Transcript Controlled Studies: PTSD

Controlled Studies: PTSD
Author
Year
# of Pts
Equipment
Results
Rothbaum
2001
16
V6 Head-Mounted Display
CAPS scores at 6 month
follow-up showed reduction
in PTSD symptoms
Tarnanas
2001
50
VPL Eye Phone 1, MR
toolkit, vibrations plate
Less negative thoughts
toward earthquake scenarios
Difede
2002
1
Head Mounted Display
90% reduction in PTSD
symptoms after VR
exposure therapy
Univ. Of
Buffalo
2003
4
UB Simulator
Preliminary results are
promising
Wiederhold 2003
8
EEG, PC computer
VR environment increased
performance on task
Livanou
2003
10
Earthquake simulator, shake
table (9 levels of intensity)
Significant improvement (8
patients improved, 2
slightly improved)
Walshe
2003
14
3D Head Mounted Display
Significant post-treatment
reductions on all measures
PTSD Environments
Driving
Virtual Earthquake
Virtual Vietnam
Virtual World
Trade Center
PTSD due to MVA
(David G. Walshe et al., 2003)
 Subject Population:
 14 participants who met DSM-IV criteria for specific phobia, situational
type-driving or PTSD with driving phobia.
 Environment:
 Game Reality Environment
Midtown Madness II
Rally Championship
London Racer
 Virtual Reality Driving Environment
 Apparatus:
 VFX-3D Head Mounted Display
PTSD due to MVA
Walshe et al…
 Method:
 7 of 14 were immersed in one of driving
simulations
 These 7 patients went through CBT
exposure program
 Graded driving simulation tasks
with physiological feedback
 Results:

- Significant reduction in Travel Distress, Travel
Avoidance, and Maladaptive driving strategies.

- 92% felt sense of Presence
 Conclusion:
- Virtual Reality and Game Reality may serve as a tool in
treating post-accident driving phobia.
PTSD due to MVA
Driving Study: 14 participants
(Walshe, Lewis, Kim, O’Sullivan, & Wiederhold, 2003)
Median
Score
18
16
14
12
10
8
6
4
2
0
P=0.008
P=0.008
Travel
Distress
Pre-treatment
Post Treatment
P=0.016
Travel
Maladaptive
Avoidance
Driving
Strategies


VGVR
VR
PTSD due to MVA
Conclusion
 50% of the participants felt task specific anxiety and immersion
caused by the combination of VR and GR tasks
 7 subjects were treated; SUDs decreased throughout the
treatment
 Subjects’ performance in the simulation translated well into reallife driving with a decrease in anxiety
 The overall decrease in heart rate at the end of the experiment
signifies that “habituation on a psychological level was matched
with physiological habituation”
 While the experiment did not focus on the accident experiences
of the victims, it did manage to decrease PTSD measures
Vietnam War Veterans
Two environments:
Open Field
Huey Helicopter
 34% decrease on clinician-rated PTSD
 45% decrease on self-rated PTSD
 Treatment gains maintained at 6-month
follow-up
World Trade Center PTSD
(Difede & Hoffman)
•Environment:
11 Graded Levels of Exposure
1st Stage: Normal day in NYC with
view of WTC towers
Final Stage: Entire re-enactment of
9/11
Results:
•Participant showed decrease in SUDs rating over
time
•83% decrease in depression levels
•90% reduction PTSD symptoms
•Patient no longer met criteria for PTSD
World Trade Center Video Clip
Post-tramatic Stress Disorder from Sept 11th
50
Before VR
After VR
Severity
40
30
20
10
0
Depression
1
2
PTSD Total score
Difede and Hoffman (2002)
Taken from: New England Journal of Medicine
“Combat experiences reported by members of
the U.S. Army and Marine Corps after
deployment to Iraq or Afghanistan”
ONR Funded Project
 Develop VR worlds for non-combatants
 Test VR worlds for treating PTSD in non-combatants
 VR will be created with off-the-shelf videogame
engine
 Received funding letter on Thursday (last week)
 Conducting focus groups with military personnel at
Camp Pendelton, Balboa Naval Hospital, and San
Diego VA Hospital
Stress Inoculation Training
Simulator Adjunct Training
Scenario 3
160
140
Heart Rate (BPM)
120
subject 1
100
subject 2
subject 3
80
subject 4
subject 5
60
subject 6
40
20
0
:01
:02
:03
:04
:05
:06
:07
Tim e (Minutes)
:08
:09
:10
:11
:12
Village
Game Description:
Features:
First Person shooter Game
Game Mode:
~ With Enemies
- Task: eliminate all enemies in the village
~ Without Enemies
- Task: navigate through the village
Iraqi Village includes:
~ Buildings
D-cycloserine shows improvement compared to placebo
in level of fear within the VR environment.
(Ressler, Rothbaum et al., 2004)
POST-PRE Highest SUDS
floor 19 completers only
Pos t-Pr e SUDS pe r floor (LOCF)
fl oor1
fl oor2
fl oor3
fl oor4
fl oor9
fl oor14
fl oor19
placebo
0
drug
0
-10
-10
-20
-20
-30
-30
*
-40
-40
plac ebo
-50
-50
DCS
-60
-60
N = 30 acrophobics,
2 weekly in virtuo exposure sessions
(35 to 45 minutes)
2 doses of DCS (50 / 500).
3 Month Post-Pre Acrophobia Anxiety
Questionnaire
0
-10
-20
-30
-40
-50
From B. Rothbaum
placebo
-60
F(19,1)=4.36, p=.05
DCS
Indexed in:
- MedLine
- PsychInfo
- Excerpta Medica
- Social Sciences Citations
Published by:
American Psychological Association
Recently Indexed in
PsycINFO
Introducing the Journal of CyberTherapy and
Rehabilitation
Publications
Coming in 2006:
Virtual Healers
VR & videogames are
tools. They do not
take the place of good
clinical skills or clinical
judgment…
Joseph Wolpe
Carl Jung
Sigmund Freud