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The evidence is still tentative, but experts on virtual worlds as well as health care say they see a lot of promise in virtual worlds as a forum for addressing real-world woes in a kinder, gentler environment.

Researchers explored the therapeutic value of virtual worlds during sessions last weekend at the American Association for the Advancement of Science's annual meeting in San Francisco.

In computer-generated worlds such as Second Life, each user is represented by an "avatar" figure who may or may not resemble the user's real-world persona. That avatar can interact with others in the virtual space — and even buy and sell items, building up a store of possessions that exist only in that space.

Thomas Malaby, a cultural anthropologist at the University of Wisconsin at Milwaukee, said Second Life isn't a video game in the strict sense of the word, since the experience isn't necessarily aimed at producing winners and losers. But Second Life does provide an environment where users can achieve success or failure, just like real life, he said.

"What we're really noticing in places like Second Life is the legacy of games, what games can contribute to creativity, and to open-ended thinking, where learning can take place, where therapy can take place," said Thomas Malaby, a cultural anthropologist at the University of Wisconsin at Milwaukee.

Virtual Iraq

Albert "Skip" Rizzo, a clinical psychologist and professor at the University of Southern California's Institute for Creative Technologies, has researched the use of virtual reality as a therapeutic distraction for children undergoing chemotherapy, and to add a gamelike thrill to the often-boring routines for motor rehabilitation.

Lately, he's been focusing on post-traumatic stress disorders among combat veterans returning from the war in Iraq.

Rizzo adapted a video game called Full Spectrum Warrior to create a "virtual Iraq" — an environment that lets veterans relive and talk through the stresses they went through in real life. The patients wear virtual-reality goggles with a video-game view of a desert or urban environment — and there's even lab equipment to duplicate the smells or vibrations that would be experienced during a Humvee ride.

The principle is basically the same as that used to counter a fear of heights or a fear of flying, Rizzo told reporters. The patients are guided through scenarios that start out with the least threatening elements of their experience — say, standing beside their Humvee on a desert road. As they progress, they become less anxious about reliving the experience, and eventually work their way up to more stressful events such as roadside bombings or sniper attacks.

Although Rizzo's studies so far are based on only a handful of patients, followed over three- or six-month periods, he said some veterans have shown "clinically significant declines" in the symptoms of post-traumatic stress disorder, such as nightmares, jumpiness vigilance or a tendency to avoid talking about their experiences.

"Those are just the cold, clinical descriptions," he said. "This translates into being able to leave your house, being able to go to work, being able to carry on a relationship with your wife or loved one."

Going forward, Rizzo said a virtual world like Second Life probably wouldn't be suitable for the kind of focused therapy provided in the clinic, but could play an important support role: "I could see there being a 'virtual barracks' — and there probably is one in Second Life," he said. Such a gathering place could provide an outlet for veterans who suspect they may be facing a tough time ahead, he said.

Virtual support

More than once, virtual worlds have provided a safe haven for those dealing with real-world problems, said John Lester, community and education manager at San Francisco-based Linden Lab, the company that created Second Life.

"Some of the interesting things that we're seeing in Second Life mirror what you see happening on the Web," he said. "You see people with cerebral palsy or stroke survivors who are doing the physical mobility thing. In virtual environments like Second Life, they're free from the physical limitations they're dealing with."

That sense of freedom from the physical world is almost as old as the World Wide Web itself. After all, on the Internet, no one knows you're a dog — or a patient with a disability. But Lester said the fact that users create online avatars that walk, talk and interact adds a dimension to the experience.

"The special thing about Second Life and virtual spaces in the world in general is that you have a great deal of emotional bandwidth — much more than just text on a screen," he said. "You have a sense of place, you have a sense of identity."

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