Researchers at USC’s Institute for Creative Technologies (ICT), New York-Presbyterian Hospital/Weill Cornell Medical Center and the Emory University School of Medicine have been awarded an $11 million, four-year grant from the U.S. Department of Defense to test different ways to treat post-traumatic stress disorder (PTSD), including the use of a virtual-reality exposure therapy developed at ICT.
The study will involve 300 military and civilian personnel who have been diagnosed with PTSD as a consequence of their service in the Iraq and Afghanistan wars. The goals are to decrease the time needed for effective treatment of PTSD, give the right treatment to the right person, and identify factors involved in its development and response to treatment.
The researchers also will examine personal and genetic factors that may impact an individual’s chances of developing PTSD, as well as future response to therapy.
The grant is a culmination of years of collaborative and novel research by investigators who are known as leaders in their field. It was led by JoAnn Difede, director of the Program for Anxiety and Traumatic Stress Studies at New York-Presbyterian/Weill Cornell and professor of psychology in psychiatry at Weill Cornell Medical College. Co-investigators were Albert “Skip” Rizzo, associate director of medical virtual reality at ICT and research professor at the USC Davis School of Gerontology, and Barbara Rothbaum, director of the Trauma and Anxiety Recovery Program and professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine.
“Combat-related PTSD is notoriously difficult to treat,” Difede said. “Our study’s large-scale, head-to-head investigation of virtual reality compared to traditional exposure treatment for PTSD could answer decisively which intervention is most effective, and for whom.”
Each group of study participants will receive two educational sessions followed by seven weekly sessions of exposure therapy – either virtual-reality exposure therapy or prolonged imaginal exposure therapy.
“Virtual-reality exposure treatment augments the therapeutic process because it offers a structured system to address traumatic memories and reduce the avoidance and anxiety that are part of PTSD,” Rizzo said. “This treatment may also appeal to a segment of the military who are very familiar and comfortable with digital technology yet may be hesitant to engage in traditional talk therapy.”
The groups also will be randomized to receive a pill containing either the drug D-cycloserine or a placebo prior to exposure therapy sessions. D-cycloserine is an antibiotic approved by the U.S. Food and Drug Administration 20 years ago to treat tuberculosis, but it also has been found by researchers at Emory to speed up the kind of learning required to reconcile fearful memories.
Exposure therapy is an evidence-based treatment for PTSD in which an individual repeatedly retells his or her traumatic story with the guidance of a trained clinician. Virtual-reality exposure therapy uses three-dimensional graphics to gradually immerse the patient into simulations that resemble the scenes where the traumatic events have occurred, Rizzo said.
A patient uses a virtual reality headset with goggles and earphones as the therapist controls the digital scenes. Sensory cues are added, such as chair vibrations that simulate an explosion.
The first addition of virtual reality to exposure therapy for PTSD was known as Virtual Vietnam – created by Emory’s Rothbaum – which was a simple virtual reality simulation designed to treat soldiers who served in the Vietnam War.
“This study could produce needed knowledge that could improve our understanding of PTSD and the ways to treat it,” Rothbaum said. “Predicting which therapy works best for whom will make treatment efforts even more efficient and effective – eventually allowing us to individually tailor treatments.”
Difede began using virtual reality with burn unit patients in the 1990s, and in 2001, she worked with Hunter Hoffman from the University of Washington to create a Virtual World Trade Center system to treat survivors of the 9/11 terrorist attack.
In 2003, Rizzo developed Virtual Iraq to treat soldiers from the war in Iraq. He initially used a modification of the ICT-developed video game “Full Spectrum Warrior” to create the sights, sounds, smells and sensations of the war – which has been updated to create the most sophisticated virtual-reality PTSD exposure therapy system to date.
Virtual Iraq and now Virtual Afghanistan are being used at 55 military, Veterans Affairs (VA) and university-based clinical sites.
The study will be conducted at the following clinical sites: the Walter Reed Army Medical Center and National Intrepid Center of Excellence in the Washington, D.C. area, the Long Beach VA Medical Center in Southern California and New York-Presbyterian/Weill Cornell Medical School in New York City.
“Developing effective treatments for PTSD is a high-priority area for VA research,” said Chris Reist, associate chief of staff for research and development at the Long Beach VA Health Care System. “We are excited about this partnership with USC to test this innovative approach to treatment.”
For more information about participation at the Long Beach VA Medical Center, call (562) 826-5784, email VRatLongBeach@gmail.com or visit scire-lb.org/ptsd.html
For more information about the other study sites, contact Brittany Mello by calling (212) 821-0783 or via email at email@example.com