B Y : M A T T H E W T I N G Z O N

Effects of Virtual Reality Therapy on Combat-Induced PTSD

Facts

Due to the past wars in Iraq and Afghanistan: 2.3 million veterans

at least 20% of veterans have PTSD

over 19% may have TBI

7% have both TBI and PTSD

about 50% do not seek treatment

increasing rates of veteran suicides

PTSD

Psychological condition that occurs after a traumatic event.

Often accompanied by depression, anger issues, increased anxiety, and other mental disorders.

Characterized by: reliving the traumatic event

avoiding thoughts, memories, people and places related to event

increased physiological reactivity

Combat PTSD

Degree of exposure to combat and adversity, trauma, and loss are the best predictors of combat related PTSD.

Exposure to atrocities was only related to re-experiencing and avoidance (Litz et al., 2009).

After a one year tour in Iraq, 13.8% of 522 National Guard Troops reported for PTSD (Polusny et al., 2010). tend to report higher rates of PTSD post-deployement, but same

severity than regular active duty

Common Treatment

Exposure Therapy allows for fear activation and modification.

Other therapies include Eye Movement Desensitization and Reprocessing, flooding, and systemic desensitization.

Despite its effectiveness, Exposure Therapy has smaller pre- and post-effect sizes for combat related trauma.

Interference with activation of memory.

Virtual Reality Therapy

“a way for humans to visualize, manipulate, and interact with computers and extremely complex data” (Aukstakalnis' and' Blatner,' 1992).‘

Can be used for phobias, stress management, acute pain reduction, and functional skill training.

Environments and settings are manipulated based on experienced trauma.

First use of VR-ET began in 1997 at Georgia Tech and Emory University.

Cont.

“Virtual Iraq/Afghanistan” has been used by studies to treat PTSD (Rizzo et al., 2013)

Simulates similar environments encountered in combat.

Can be tailored to target specific traumatic events.

Circumvents avoidance of memories, does not rely on imagination.

Introduces participants slowly through series of sessions.

Rothbaum (2001), reported a 34% reduction in clinician-rated symptoms and 45% for self-reported among Vietnam veterans.

Virtual Scenarios

Virtual Scenarios

Methods

Articles were retrieved from PsycInfo, PsycArticles, PsycExtra, and other academic databases.

After reviewing commonly used therapies, VR-ET computer technology as a form of therapy. Previous reviews used initial results of studies.

Studies included required combat induced PTSD, not including mild PTSD (score 30 or below on the PCL-M).

Rates of PTSD were measured using either the CAPS or PCL-M.

Effect size for PTSD TREATMENT Table

Source Participants (N) PTSD Scale Conditions Statistics d

Rizzo et al.

(2013)

24 Clinician

Administered

PTSD Scale (CAPS)

Virtual Reality – Exposure

Therapy

t(19)=5.99, p<.001 1.08

Miyahira et al.

(2012)

22 CAPS Wait-List Virtual Reality

– Exposure

Therapy

F(1,20)=8.705, p=.008 0.72

McLay et al.

(2012)

20 PTSD Checklist-

military (PCL-M)

Virtual Reality – Graded

Exposure Therapy

t(19)=5.92,p<.001 1.94

Ready et al.

(2011)

21 PCL-M Virtual Reality – Exposure

Therapy

N/A 0.80

Reger et al.

(2011)

24 PCL-M Virtual Reality – Exposure

Therapy

t(23)=6.5, p<.001 1.25

Discussion

VR-ET has shown improvement of PTSD symptoms. daverage = 2.46

Factors to consider: lack of participants

number of dropouts

time constraints

References

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706.

Polusny, M. A., Erbes, C. R., Murdoch, M. M., Arbisi, P. A., Thuras, P. P., & Rath, M. B. (2011). Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq. Psychological Medicine, 41(4), 687-698.

Rizzo, A., Buckwalter, J.G., Forbell, E., Reist, C., Difede, J., Rothbaum, B.O., Lange, B., Koenig, S., & Talbot, T. (2013). Virtual reality applications to address the wounds of war. Psychiatric Annals, 43(3), 123-138.

Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J. S., & North, M. (1995). Virtual reality graded exposure in the treatment of acrophobia: A case report. Behavior Therapy, 26(3), 547-554.