Activation of Combat Trauma Memories Using Virtual Reality
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Activation of Combat Trauma Memories Using Virtual Reality Greg M. Reger, PhD
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Dr. Greg Reger reviews the rationale for virtual reality exposure in the treatment of PTSD and presents summaries of some of the published literature. The presentation includes a description of T2's on going clinical trial study.
Transcript of Activation of Combat Trauma Memories Using Virtual Reality
Activation of Combat Trauma Memories
Using Virtual RealityGreg M. Reger, PhD
Acknowledgements
• RCT VR vs. PE is sponsored by the Department of the Army, W81XWH-08-2-0015. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office.
• Greg Gahm, Kevin Holloway, Patie Woods, Kimberlee Zetocha, Amber Shaw, Emily Fantelli, Skip Rizzo, Barbara Rothbaum, Joann Difede, Frank Andrasik, Andy Leon
Disclaimer
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
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Prolonged Exposure
Foa & Kozak’s Emotional Processing Theory
• Activation of the fear structure (Emotional Engagement)
• Incorporation of new, corrective disconfirming information
Activation of the Fear Structure
StimulusPhysiological and Behavioral Responses
Meaning of the stimulus and responses
“Garbage on the road is dangerous”
“Increased heart rate means there is threat”
Increased sweating, increased heart rate
Representations of IEDs
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Scientific Literature on Exposure Therapy
“...the evidence from many well-controlled studies across a wide range of trauma survivors is very compelling…no other specific CBT program has such strong evidence for its efficacy…”
– Practice Guidelines from the International Society for Traumatic Stress Studies (2009)
“…strongly recommended…”– VA/DoD Clinical Practice Guidelines for PTSD
“…the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD…”
– Institute of Medicine, Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence (2007)
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Treatment Response by Trauma Type
Trauma Type Effect Size
(d)
• Sexual or Physical Assault 1.82
• Mixed Trauma 1.24
• Combat Trauma .81
Bradley et al. (2005) American Journal of Psychiatry
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OIF PTSD and VR Exposure: Case Report
PreTreatment PostTreatment17
37
57
77
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Case Background
1. OIF Gunner in HMWVV
2. Traumatic Death of an enemy combatant
3. 90-minute sessions
4. 6 Sessions provided across four weeks.
5. Utilized ICT VR Iraq Convoy environment
** P < .001
Reger & Gahm (2008). Journal of Clinical Psychology
PCL-
M
p < .001 (n=18)
Treatment Completers n=18
14 of 18 No Longer meet DSM criteria for PTSD at Post-TX
PC
L-M p < .001
(n=13)
Treatment Completers Mean Pre/Post Scores: PTSD Checklist-Military (PCL-M)
PRE TX POST TX POST TX17
22
27
32
37
42
47
52
57
Pre-Treatment
Post-Treatment
VR Exposure in Clinical PracticeActive Duty Soldiers
PreTreatment PostTreatment17
37
57
77
VRET
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Study Method
1. Treatment non-responders or those specifically seeking VR treatment.
2. 90-minute sessions
3. Sessions were approx weekly
4. Range number of sessions was 5-11 depending on progress.
5. 24 patients received VR Exposure
** P < .0005
**
Reger et al. (2011), Journal of Traumatic Stress
PCL-
M
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Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD
Referred for study assessment (n = 362)
12 pending assessment completion
127 Others not appropriate for screen/not interested/no contact
Assessed for eligibility (n = 223)
Excluded : 96
Randomized (n = 127)
Assigned VRET: 42 Assigned PE: 42 Assigned WL: 43
Study Design
-1 0 2.5 5 17
Referral and
Consent
Clinical Screening Interview
Time in Study (weeks) :
Follow-up Period
PE, VRET, or WL Assignment
Outcome
Treatment Session: 1 5 10
SUDs, Psycho-physiology
Treatment Satisfaction
Baseline
-1 0 2.5 5 17
Referral and
Consent
Clinical Screening Interview
Time in Study (weeks) :
Follow-up Period
PE, VRET, or WL Assignment
Outcome
Treatment Session: 1 5 10
SUDs, Psycho-physiology
Treatment Satisfaction
Baseline
-1 0 2.5 5 17
Referral and
Consent
Clinical Screening Interview
Time in Study (weeks) :
Follow-up Period
PE, VRET, or WL Assignment
Outcome
Treatment Session: 1 5 10
SUDs, Psycho-physiology
Treatment Satisfaction
Baseline
•Enrollment planned at 2 sites:JBLM (enrolling since 2009)Ft. Bragg (planned enrollment spring 2012)
•Original single-site enrollment planned for 162 randomized, increased with multisite addition
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VR Exposure Therapy
Greg M. Reger, Ph.D.
Innovative Technology Applications
National Center for Telehealth & Technology
9933C West Hayes Street
Joint Base Lewis-McChord
Tacoma, WA 98431
