I thought I would add that exposure therapy or any therapy doesn't make people immune to being retraumatized. Once compromised, the nervous system tends to break down a lot faster with any new trauma, so the idea of sending soldiers back into the field is beyond the pale. Being re-exposed can actually break a part whatever confidence the person had in the original therapy and make it more difficult to recover from the next time.

Something else I thought I would add is that PTSD untreated can lead to what is called "chronic" PTSD (usually from childhood sexual and physical abuse) and then another level of it with people who have suffered with it for years that is called "malignant" PTSD that literally destroys people's identity. This last is almost always associated with war trauma and involves as a major component the extreme "guilt" associated with killing others or not being able to stop the killing of others. These people literally cannot forgive themselves. Difficult to treat PTSD ALWAYS has a component of guilt and/or shame. Guilt and shame can lock PTSD in a person into a self-destructive cycle. And since I don't hear that "Smith" was fully through with his anxieties, etc., I doubt seriously that utilizing just the game video exposure therapy does much with this particular component. And this would be obvious since it is something that would be detrimental to the cause of fighting the war and guilt is a huge behavioral control the armed forces use to keep soldiers in line (e.g., Smith's saying he had been told it would be his fault for getting shot((!!!). I wonder that they even mention it. So that relieving that guilt is forbidden and the other guilt of killing people is often hidden and unacknowledged - which then brings the feeling guilty about feeling guilty because you're guilt is some how dishonorable to your war buddies! But if you do not deal with the guilt as a crucial aspect of the PTSD, you're only putting a bandaide on a seriously infected wound.

Yes, loss of hope or no hope or no previous experience of hope or safety makes it extremely difficult to help people. Think about it. As a child, you probably had experiences that were safe and "hopeful" and wonderful. Children without these or few of these have no foundational or developmental experiences or memory from which to draw on to create new ones. Prisoners in extreme situations soon accumulate experience after experience of no hope and no safety so that even what they had before is of little use. They're inundated with life as one shitty experience. Many prisoners who get out finally have little coping skills in real life. They have no idea of how to support themselves and how to deal with life on the outside. And loss of hope does impact memory. If life sucks now, then maybe that memory of how great it was, is just a lie. This happens to people all of the time.

As far as sending people to war that have "stable" backgrounds, this doesn't always matter. In my experience, it's usually the degree of supportive environment around them (good war buddies, good and understanding commander, relaxing environment to get back to, etc.) and how quickly they "get away" from what "just happened". Its the myth of being "in control". Okay, I'm safe now. Previous trauma and being too young and impressionable are also huge factors but getting older can predispose people to more trauma than youth because the body is more susceptible to the nervous system not working as well as when one was young.

And I'm not a big on recovered memory. Experiences can be recovered, memory is malleable. Which means there is an underlying "resource" or meaning that recovered from certain experiences whether they're remembered correctly or not. The resource or meaning (like hope or safety) is what tells the story as opposed to memory.

And the usual timeframe is a minimum of 6 months for "regular" PTSD in therapy even with EMDR (usually 6 months to a year). I've had people do in less but I'm not sure it sticks as well if they're not there for at least 6 months so we can clean up all the remnants that show up in their life. I have some serious chronic cases, which I doubt will ever not need some sort of supportive therapy. I'm not a big proponent of people becoming dependent on therapy so I try and push them out of the nest at some point, but some people have been so damaged that they seem to have to have someone to cling to in the traumatic times that show up in life in general.