Virtual Reality Exposure Efficacious Treatment for Combat PTSD
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) Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Prevalence of Mental Health or Cognitive Impairment Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
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 Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
“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 § Early studies show promising results Rothbaum et al (2001) Difede and Hoffman (2002; 2006) § Few published controlled studies § More empirical evidence required Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
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 (2 x/week) Graded VR exposure (auditory, visual, kinesthetic stimuli) Physiologic monitoring: heart rate, temperature, skin conductance, respiration
VR Environment: Middle East World (MEW) Humvee convoy in Middle East town Critical events: IED explosions, gunfire attack, swerving car, RPG attack VR elements: 3 D 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 Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
VR Environment: Middle East World
VR Environment: Middle East World
Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
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%) Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
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 Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Sessions 2 -6 - Temp Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Sessions 2 -6 - Resp Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Sessions 2 -6 - HR Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Sessions 2 -6 - EDR Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
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
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 Pacific Telehealth and Technology Hui A Do. D/DVA Joint Venture
Contact Information: Sarah D. Miyahira, Ph. D. Pacific Telehealth & Technology Hui 459 Patterson Road Ste. 4 E-B 100 Honolulu, Hawaii, USA 96819 -1522 Sarah. Miyahira@pacifichui. org
- Slides: 21