Emory Researchers Report First Findings of Virtual Reality Exposure Therapy for Veterans With PTSD

Emory researchers presented the first findings of a randomized, controlled clinical trial of veterans with PTSD using virtual reality exposure therapy (VRE) today at APA’s 2014 annual meeting. The study was conducted with 156 Iraq and Afghanistan veterans with combat-related PTSD and found that VRE reduces PTSD diagnoses and symptoms. After an introductory session, each veteran was randomly assigned to receive D-cycloserine (n=53), alprazolam (n=50), or a placebo (n=53) before each of five sessions of VRE.

Researchers found PTSD symptoms significantly improved from pre- to post-treatment with the VRE and that D-cycloserine may enhance the VRE results for veterans who demonstrated better emotional learning in sessions. Alprazolam (Xanax) impaired recovery from symptoms. Additionally, researchers used objective measures of cortisol, a stress hormone, and the startle response, and found reductions in reactivity during the VRE after treatment.

“D-cycloserine combined with only five sessions of the virtual reality exposure therapy was associated with significant improvements in objective measures of startle and cortisol and overall PTSD symptoms for those who showed emotional learning in sessions,” said lead researcher Barbara Rothbaum, Ph.D., at APA’s 2014 annual meeting. She is a professor of psychiatry and behavioral sciences at Emory University School of Medicine and director of the Trauma and Anxiety Recovery Program.

The double-blind, placebo-controlled study consisted of an initial screening assessment, six treatment visits, and follow-up assessments at three, six, and 12 months posttreatment. The VRE therapy involved 30 to 45 minutes of exposure to virtual environments on a head-mounted video display that attempts to match stimuli described by the veteran. Scenes depict a variety of Iraq and Afghanistan environments, including street scenes and neighborhoods, as well as from different points of view, that is, as a driver, passenger, or walking on foot. Thirty minutes before each session, participants took a single pill.

Rothbaum is a consultant to and owns equity in Virtually Better Inc., which creates virtual environments; however, Virtually Better did not create the Virtual Iraq environment tested in this study. Co-authors Kerry Ressler, Ph.D., and Michael Davis, Ph.D., are founding members of Extinction Pharmaceuticals/Therpade Technologies, which seek to develop D-cycloserine and other compounds for use to augment the effectiveness of psychotherapy. (Note: The researchers have received no equity or income from this relationship within the last three years, and the terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict-of-interest policies.)

More information appears in the April 18 American Journal of Psychiatry in the study “A Randomized, Double-blind Evaluation of D-Cycloserine or Alprazolam Combined with Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder (PTSD) in OEF/OIF War Veterans.”