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By KATHERINE MANGAN

The 19-year-old woman glares at her computer screen, furious because her 
roommate wants a friend to move in with them, rent-free. But instead of 
calmly asserting herself, she begins yelling, and her virtual world is put 
on pause.

Then the woman replays the encounter, which occurred not with a live 
roommate, but between digital characters, or avatars, guided by a 
clinician in the Center for Brain Health at the University of Texas at 
Dallas. The woman and the clinician consider how she could have handled 
the situation better.

Then the woman is back in the virtual town, created specially for patients 
who, like her, have Asperger's syndrome. The disorder is a mild form of 
autism marked by normal intelligence and a variety of cognitive defects, 
including troubles with social interaction or adapting to change.

Asperger's patients have been treated by role-playing with real-life 
therapists. The virtual-reality town at the medical center is a new twist. 
"The clinicians can change the virtual world to increase the complexity of 
the exercise, control for sensory overload, provide motivation, and record 
feedback. It's very safe," says the center's executive director, Sandra B. 
Chapman.

The university uses a platform from Second Life, the popular virtual 
world, in which patients go to an "island" customized for therapeutic 
purposes. The island was built by undergraduates in the university's 
game-design program, guided by the center's clinicians.

Patients design their avatars to look as much like themselves as possible, 
and can readily access programmed gestures to make their likenesses smile, 
shrug, or express impatience by tapping their feet.

Building Social Skills

Virtual reality is gaining traction as a form of psychotherapy at many 
academic medical centers, says Zachary Rosenthal, director of the 
Cognitive Behavioral Research and Treatment Program at Duke University 
Medical Center. It "allows you a wider, more flexible platform, with a 
broader variety of cues and potential scenarios to build social skills," 
he says. Mr. Rosenthal has created a virtual crackhouse at Duke to help 
addicts control their craving.

In Dallas, says Ms. Chapman, Asperger's patients experience the same 
emotions they would in a direct encounter. "They're interacting in real 
time with real people in surprisingly realistic scenarios," she explains. 
They make small talk, using headsets and microphones, and settle conflicts 
with people in virtual restaurants, shops, offices, and parks. These 
people are mostly clinicians and volunteers represented by their own 
avatars.

Researchers in Dallas also conduct brain-imaging and neurocognitive tests 
on the patients before and after the virtual-world therapy sessions. The 
three patients they have tested so far have shown improvements in several 
areas, including "social appropriateness." They are less likely, for 
instance, to make inappropriate jokes and more likely to be able to read a 
person's body language.

Matt Kratz, a 35-year-old graduate student with Asperger's syndrome who 
has been treated in the program, says he feels more confident making small 
talk, especially with women, since practicing in virtual reality.

"I'm usually not good with someone face to face," he says. "I tend to feel 
awkward and put my foot in my mouth."

In his virtual world, Mr. Kratz was able to see, for example, that an 
innocent comment about a rose on a woman's shirt could be misconstrued as 
a pickup line, and how his flat tone when talking with a friend who had 
just received a promotion could be construed as a lack of concern. "I feel 
like I'm more prepared now," he says, "when I go out into the real world."