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

Combat Related Post Traumatic Stress Disorder in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom: A Review of the Literature

The conflict Afghanistan and Iraq have now taken their places amongst the longest running wars in American history. As many Americans return from military service, the prevalence of combat related post traumatic stress syndrome is estimated to be as high as 30% or returning veterans. This debilitating condition impacts the individual, their family, and their community in significant ways. A variety of treatments including Cognitive Behavioral Therapy, Prolonged Exposure Therapy, and Virtual Reality Therapy have all been cited as effective interventions for this population. As our nation continues military conflict in the middle east, clinicians need to be prepared to screen and treat individuals suffering from combat related PTSD

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

TREATING POSTTRAUMATIC STRESS DISORDER AMONG AGING VETERANS: WHAT WORKS?

Posttraumatic stress disorder (PTSD) is a serious condition with debilitating symptoms which affects military veterans and has been understudied in the older population. Aside from treating the veterans of the Vietnam War and World War II, as service members from more recent conflicts age, the mental healthcare system needs to be able to treat them with empathy and effective therapies. As there is a need for future research focusing on this population, this paper reviews the current literature and utilizes Grounded theory to further the research related to PTSD in aging veterans. A selection of mental health clinicians with experience treating this population were interviewed and the results discussed. Those therapists who work for the Department of Veterans Affairs (VA) most often use Cognitive Behavioral Therapy to treat their clients, with Prolonged Exposure Therapy being the next most popular therapeutic modality. Those clinicians who are separate from the VA are able to employ therapies such as Cognitive Restructuring or blend theories to meet the precise needs of individual veterans. Also addressed are the differences and commonalities in PTSD symptoms between veterans of different conflict eras. Based upon these interviews, suggestions were made for changes to the treatment of military-related PTSD

Therapeutic treatments for PTSD : does type of treatment impact help seeking behaviors in a military sample?

There are several known barriers that people face that decrease the likelihood of seeking professional psychological help. The present study sought to identify whether certain treatment types for PTSD serve as barriers to seeking psychological help. It specifically sought to identify trauma-focused treatments as potential barriers due to their perception of being emotionally challenging. A survey was administered to 84 respondents. Of the respondents, 41 were randomly assigned to read a treatment protocol for an exposure-based, trauma-focused psychotherapy for PTSD, which 43 were randomly assigned to read a protocol for a trauma-avoidant psychotherapy for PTSD. Measures of attitudes toward seeking help and mental health stigma were then administered, with treatment type serving as two levels of an independent variable. We hypothesized that participants in the trauma-focused condition would subsequently report higher levels of stigma and more negative attitudes toward seeking help. MANCOVA results did not support our hypothesis as both groups were shown to have equal reactions to the protocols. This held true when controlling for four potential covariates: PTSD symptoms, avoidant coping styles, conformity to masculine gender norms, and previous PTSD treatment history. Treatment implications and future directions were discussed

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

REM Desensitization as a New Therapeutic Method for Post- Traumatic Stress Disorder: A Randomized Controlled Trial

Aim: to evaluate potential efficacy of a new therapeutic approach in posttraumatic stress disorder in comparison with eye movement desensitization and reprocessing (EMDR), a standard treatment approach and controls. Methods: the study was designed using a randomized controlled trial methodology. Participants were recruited from military servicemen aged between 25 to 50 years who were admitting hospitals of Bushehr, Iran, with the final diagnosis of PTSD. Finally 33 male patients were devided into three subgroups: G1: EMDR; G2: REM Desensitization; and group 3: controls who received no therapy. Mississippi Scale for Posttraumatic Stress Disorder, Pittsburgh Sleep Quality Index (PSQI) and a 37 item death anxiety questionnaire were used for measures. Results: multiple comparisons showed that intrusive thoughts were significantly more likely to improve with REM Desensitization versus EMDR (P=0.03), while depression was more responsive to EMDR (p=0.03). Among the Pittsburgh scale for the quality of sleep items, sleep quality (p=0.02), sleep duration (p=0.001), and total sleep quality score (p=0.002) were significantly more likely to improve in the REM Desensitization group. Change in the absolute death anxiety scores was not different between subgroups excepting EMDR versus control group (p=0.05). Conclusion: REM, desensitization, the new therapeutic approach to PTSD is a highly effective strategy, even more than EMDR, the standard treatment, in most of the evaluated subjects, with special emphasis on sleep symptoms, and also in the management of intrusive thoughts. Depression is the only factor in which, REM Desensitization was significantly less likely to represent a superior therapeutic effect than EMDR. Key words: post traumatic stress disorder (PTSD), eye movement desensitization and reprocessing, new treatment

Weaponized Women in Contemporary Visual Culture : Representing Military Women in the ‘War on Terror’

This thesis examines representations of military women in contemporary Western visual culture during the ‘War on Terror’ (2001-present). Through the comparison of cultural productions that center on military women (e.g. films, TV series, etc.), I assess the current perpetuation of representational patterns established by a long tradition of the military/war genre. Moreover, I attempt to identify new patterns and tropes, and also categorize any divergences to pre-established patterns. With this study I intend to explore the hypothesis that military women are subjected to systematic stereotyping when featured in fictional narratives as protagonists, which I understand to be a signal of a larger problem, concerning the instrumentalization of military women by military/political forces. Drawing from the works of Cynthia Enloe, Barbara Ehrenreich, Yvonne Tasker, among other critics who theorized on this subject, I attempt to expand on what was already written, adding original material relating exclusively to the period of the ‘War on Terror’. Through the comparison and analysis of intermedia artworks from the US and European countries (UK, and France), I offer a wide cultural study on the fictionalization of military women. By focusing on US and European cultural representations of servicewomen I aim to verify the existence of similarities which may suggest a transatlantic cohesion in regard to not only representational tropes, but also military/political interests. The thesis is divided into three parts, each corresponding to an important stage in military life. Therefore, chronologically, the first part is dedicated to ‘Boot Camp’, the second to ‘Deployment’, and the last to ‘Discharge’. This structure is intended to compartmentalize stages that introduce different sets of challenges to women in the military. Through this approach, I am able to direct my focus towards each segment as a whole, exploring correspondent cultural products that encompass dominant representations in each stage of military life. The final objective of this research is to acknowledge how fictional depictions of military women can help us achieve a clearer image of a collective Western understanding of what it means to be a female and a soldier. Additionally, I aim to identify how those depictions are used to convey specific ideological messages pertaining to (trans)national interests during the ‘War on Terror’. Furthermore, through this cultural analysis I intend to contribute to an expanding field concerned with gender equality in Western armed forces.Esta tese analisa representações da mulher militar na cultura visual Ocidental contemporânea durante o período da ‘Guerra ao Terror’ (2001-presente). Através da comparação de produtos culturais centrados na mulher militar (e.g. filmes, séries de TV, etc.), examino a perpetuação actual de padrões de representação estabelecidos por uma longa tradição do género militar/guerra. Para além deste trabalho de comparação, identifico novos padrões e estereótipos, ao mesmo tempo categorizando divergências dos padrões previamente estabelecidos. Com este estudo, pretendo explorar a hipótese de que as mulheres militares estão sujeitas a estereótipos sistemáticos aquando protagonizam narrativas ficcionais, o que problematizo enquanto instrumentalização da mulher militar por forças militares/políticas. Apoiando-me nos trabalhos de Cynthia Enlow, Barbara Ehrenreich, Yvonne Tasker, entre outra/os crítica/os que teorizaram acerca deste tópico, pretendo expandir o trabalho que já existe, acrescentando material original relacionado exclusivamente com o período da ‘Guerra ao Terror’. Através da comparação e análise de vários tipos de obras artísticas visuais provindas dos Estados Unidos e de países Europeus (Reino Unido e França), dedico-me a um alargado estudo cultural focado na ficcionalização da mulher militar. Ao focar-me em representações culturais estadunidenses e europeias pretendo verificar a existência de semelhanças que possam sugerir uma coesão transatlântica no que diz respeito não só a estereótipos representacionais, mas também a interesses militares/políticos. Esta tese está dividida em três partes, cada uma correspondendo a uma fase importante da vida militar. Desta forma, cronologicamente, a primeira parte intitula-se ‘Boot Camp’ (campo de treino militar), a segunda ‘Deployment’ (projecção das forças militares no terreno), e a última ‘Discharge’ (dispensa militar). Esta estrutura visa compartimentar períodos que apresentam conjuntos de dificuldades diferentes para a mulher militar. Através desta abordagem, direcciono o meu foco de atenção para cada segmento como um todo, explorando produções culturais correspondentes que demonstram as representações dominantes em cada fase da vida militar. O objectivo final deste trabalho de investigação é identificar o que dizem as representações ficcionais da mulher militar acerca de um entendimento Ocidental colectivo do que significa ser mulher e soldado. Adicionalmente, pretendo também reconhecer como essas representações são utilizadas para transmitir mensagens ideológicas específicas, relativas a interesses (trans)nacionais durante a ‘Guerra ao Terror’. Através desta análise cultural pretendo ainda contribuir para os estudos que apoiam a igualdade de género nas forças armadas Ocidentais

Combat Exposure, Agency, Perceived Threat, Guilt, and Posttraumatic Stress Disorder among Iraq and Afghanistan War Veterans

This study assessed how various combat experiences related to post-deployment adjustment among 289 Iraq/Afghanistan veterans. The study examined the relationships among three predictor variables (combat exposure, agency, perceived threat), one mediator (guilt), and two criterion factors (posttraumatic stress disorder/PTSD, and psychological wellbeing/PWB). It distinguished agency (e.g., firing or killing) from combat exposure (e.g., being fired at or witnessing). The study sought to: a) examine whether combat exposure differs from agency as constructs of combat experiences; b) determine the contributions of three predictors to the degree of PTSD and PWB; and c) determine whether guilt mediated the relationships between the three predictors and the two criterion factors. Instruments used included the Combat Experiences Subscale, the Post-Battle Subscale, and the Perceived Threat Subscale from the Deployment Risk and Resilience Inventory (DRRI), the Atrocities Exposure Subscale, the Laufer-Parson Guilt Inventory, the PTSD Checklist (PCL – Military), the Satisfaction With Life Scale, the Self-Acceptance Subscale and the Purpose in Life Subscale developed by Ryff (1989). Factor analyses, correlational analyses, hierarchical regression analyses, and Sobel Tests were used to analyze the data. Results indicated that exposure and agency were two constructs with shared commonalties (especially those involving injuring and killing of enemy combatants). Agency-Civilian-Casualties emerged as a new variable that merits further exploration due to the increases in civilian causalities in modern warfare. Atrocity also appeared to be a distinct variable that needs further examination. About 96% of participants reported having been under fire. However, 41% reported never having fired at the enemies. About 72% reported having at least one moderate PTSD symptom, and 43% could be identified as PTSD positive. All three predictors were highly correlated with guilt, PTSD, and PWB. PTSD was found to be highly (negatively) correlated with PWB. Together, the three predictors accounted for 58% of the total variance for PTSD, and 46% for PWB. When guilt was included in the regression, the four variables accounted for 78% of the total variance for PTSD, and 64% for PWB. Guilt mediated between exposure and PTSD, agency and PTSD, and agency and PWB. Implications of these findings were discussed