Virtual Reality Exposure Therapy for The Treatment of Combat Related PTSD

Virtual reality exposure therapy (VRET) has emerged as a developing treatment modality in the treatment of post-traumatic stress disorder (PSTD) related to combat. Current evidenced based practice guidelines favor psychotherapy involving exposure through guided visual imagery. However there are limitations to this method. The technology of virtual reality brings an integrated and authentic enviromnent to prolonged exposure therapy that was previously unattainable. Tlu·ough an extensive review of the literature this paper seeks to answer the question: ls virtual reality exposure therapy effective in treating combat related PTSD when compared to more traditional methods or no treatment? There were 12 studies included in the review. There is significant evidence from current research supporting the use of VRET to reduce or eliminate the symptoms of combat related PTSD. In all studies reviewed, PSTD symptoms were reduced in patients as measured by either the Clinician Administered PTSD Scale (CAPS) or PTSD Checklist, military version (PCL-M). Small sample size was a limiting factor in all studies. Minimal information is available regarding the efficacy of VRET compared to imaginal exposure therapy and other traditional PTSD treatments. More research is needed to determine if VRET is a first line treatment for combat related PTS

Virtual reality exposure therapy for armed forces veterans with Post-Traumatic Stress Disorder: a systematic review and focus group

This study aims to determine the guidelines for designing a Virtual Reality - War Scenario program for Armed Forces veterans diagnosed with Post-Traumatic Stress Disorder. This article encompasses two studies: Study 1, a systematic review of eleven articles indexed in the databases B-on, PubMed, Clinical trials and Cochrane Library; Study 2, a focus group of Portuguese armed forces veterans, discussed the outline of such a programme. A set of guidelines were identified as central and consensual, which should be included in the program. This type of program must have a realistic, multisensorial and interactive approach that allows veterans to re-adapt to their past, which is still so present. Virtual reality offers veterans with Post-Traumatic Stress Disorder unlimited opportunities, enhancing a personalized intervention. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest nevertheless, VRET, as a co-creation process, requires more controlled and in-depth research on their clinical applicability

Virtual reality exposure therapy for armed forces veterans with post-traumatic stress disorder: A systematic review and focus group [artigo]

Virtual reality exposure therapy (VRET) is an emerging treatment for people diagnosed with Post-Traumatic Stress Disorder (PTSD) due to the limited accessibility of psychotherapies. This research aims to determine the guidelines for developing a Virtual Reality–War Scenario program for Armed Forces veterans with PTSD and encompasses two studies: Study 1, a systematic electronic database review; Study 2, a focus group of twenty-two Portuguese Armed Forces veterans. Results showed a positive impact of VRET on PTSD; however, there were no group differences in most of the studies. Further, according to veterans, new VRET programs should be combined with the traditional therapy and must consider as requirements the sense of presence, dynamic scenarios, realistic feeling, and multisensorial experience. Regardless, these findings suggest VRET as a co-creation process, which requires more controlled, personalized, and in-depth research on its clinical applicability.info:eu-repo/semantics/publishedVersio

Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability

Introduction The essential feature of post-traumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. According to evidence-based intervention guidelines and empirical evidence, one of the most extensively researched and validated treatments for PTSD is prolonged exposure to traumatic events; however, exposure therapy can present some limitations. Virtual reality (VR) can help to improve prolonged exposure because it creates fictitious, safe, and controllable situations that can enhance emotional engagement and acceptance. Objective In addition to carrying out a review to evaluate the efficacy of VR exposure-based therapy (VR-EBT) for the treatment of PTSD, the aim of this study was to contribute to analyzing the use of VR-EBT by: first, evaluating the adequacy of psychological treatment protocols that use VR-EBT to treat PTSD; and second, analyzing the acceptability of VR-EBT. Method We performed a replica search with descriptors and databases used in two previous reviews and updated to April 2015. Next, we carried out an evaluation of the efficacy, adequacy, and acceptability of VR-EBT protocols. Results Results showed that VR-EBT was effective in the treatment of PTSD. The findings related to adequacy showed that not all studies using VR-EBT reported having followed the clinical guidelines for evidence-based interventions in the treatment of PTSD. Regarding acceptability, few studies evaluated this subject. However, the findings are very promising, and patients reported high acceptability and satisfaction with the inclusion of VR in the treatment of PTSD. Conclusion The main weaknesses identified in this review focus on the need for more controlled studies, the need to standardize treatment protocols using VR-EBT, and the need to include assessments of acceptability and related variables. Finally, this paper highlights some directions and future perspectives for using VR-EBT in PTSD treatmen

Active duty and ex-serving military personnel with post-traumatic stress disorder treated with psychological therapies: systematic review and meta-analysis

Background: Post-traumatic stress disorder (PTSD) is a major cause of morbidity amongst active duty and ex-serving military personnel. In recent years increasing efforts have been made to develop more effective treatments. Objective: To determine which psychological therapies are efficacious in treating active duty and ex-serving military personnel with post-traumatic stress disorder (PTSD). Method: A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measure was reduction in PTSD symptoms and the secondary outcome dropout. Results: Twenty-four studies with 2386 participants were included. Evidence demonstrated that CBT with a trauma focus (CBT-TF) was associated with the largest evidence of effect when compared to waitlist/usual care in reducing PTSD symptoms post treatment (10 studies; n = 524; SMD −1.22, −1.78 to −0.66). Group CBT-TF was less effective when compared to individual CBT-TF at reducing PTSD symptoms post treatment (1 study; n = 268; SMD −0.35, −0.11 to −0.59). Eye Movement Desensitization and Reprocessing (EMDR) therapy was not effective when compared to waitlist/usual care at reducing PTSD symptoms post treatment (4 studies; n = 92; SMD −0.83, −1.75 to 0.10). There was evidence of greater dropout from CBT-TF therapies compared to waitlist and Present Centred Therapy. Conclusions: The evidence, albeit limited, supports individual CBT-TF as the first-line psychological treatment of PTSD in active duty and ex-serving personnel. There is evidence for Group CBT-TF, but this is not as strong as for individual CBT-TF. EMDR cannot be recommended as a first line therapy at present and urgently requires further evaluation. Lower effect sizes than for other populations with PTSD and high levels of drop-out suggest that CBT-TF in its current formats is not optimally acceptable and further research is required to develop and evaluate more effective treatments for PTSD and complex PTSD in active duty and ex-serving military personnel

A Systematic Review of Psychological Treatments for Combat-Related PTSD

With ongoing military operations spanning the globe, a new population of combat veterans is emerging. Posttraumatic stress disorder is an enormous issue for veterans, and knowing the status of psychosocial treatments for it seems necessary. The current study seeks to provide a more comprehensive description of the current status of outcome research for combat-related posttraumatic stress disorder, including treatments being utilized, attrition rates, percent responders/nonresponder, and population conflict (i.e., OIF, OEF, Vietnam). The literature was systematically reviewed and 10 randomized controlled trials were identified that focused solely on veteran populations with posttraumatic stress disorder. Treatments utilized in these studies included Trauma Maintenance Therapy, Exposure Therapy, Cognitive Processing Therapy, as well as others. The average dropout rate of the studies examined was 21 %, with rates up to 38%. Furthermore, 50% of the studies reviewed utilized completer data, instead of the Intent-to-Treat (ITT) model which has notable implications for the generalizability of the findings. Non-responders at post ranged from 19% to 94%, with similar results at follow-up. The implications of these results are discussed and recommendations for future directions are provided

Psychotrauma and effective treatment of post-traumatic stress disorder in soldiers and peacekeepers

Psychotrauma occurs as a result to a traumatic event, which may involve witnessing someone's actual death or personally experiencing serious physical injury, assault, rape and sexual abuse, being held as a hostage, or a threat to physical or psychological integrity. Post-traumatic stress disorder (PTSD) is an anxiety disorder and was defined in the past as railway spine, traumatic war neurosis, stress syndrome, shell shock, battle fatigue, combat fatigue, or post-traumatic stress syndrome (PTSS). If untreated, post-traumatic stress disorder can impair relationships of those affected and strain their families and society. Deployed soldiers are especially at a high risk to be affected by PTSD but often receive inadequate treatment. Reviews to date have focused only on a single type of treatment or groups of soldiers from only one country. The aim of the current review was to evaluate characteristics of therapeutic methods used internationally to treat male soldiers' PTSD after peacekeeping operations in South Eastern Europe and the Gulf wars

PTSD AND THE WARFIGHTER: A TECHNOLOGY-BASED APPROACH TO THERAPY

The missions in support of Global War on Terrorism may have concluded throughout the Middle East, but the residual effects of the sustained combat operations remain present and continue to influence the lives of so many combat Veterans. Advances in technology, such as health monitoring and wearable devices, could improve the treatment of the warfighters and the approach adopted by the Defense Health Agency and the U.S. Department of Veterans Affairs. The U.S. Navy and U.S. Marine Corps have policies established to remove their respective Sailors and Marines from their standard deployable status to a Limited Duty (LIMDU) position, which are limited to six-month periods and two concurrent periods before personnel must go before a Medical Review Board, where they are susceptible to medical separation or medical retirement. It is important to explore additional treatment options so the victims can obtain a renewed sense of purpose, eliminate suicidal thoughts and ideations, and if preferred, continue their military service and share their valued experiences with the next generation. This research explores nontraditional methods of PTSD treatment, to include technology, mood tracking, and sleep data, and how these data points influence one another.Approved for public release. Distribution is unlimited.Lieutenant, United States NavyLieutenant, United States Nav

Optimal treatment for post traumatic stress disorder

Thesis (M.A.)--Boston UniversityThough recognized previously as “shell shock” or “combat neurosis” Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that was first introduced in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. Diagnosis of PTSD requires the experience of a traumatic event followed by symptoms including avoidance, hyperarousal, re-experiencing, numbing and intense fear. The current treatment options include psychotherapy and pharmacotherapy. Brain stimulation is also emerging as an effective treatment option. The most widely studied and successful treatment is termed Prolonged Exposure therapy (PE). This involves the therapeutic repetition of the traumatic experience in order for the patient to understand that they are no longer in danger. Despite the effectiveness of PE, many individuals continue to suffer from PTSD. There are several obstacles between research and practice, as well as barriers to care for those suffering from PTSD. Even when evidence based practice is applied to those in need, there is still a high rate of treatment failures. Further research must be done to determine the best course of treatment for the increasing number of individuals suffering from PTSD