Ukrainian Refugees Are Working Through Trauma in a Metaverse Version of Kyiv

Valeria Balashova, a 28-year-old woman from the southern Ukrainian city of Odessa, fled to Bucharest in March of last year to escape the war. She has since been back only in virtual reality.

In October, she was contacted by a Romanian colleague’s psychologist and asked if she would be interested in taking part in a new program designed to provide therapeutic support for Ukrainians, both at home and abroad, who were being affected by the war. This program, she was told, would take place not in a therapist’s office but in VR. “I told him that it's a very great idea, and of course I would be glad to take part in it,” she told me on a Zoom call.

The program is set within a virtual rendering of Kiev’s House with Chimaeras, a squat fortress bristling with ornate statues of animals, which sits just across the street from Zelensky’s office in the Ukrainian capital. 

The virtual environment is serene: a blue sky, plenty of greenery, and graceful buildings cloaked in the shade of a summer afternoon. In the middle of the square sits a dark circular area, ringed by blue couches—the type you might see in a therapist’s office. 

This virtual House with Chimaeras has been designed as a space where Ukrainians, many of them displaced from their home country since the start of the war, can meet in VR, share stories, and hopefully recover from their individual and shared traumas. 

The VR program is oriented around talk therapy and peer support, two of psychiatry’s traditional frontline defenses against PTSD. Developed by an international team of psychologists in partnership with the VR platform 8agora, each participant—including a therapist, who guides each session—appears as a customizable avatar. In a pilot session which was recorded and posted to YouTube, Balashova and two other Ukrainian refugees currently living in Bucharest discussed some of the more mundane challenges they’ve encountered since relocating to a new country. 

“I moved to Romania with my [two] daughters,” a Ukrainian woman says through her avatar, which has pink hair and symmetrical face tattoos. “[We] faced the problem of the language barrier… The first time was hard, but I signed up for a course.” Another woman lamented the difficulties of adapting to the transit system in Bucharest. And so on. 

The subject matter of the conversation was easygoing by design. “People with PTSD sometimes don't react well when other people mention a traumatic event that they themselves went through,” says Dr. Cezar Giosan, Associate Professor of Psychology, University of Bucharest, who helped design the virtual peer support group. “They may have a panic attack during the session… we don't want that.” Better to have the participants start slow, discussing everyday frustrations, before delving deeper into the traumas they've experienced.

The psychologists leading the project hope that VR will help to cut through some of the stigma surrounding PTSD. One study published last year in the European Journal of Psychotraumatology assessed 194 adults with PTSD in the UK and found that close to half (41.2 percent) were affected by “self-stigma,” which the authors of the study defined as “the internalization of negative societal views and stereotypes.” That study also found that the participants who reported feeling self-stigma were also experiencing “lower income and higher levels of anxiety, depression, and traumatic stress symptoms.”

In VR, however, it appears that some of that stigma can be ameliorated: “There's really no shame in it, but [sexual assault is] not an easy thing to talk about,” Dr. Albert ”Skip” Rizzo, a clinical psychologist, the director of medical virtual reality at the Institute for Creative Studies (ICT) at the University of Southern California (USC), and one of the experts developing the project, said about one specific type of trauma that VR therapy has shown promise in treating. “You should be able to talk about it and get support, but a lot of people [feel] stigma about it. By doing it behind the face of an avatar it becomes a little easier, and for the first time, maybe people start to feel more comfortable talking about the pain that they went through, and that becomes the first step towards healing.”

According to Balashova, Ukrainians tend to feel their own, culturally unique form of stigma. “We’re not used to asking for help, because we know that nobody will help us,” she told me. “Our government will not help us— usually, everybody is on his [or her] own.” But within VR, she says that she and the other participants felt more relaxed, more at ease with their vulnerability. “It gives you freedom of thinking, freedom of speech. It opens you more … I hope that they will continue developing [the program], so it will really start working and helping people daily.”

The peer support VR program also has the added benefit of being accessible across platforms; no expensive VR headset required. “You can [access the program] from any device that's connected to the internet,” Giosan says. “You want to make these things as simple as possible — point and click, basically.”

Walking through a war-torn Ukraine with Katniss Everdeen

A military helicopter flies overhead, scanning the streets below like a bird of prey. Cratered buildings billow smoke. A large fire burns in the middle of a rubble-strewn street. Abandoned tanks. Blue and yellow Ukrainian flags blow stiffly in the breeze. Indiscernible shouting. Distant gunfire from automatic weapons. The sudden, shrill wail of an air raid siren. Two carbon copies of Katniss Everdeen—the messianic protagonist from The Hunger Games franchise—standing stoically through the entire chaotic scene and staring at you expressionlessly.

These are the sights and sounds that one encounters in a demo video for “Ukraine World,” another VR program that’s currently being developed by 8agora, Rizzo, and his colleagues in an effort to help Ukrainians suffering from PTSD. The program—a prototype for what its creators hope will evolve into a much more realistic virtual experience—currently resembles early versions of Call of Duty. 

Katniss, a symbol of strength and courage in the face of tyranny, was programmed into the demo version of Ukraine World as one of its default avatars.

“Our view for this was to set a stage where people could be in realistic surroundings, which might serve to activate their emotional memories in a more direct way,” Rizzo says. “We're using VR because it's an emotionally evocative technology. It's different than abstract recollection; it’s a tool to help people who oftentimes are bottled up to express their emotions and confront and reprocess difficult emotional memories.”

“I know female psychologists who work with [Ukrainian] females who have been prisoners of war—they could do only two or three sessions, and then they have to switch, because it's just impossible to even hear all of the atrocities that these women were experiencing,” says Olya Zaporozhetz, a Ukrainian psychologist who currently teaches at Regent University in Virginia. “It’s just horrible.”

Rizzo, who has also heard these accounts second-hand, puts it a bit more bluntly. “It's like a fucking horror show,” he says. “Ukraine will be a Petri dish of PTSD and [other] mental health challenges for many years to come.”

Zaporozhetz—who was born and raised in Zaporizhzhya, a city in southeastern Ukraine and home to Europe’s largest nuclear power plant (currently occupied by Russian forces)—has been working with Rizzo to develop the Ukraine World program, which is based on Bravemind, a VR software developed by the ICT that has been previously used to create virtual versions of Iraq and Afghanistan. 

In the process of building Virtual Iraq, Rizzo and his colleagues enlisted the help of an audio anthropologist from New York University who (actually) visited Iraq during the war to record the spectrum of sound—including those from weapons, of course, but also more mundane sounds which filled the quiet moments, such as casual conversations and birdsong. “The sound of birds chirping is ubiquitous in Iraq, believe it or not,” says Rizzo.

The compilation of what Rizzo describes as “very high-fidelity sound” from Virtual Iraq is now “directly translatable to the Ukrainian situation,” he tells me.

An outsider might expect the more explicit sounds of violent conflict—the steady pop-pop-pop of an AK-47, for example, or a nearby explosion. But Rizzo says the real triggers are often much more subtle. “One of the most evocative sounds that we have is one of a baby crying,” he says. “You blow up a bomb, you create a disturbance in the marketplace, you hit a button that [activates] sounds of people freaking out, and then you hear this haunting baby crying in the background; Christ, that brings people to tears sometimes.”

Zaporozhetz is currently collaborating with the ICT to test and further develop the Ukraine World program. She hopes to begin making it accessible to psychologists in Ukraine sometime this summer, and she’s keeping a long-term vision in mind: “We're preparing this tool for after [the] war,” she says. Like the VR peer support group, Ukraine World will be accessible via VR headsets, desktop computers, and mobile devices.

‘You just have to live’

Towards the end of my Zoom call with Balashova—the Ukrainian woman living in Romania—I asked her how she managed to keep herself from being overwhelmed by stress; despite everything she’s been through, she seemed cheery and upbeat throughout most of our conversation. 

“The hardest part is that I left my family there,” she said. Her mother had died of cancer just a couple of months before the Russians invaded in February; her father, her uncle, one of her brothers, her two grandmothers, her dog, and her cat would all remain behind in Odessa. She recalls that when her father drove her to the border and said goodbye, he told her: “Maybe we will see [each other] sometime again.”

In addition to losing her mom and being separated from the rest of her family, she also recently lost a friend, who was killed in the fighting in Ukraine. 

“All of us have lost something or somebody in this war,” she told me. “[But] I never never let the thought, ‘Everything is bad,’ get in my head. Like, yeah, everything can be bad, but it's just today, and you have tomorrow. The sun is shining. Sunrise is beautiful. Sunset is beautiful … You just have to live, not swim in this lake of sadness.

“And also I’m distracting myself from my emotions,” she adds with a laugh. “That's what I'm working on with my psychologist.”