In a 2008, a Palestinian construction worker attacked a woman and infant in a car, ramming the plow of his bulldozer into their windshield, decapitating the 54 year old female driver with his plow. He subsequently used his bulldozer to lift two public buses loaded with civilian passengers onto their sides, trapping the passengers inside, and went on to crush several more cars. This case report presents the first results of treatment utilizingCognitive Behavioral Therapy (CBT) + virtual reality exposure therapy (BusWorld) to treat PTSD in a civilian survivor/witness to the bulldozer attack. VR helped the patient remember and habituate to his memory of the traumatic event and stop avoiding it. Following treatment, the patient demonstrated large reductions in PTSD symptoms, and no longer met criteria for PTSD or major depression on post-treatment standardized measures (see www.vrpain.com).