VRE-Efficacious Tx for PTSD?

1
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 Cybert
herapy 2008 Conference San Diego, CA, USA June
24, 2008
2
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)

3
Prevalence of Mental Health or Cognitive
Impairment
4

• What We Know About Exposure to Combat
• 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

5
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
6
Virtual Reality Treatment for PTSD

• Potentially powerful treatment approach
• Early studies show promising results
• Rothbaum et al (2001)
• Difede and Hoffman (2002 2006)
• Few published controlled studies
• More empirical evidence required

7
VR Exposure Treatment of Combat PTSD

• Randomized controlled study
• 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

8
VR Environment Middle East World (MEW)

• Humvee convoy in Middle East town
• 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

9
VR Environment Middle East World
10
VR Environment Middle East World
11
VR Environment Middle East World
12
(No Transcript)
13
Sample Characteristics
Characteristic Mean Value or Status
Age 24.2
Number of Months in Military 59.3
Length of Deployment 14 months
Rank E 4-5
Function Infantry, MP, Medic
Education HS Diploma/Some College
Martial Status Separated or Divorced
Ethnicity White (71)/Hispanic (29)
14
Pre-Treatment Status
Measure Mean Level
CES 30.2 Moderate Heavy
CAPS 81.5 Severe
PDS 35.5 Moderate Severe
BDI 24.7 Moderate
TRGI 51.7 Mild
QOLI 35.5 Low
15
Sessions 2-6 - Temp
16
Sessions 2-6 - Resp
17
Sessions 2-6 - HR
18
Sessions 2-6 - EDR
19

Summary

• 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

20
Acknowledgements 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
21
Contact Information Sarah D. Miyahira,
Ph.D. Pacific Telehealth Technology Hui
459 Patterson Road Ste. 4E-B100
Honolulu, Hawaii, USA 96819-1522
Sarah.Miyahira_at_pacifichui.org