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Virtual Reality Therapy May Help PTSD Patients
Date:5/7/2008

Coupled with medication, it helps ease the shock of trauma, study finds

WEDNESDAY, May 7 (HealthDay News) -- People suffering from post-traumatic stress disorder may ultimately benefit from a combination of prescription medication and cutting-edge virtual reality psychotherapy, new research suggests.

The study findings are preliminary. But, early results with Iraq war veterans point to a potent way to help PSTD patients through the use of drugs along with exposure to interactive reenactments of the sights, sounds, smells, and movements related to a highly traumatic experience.

"I am very optimistic," said study lead author Barbara O. Rothbaum, a professor of psychiatry, and director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine in Atlanta. "We think that, aided by medications, virtual reality is going to be a useful way to help people haunted by an experience confront their fears in a more complete and therapeutic way."

Rothbaum and her team were expected to present their findings Wednesday at the American Psychiatric Association annual meeting, in Washington, D.C.

Post-traumatic stress disorder affects about 7.7 million American adults, although it can strike at any age and is more common among women, according to the U.S. National Institute of Mental Health, sponsor of the new study.

The risk for developing PTSD is highest following exposure to physical harm or the threat of physical harm. Soldiers at war are particularly vulnerable, but victims of rape, violent assault, and even traumatic accidents may also develop the disorder.

A range of anti-depressant and anti-anxiety medications can help manage, but not cure, PTSD. The medications are often prescribed along with cognitive-behavioral therapy.

Rothbaum and her colleagues decided to explore the potential of one form of exposure therapy -- virtual reality treatment -- among 24 war veterans. All the participants were men in their 20s or 30s, and all had recently been involved in the war in Iraq.

The veterans suffered from a particular aspect of PSTD known as "acoustic startle" -- a form of hyper arousal that causes an uncontrollable reflexive response provoked by sudden loud sounds.

Two-minute video clips were specifically tailored for each veteran to re-enact, as closely as possible, the traumatic event that led to their PSTD. Besides providing imagery and sounds, the computer-generated 360-degree virtual experience also involved mimicked vibrations and smells, such as burning fires and smoke.

Clips, for example, depicted the Iraq war, and included scenes of Humvee vehicles driving alone or in convoys on a desert highway, as well as a soldier on foot patrol in an urban setting.

During treatment, the patients watched the videos through helmets outfitted with tiny TV screens placed in front of each eye, and headphones. Position trackers enabled each veteran to maintain realistic views of his visual environment, the researchers said.

The patients were also divided into three prescription medication groups: the first taking the antibiotic d-cycloserine, the second taking the anti-anxiety drug Xanax, and the third taking a placebo. D-cycloserine has been shown to help boost the learning of safety memories, potentially enhancing the benefits of exposure therapy.

The researchers measured the severity of each veteran's acoustic startle response before treatment, during treatment, and immediately after treatment, as well as three and six months later. By the six-month mark, all the men appeared to benefit from the virtual reality therapy, with startle severity reduced, on average, by 75 percent.

Although the researchers haven't been able yet to analyze the comparative benefits of the three complementary medications, they said the first patient placed on a d-cycloserine regimen experienced a 56 percent drop in PSTD measurements after just four virtual reality sessions.

Dr. Randall Marshall, director of Trauma Studies and Service at the New York State Psychiatric Institute, and an associate professor of clinical psychiatry at Columbia University College of Physicians & Surgeons, called the finding "exciting."

"We already have very effective cognitive behavioral therapies," he said. "But there are a lot of patients who are avoidant about talking about their trauma. Doing so scares them. Many just hope that the nightmares go away.

"In contrast," Marshall added, "it does seem that people are much more interested in virtual reality -- especially young patients who have the idea that it might be much more fun and interesting and unthreatening. So you'll have a much lower rate of therapy refusal in relation to being offered the opportunity to talk about their issues. So even if it's only just as good as what we have now, it expands the options."

More information

To learn more about PSTD, visit the U.S. National Institute of Mental Health.



SOURCES: Barbara O. Rothbaum, Ph.D., A.B.P.P., professor, psychiatry, and director, Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta; Randall Marshall, M.D., director, Trauma Studies and Service, New York State Psychiatric Institute, and associate professor, clinical psychiatry, Columbia University College of Physicians & Surgeons, New York City; May 7, 2008, presentation, American Psychiatric Association annual meeting, Washington, D.C.


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