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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 - PowerPoint PPT Presentation
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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.DUniversity 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 ConferenceSan Diego, CA, USA
June 24, 2008
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
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 DoD/DVA Joint Venture
Prevalence of Mental Health or Cognitive Impairment
Pacific Telehealth and Technology Hui
A DoD/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
“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
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
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
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
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
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
VR Environment: Middle East World
VR Environment: Middle East World
VR Environment: Middle East World
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
Pacific Telehealth and Technology Hui
A DoD/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 DoD/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 DoD/DVA Joint Venture
Sessions 2-6 - Temp
8 11
04
22
00
32
96
43
92
54
88
65
84
76
80
87
76
98
72
10
96
812
06
413
16
014
25
615
35
216
44
817
54
418
64
019
73
620
83
221
92
823
02
424
12
025
21
626
31
227
40
8
Case Number
90.000
92.000
94.000
96.000
Va
lue
Temp2
Temp3
Temp4
Temp5
Temp6
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
Sessions 2-6 - Resp
8 11
04
22
00
32
96
43
92
54
88
65
84
76
80
87
76
98
72
10
96
81
20
64
13
16
01
42
56
15
35
21
64
48
17
54
41
86
40
19
73
62
08
32
21
92
82
30
24
24
12
02
52
16
26
31
22
74
08
Case Number
10.000
20.000
30.000
40.000
Valu
eResp2
Resp3
Resp4
Resp5
Resp6
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
Sessions 2-6 - HR
1 4 7 10
13
16
19
22
25
28
31
34
37
40
43
46
49
52
55
58
Case Number
65.00
70.00
75.00
80.00
85.00
Valu
eHR250to90
HR350to90
HR450to90
HR550to90
HR650to90
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
Sessions 2-6 - EDR
8 1088
2168
3248
4328
5408
6488
7568
8648
9728
10808
11888
12968
14048
15128
16208
17288
18368
19448
20528
21608
22688
23768
24848
25928
27008
Case Number
0.000
1.000
2.000
3.000
Va
lue
EDR2
EDR3
EDR4
EDR5
EDR6
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
Summary
Pacific Telehealth and Technology Hui
A DoD/DVA Joint Venture
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
Contact Information:
Sarah D. Miyahira, Ph.D. Pacific Telehealth & Technology Hui 459 Patterson Road Ste. 4E-B100 Honolulu, Hawaii, USA 96819-1522 [email protected]