Controlled Studies: PTSD

1. Controlled Studies: PTSD

2. PTSD Environments Driving Virtual Earthquake Virtual World Trade Center Virtual Vietnam

3. 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

4. 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.

5. PTSD due to MVA Driving Study: 14 participants(Walshe, Lewis, Kim, O’Sullivan, & Wiederhold, 2003) • VGVR • VR

6. 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 real-life 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

7. 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

8. 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

10. World Trade Center Video Clip

12. 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”

13. 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

14. Stress Inoculation Training

15. Simulator Adjunct Training

17. 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

18. 3 Month Post-Pre Acrophobia Anxiety Questionnaire placebo DCS 0 -10 -20 -30 -40 -50 F(19,1)=4.36, p=.05 -60 D-cycloserine shows improvement compared to placebo in level of fear within the VR environment. (Ressler, Rothbaum et al., 2004) N = 30 acrophobics, 2 weekly in virtuo exposure sessions (35 to 45 minutes) 2 doses of DCS (50 / 500). From B. Rothbaum

19. Indexed in: - MedLine - PsychInfo - Excerpta Medica - Social Sciences Citations Published by: American Psychological Association

20. Recently Indexed in PsycINFO Introducing the Journal of CyberTherapy and Rehabilitation

21. Publications Coming in 2006: Virtual Healers

22. VR & videogames are tools. They do not take the place of good clinical skills or clinical judgment… Joseph Wolpe Carl Jung Sigmund Freud