Virtual Reality Exposure:  Efficacious Treatment for Combat PTSD?
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Virtual Reality Exposure: Efficacious Treatment for Combat PTSD?. Sarah D. Miyahira, Ph.D. Pacific Telehealth & Technology Hui Department of Veterans Affairs Pacific Islands Health Care System Honolulu, Hawaii Hunter G. Hoffman, Ph.D University of Washington, Seattle, Washington

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Virtual Reality Exposure: Efficacious Treatment for Combat PTSD?

Sarah D. Miyahira, Ph.D.

Pacific Telehealth & Technology Hui

Department of Veterans Affairs Pacific Islands Health Care System

Honolulu, Hawaii

Hunter G. Hoffman, Ph.D

University of Washington, Seattle, Washington

Raymond A. Folen, Ph.D.

Tripler Army Medical Center, Honolulu, Hawaii

Azucena Garcia-Palacios, Ph.D.

Universitat Jaume 1, Castellon,Spain

Cybertherapy 2008 Conference

San Diego, CA, USA

June 24, 2008


U s warfighters deployed to iraq afghanistan rand report 2008

Approximately 1.64 million U.S. warfighters deployed to Iraq and Afghanistan since October 2001

Many experience prolonged exposure to stressful and traumatic combat events

18.5% returning troops have PTSD or depression

≈50% who need treatment, seek treatment

≈50% who are treated receive minimally adequate care

Recommendation: improve access to High Quality care (supported by scientific evidence)

U.S. Warfighters Deployed to Iraq & Afghanistan-RAND Report, 2008


Prevalence of mental health or cognitive impairment
Prevalence of Mental Health or and Afghanistan since October 2001Cognitive Impairment


  • What We Know About Exposure to Combat and Afghanistan since October 2001

  • Intensity and frequency of violence and threat of death in combat increases risk for PTSD

  • Most warfighters do not develop PTSD

  • Most with PTSD will recover naturally over time

  • Others develop chronic PTSD if not treated

  • High co-morbidity: alcohol & drug abuse, medical problems, depression, other psychiatric disorders


“To this day I can still hear our screams and recall the feeling of the truck being lifted and shaken with every explosion.” Spc. J. Norrel Convoy attack and IED explosion survivor


Virtual reality treatment for ptsd

Potentially powerful treatment approach feeling of the truck being lifted and shaken with every explosion.”

Early studies show promising results

Rothbaum et al (2001)

Difede and Hoffman (2002; 2006)

Few published controlled studies

More empirical evidence required

Virtual Reality Treatment for PTSD


Vr exposure treatment of combat ptsd

Randomized controlled study feeling of the truck being lifted and shaken with every explosion.”

Compare VR exposure treatment to delayed treatment of PTSD in returning warfighters from Iraq and Afghanistan

Treatment: CBT augmented with VR exposure

10 treatment sessions (2x/week)

Graded VR exposure (auditory, visual, kinesthetic stimuli)

Physiologic monitoring: heart rate, temperature, skin conductance, respiration

VR Exposure Treatment of Combat PTSD


Vr environment middle east world mew

Humvee convoy in Middle East town feeling of the truck being lifted and shaken with every explosion.”

Critical events: IED explosions, gunfire attack, swerving car, RPG attack

VR elements: 3D visual animation, stereophonic audio, chair vibrations

Therapist interface: keyboard to activate and deactivate images, sounds, and animation

Individual customization of stressful events

Increase or decrease level of stress arousal

VR Environment: Middle East World (MEW)


Vr environment middle east world
VR Environment: Middle East World feeling of the truck being lifted and shaken with every explosion.”


Vr environment middle east world1
VR Environment: Middle East World feeling of the truck being lifted and shaken with every explosion.”


Vr environment middle east world2
VR Environment: Middle East World feeling of the truck being lifted and shaken with every explosion.”


Sample characteristics
Sample Characteristics feeling of the truck being lifted and shaken with every explosion.”


Pre treatment status
Pre-Treatment Status feeling of the truck being lifted and shaken with every explosion.”


Sessions 2 6 temp
Sessions 2-6 - Temp feeling of the truck being lifted and shaken with every explosion.”


Sessions 2-6 - Resp feeling of the truck being lifted and shaken with every explosion.”


Sessions 2-6 - HR feeling of the truck being lifted and shaken with every explosion.”


Sessions 2-6 - EDR feeling of the truck being lifted and shaken with every explosion.”


Surveys of OIF warfighters report significant levels of mental health impairment

Sample data indicates moderately heavy combat exposure and high PTSD severity

Preliminary physiologic data indicates VR arousal & habituation with repeated exposure

Anecdotal & subjective ratings indicate high presence

Controlled studies needed to demonstrate efficacy of VR

Summary


Acknowledgements mental health impairment

Funding for this research study is provided by the Office of Naval Research, Science and Technology

This material is the result of work supported with resources and the use of facilities at the, Department of Veterans Affairs, Pacific Islands Health Care System, Honolulu, HI


Contact Information: mental health impairment

Sarah D. Miyahira, Ph.D.

Pacific Telehealth & Technology Hui

459 Patterson Road

Ste. 4E-B100

Honolulu, Hawaii, USA 96819-1522

[email protected]


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