic self-reports including the ptsd military checklist, a screening tool used by the military in the determination of the intensity of the diagnosis of ptsd by measuring the presence of ptsd symptoms. although 22 of the servicemen dropped out of the study, the results of the study concerning the 20 remaining servicemen still has merit. the servicemen were given the same diagnostic tests after the study which consisted of multiple sessions of virtual reality exposure and virtual reality exposure therapy. the servicemen showed much improvement in the diagnostic scores, signaling a decrease of symptoms of ptsd. likewise, a three-month follow-up diagnostic screening was also administered after the initial sessions that were undergone by the servicemen. the results of this study showed that 15 of the 20 participants no longer met diagnostic criteria for ptsd and improved their ptsd military checklist score by 50% for the assessment following the study. even though only 17 of the 20 participants participated in the 3-month follow-up screening, 13 of the 17 still did not meet the criteria for ptsd and maintained their 50% improvement in the ptsd military checklist score. these results show promising effects and help to validate virtual reality therapy as an efficacious mode of therapy for the treatment of ptsd (mclay, et al., 2012). vr combined real instrument training was effective at promoting recovery of patients' upper-extremity and cognitive function, and thus may be an innovative translational neurorehabilitation strategy after stroke. in the study, the experimental group showed greater therapeutic effects in a time-dependent manner than the control group, especially on the motor power of wrist extension, spasticity of elbow flexion and wrist extension, and box and block tests. patients in the experimental group, but not the control group, also showed significant improvements on the lateral, palmar, and tip pinch power, box and block, and 9-hpts from before to immediately after training. continued development larry hodges, formerly of georgia tech and now clemson university and barbara rothbaum of emory university, have done extensive work in vrt, and also have several patents and founded a company, virtually better, inc. in the united states, the united states department of defense (dod) continues funding of vrt research and is actively using vr in treatment of ptsd. millions of funding is being put towards developments and early trials in the realm of virtual reality as companies race for fda approval for their medical applications. bravemind software in 2014, a virtual reality application used as a prolonged exposure (pe) therapy tool for military related trauma called bravemind was reported bravemind is as an acronym for battlefield research accelerating virtual environments for military individual neuro disorders. virtual reality exposure therapy (vret) applications have been used to assist civilian populations with anxieties about flying, public speaking, and heights. bravemind has been studied in populations of military medics as well as survivors of military sexual assault and combat. this technology was developed by researchers at the university of the southern california in collaboration with the u.s. army research laboratory. in 2004, reports stated that 40% of military members experience ptsd but only 23% seek medical help. emory physicians described one of the strongest indicators of ptsd to be avoidance, saying this inhibits those affected from seeking treatment. pe requires that the patient close their eyes and relate the pertinent episode in as much detail as possible. the methodology was based on the concept that in facing the event, the charge of the triggers may be attenuated over time. the vret application bravemind differs from pe in that the patient does not reimagine the episode but instead wears a headset that places them in the familiar environment. this headset is equipped with two screens (one for each eye), headphones, and a position monitor that shifts the visual scene to match the patient's head movements. depending on the patient's experience they may be standing or sitting on top of a raised platform with a bass shaker. this allows for vibrations that simulate the experience of riding a military vehicle. other accessories such as joysticks or mock machine guns are given to the patients, if appropriate, to enhance realism. the clinician introduces triggers, such as gunfire, explosions, etc. into the virtual environment as they see fit. the clinician can also adapt sound and lighting conditions to match the patient's description. the researchers who developed the bravemind system reported that in a 20-patient trial, the patients' scores on the diagnostic ptsd checklist–military version (pcl-m) dropped from 54.4 pre-treatment to 35.6 post-treatment after eleven sessions. in another clinical trial, consisting of 24 active-duty soldiers, it was reported that after 7 sessions 45% no longer were identified as positive for ptsd while 62% demonstrated symptomatic improvement. these experimental results were compared with those of alternative pe treatments. the bravemind software has 14 different environments available including military barracks, iraqi markets, and desert roads. included in these are environments specific to military sexual trauma (mst). designed environments such as u.s. base settings, shower areas, latrines, remote shelters, and others were developed after consulting subject matter experts from emory university. proponents of this research have said that with military based videogames being so prevalent, this technology may be more appealing to patients and reduce the stigma surrounding treatment. they also have argued that as research on ptsd unfolds, possible subtypes may respond to treatments differently, and therefore diversifying treatment options is best. others have expressed reservations about the capacity to properly personalize vret for individualized treatment and the use of ethnic stereotyping while developing arab populated environments. treatment for lesions virtual reality therapy has two promising potential benefits for treatment of hemispatial neglect patients. these include improvement of diagnostic techniques and as a supplement to rehabilitation techniques. current diagnostic techniques usually involve pen and paper tests like the line bisection test. though these tests have provided relatively accurate diagnostic results, advances in virtual reality therapy (vrt) have proven these tests to not be completely thorough. dvorkin et al. used a camera system that immersed the patient into a virtual reality world and required the patient to grasp or move object in the world, through tracking of arm and hand movements. these techniques revealed that pen and paper tests provide relatively accurate qualitative diagnoses of hemispatial neglect patients, but vrt provided accurate mapping into a 3-dimensional space, revealing areas of space that were thought to be neglected but which patients had at least some awareness. patients were also retested 10 months from initial measurements, during which each went through regular rehabilitation therapy, and most showed measurably less neglect on virtual reality testing whereas no measurable improvements were shown in the line bisection test. virtual reality therapy has also proven to be effective in rehabilitation of lesion patients with neglect. a study was conducted with 24 individuals with hemispatial neglect. a control group of 12 individuals underwent conventional rehabilitation therapy including visual scanning training, while the virtual reality group (vr) were immersed in 3 virtual worlds, each with a specific task. the programs consisted of "bird and ball" in which a patient touches a flying ball with his or her hand and turns it into a bird "coconut", in which a patient catches a coconut falling from a tree while moving around "container" in which a patient moves a box carried in a container to the opposite side. each of the patients of vr went through 3 weeks of 5-day-a-week 30-minute intervals emerged in these programs. the controls went through the equivalent time in traditional rehabilitation therapies. each patient took the star cancellation test, line bisection test, and catherine bergego scale (cbs) 24 hours before and after the three-week treatment to assess the severity of unilateral spatial neglect. the vr group showed a higher increase in the star cancellation test and cbs scores after treatment than the control group (p<0.05), but both groups did not show any difference in the line bisection test and k-mbi before and after treatment. these results suggest that virtual reality programs can be more effective than conventional rehabilitation and thus should be further researched. vr advantages over ive the preference of virtual reality exposure therapy over in-vivo exposure therapy is often debated, but there are many obvious advantages of virtual reality exposure therapy that make it more desirable. for example, the proximity between the client and therapist can cause problems when in-vivo therapy is used and transportation is not reliable for the client or it is impractical for them to travel as far as needed. however, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. going along with the idea of unavailable transportation and proximity, there are many individuals who require therapy but due to various forms of immobilizations (paralysis, extreme obesity, etc.) they can not physically be moved to where the therapy is conducted. again, because virtual reality exposure therapy can be conducted anywhere in the world, those with mobility issues will no longer be discriminated against. another major advantage is fewer ethical concerns than in-vivo exposure therapy. another advantage to virtual reality rehab over the traditional method is patient motivation. when presented with difficult tasks during a prolonged period, patients tend to lose interest in these tasks. this causes a decrease in compliance due to decreased motivation of completing a given task. virtual reality rehab is advantageous in such a way that it challenges and motivates the patient to do more. with simple things like high scores, in-game awards, and ranks, not only are patients motivated to do their daily therapies, they are having fun doing it. not only is this advantageous to the patients, it is advantageous to the physical therapist. with these high scores, and data the game or application collects, therapists can analyze the data to see progression. this progression can be charted and visually shown to the patient for increased motivation on their performance and the progression they have made thus far in their therapies. this data can then be charted with other participants doing similar tasks and can show how they compare to people with similar therapy regimens. this charted data in the program or game can then be used by researchers and scientists alike for further evaluation of optimal therapy regimens. a recent study done in 2016 where a vr based virtual simulation of a city named reh@city was made. this city in virtual reality evoked memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. this study looked at activities of daily living in post stroke patients and found it to have more of an impact than conventional methods in the recovery process. concerns there are a few ethical concerns concerning the use and development of using virtual reality simulation for helping clients/patients with mental health issues. one example of these concerns is the potential side effects and aftereffects of