Virtual Reality for Treatment of PTSD

Three fast track articles were recently published on CyberPsychology and Behavior about the treatment of PTSD with virtual reality exposure therapy. Exposure therapy is the most evidence based treatment for Post Traumatic Stress Disorder (PTSD). More than 18 studies have been published on the use of virtual reality exposure treatment for PTSD.

One of the articles is a case series of treatment with virtual reality exposure treatment within the combat theater. Until now this treatment was done at home. In this article a portable set of virtual reality machines was take to Iraq for treatment of PTSD within the combat theater, at the front in Fallujah in Iraq. Camp Fallujah was a Marine base located outside the city of Fallujah. The virtual reality was compared to traditional exposure therapy. This study is the retrospective review of cases, not a randomized prospective controlled trial.

How is Virtual Reality (VR) done?

VR simulation of situations from Iraq and Afghanistan were provided by means of a two-computer system. The client computer provided 3D images of wartime situations viewed through a head-mounted display (HMD). Movement of the HMD and a joystick controller allowed the participant to move and interact with the simulated world. The second computer served as controller and was used by the therapist to control sights and sounds within the simulation to re-create
situations such as a base camp, battlefield, Iraqi marketplace, or military convoy coming under attack

Six patients were treated with VR, four patients with traditional ET. Both treatments were efficacious and there was no significant difference between the two treatments. Moreover, both treatments also equally improved depressive and anxiety symptoms.

This work shows that patients with combat PTSD can be successfully treated with ETs while in a combat theater.

Another article is about a VR adaptive display called EMMA’s World.

It allows a therapist to customize clinically significant environments for each participant, which can vary according to the significance of the trauma for the individual; this is in contrast to other therapeutic VR approaches that focus on simulating the physical characteristics of the traumatic event with high realism. Rather than aiming for realism, EMMA’s World employs customized symbols and personalized aspects to evoke emotional reactions in participants.

They compared cognitive behavioral therapy with cognitive behavioral therapy and augmentation with EMMA’s World. Participants were randomly assigned to the two conditions and treatment lasted 9-12 weeks. The treatments didn’t differ in efficacy.

The third publication is a clinical controlled pilot study. Ten patients were assigned to 3 groups: VR with exposure therapy, exposure in imagination and a waiting list group. The group consisted of 10 elderly war veterans with chronic PTSD in Portugal. In this study VRET also shows promising results, also on depressive and anxiety symptoms.

So it’s time for some larger, prospective double blind randomized studies on VR exposure therapy and the golden standard traditional exposure therapy.

McLay, R., McBrien, C., Wiederhold, M., & Wiederhold, B. (2009). Exposure Therapy with and without Virtual Reality to Treat PTSD while in the Combat Theater: A Parallel Case Series CyberPsychology & Behavior DOI: 10.1089/cpb.2009.0346

Gamito, P., Oliveira, J., Rosa, P., Morais, D., Duarte, N., Oliveira, S., & Saraiva, T. (2009). PTSD Elderly War Veterans: A Clinical Controlled Pilot Study CyberPsychology & Behavior DOI: 10.1089/cpb.2009.0237

Botella, C., García-Palacios, A., Guillen, V., Baños, R., Quero, S., & Alcaniz, M. (2009). An Adaptive Display for the Treatment of Diverse Trauma PTSD Victims CyberPsychology & Behavior DOI: 10.1089/cpb.2009.0353