Virtual Reality Treatment

Virtual reality exposure (VRE) therapy gives veterans another opportunity to process the event — this time with a therapist present.

VRE first was used to treat PTSD when Rothbaum and her colleagues recruited Vietnam veterans who had lived for decades with chronic PTSD. With a VRE helmet strapped to their heads, patients were run through two scenarios: a landing zone and the inside of an in-flight helicopter skirting over rice paddies and jungle. Therapists were able to follow the veterans’ progress on a monitor and comment appropriately.

Since the treatment’s demonstrated success, VRE scenarios have been developed to help veterans and civilians.

Now, Rothbaum is studying the use of a chemical enhancer to the therapy. D-Cycloserine (DCS) — an NMDA partial agonist which has been used in the extinction of fear in rodents; preclinical trials indicated it could work similarly in humans.

An initial trial using it in patients with fear of heights showed that combining DCS with VRE resulted in a significantly greater decrease in anxiety. Three months after treatment, patients who used both maintained significant improvement.

With that success, Rothbaum has moved on to a trial involving veterans of the Iraq conflict. Veterans receive five sessions of VRE therapy where they are virtually placed in a Humvee. The session is augmented to match the veteran’s actual experience. For example, they can be placed in the driver or passenger seat, or in the turret if they were the gunner. What happens to the Humvee in the virtual scenario matches as much as possible what happened to them in combat.

The study participants are placed in one of three groups: DCS, placebo and alprozolam, which is used to treat anxiety and panic disorder and which some patients already are taking.

So far, the patients are showing overall improvement, which is expected because VRE alone has been proven to work. Rothbaum and her colleagues have yet to break the study’s blinds, but, when they do, they expect to see three lines of improvement, with DCS enhancement showing the greatest.

Early Treatment Prevents PTSD

The next step for Rothbaum is to find a way to prevent chronic PTSD from developing.

“I’ve spent my entire career treating chronic PTSD. Where I would love to go is into preventing it,” she said. “The primary way to prevent it is to prevent exposure to traumatic events, but that’s not going to happen. Life is dangerous.”

In animal studies, researchers have found that using extinction training (the equivalent of exposure therapy) within 10 minutes of a traumatic event can prevent consolidation of fear memory. Essentially, if given quickly enough, therapy can prevent PTSD from becoming chronic.

As part of that research, Rothbaum and her colleagues stationed investigators in the emergency department at Grady Memorial Hospital in Atlanta from 7 a.m. to 7 p.m. By the time they were finished, they had assessed 9,000 patients. Of those, only 3,000 were trauma victims. Of those, only 137 met the criteria and agreed to participate.

Half of those patients were not only assessed but were given a modified exposure therapy. Patients were asked to describe the event. Their description was taped and given to them to listen to. They talked about unhelpful thoughts, and therapists walked them through things they might want to avoid.

Those getting the treatment also were seen one week and two weeks later for follow-up treatment. In one-month and four-month follow-ups, researchers found that those who received the intervention had significantly lower PTSD severity, as well as less depression.

The next step, Rothbaum said, is to figure out how to transfer this to combat theater and to mass-casualty events.

Virtually Better Website

Back to May Articles