VRPE: Exposure Therapy for Active Duty Soldiers With Post Traumatic Stress Disorder
Study Details
Study Description
Brief Summary
This study is evaluating the efficacy of virtual realty exposure therapy (VRET)by comparing it to prolonged exposure therapy (PE) and a waitlist (WL) group for the treatment of post traumatic stress disorder (PTSD) in active duty (AD) Soldiers with combat-related trauma. The investigators will test the general hypotheses that 10 sessions of VRET or PE will successfully treat PTSD, therapeutically affect levels of physiological arousal, and significantly reduce perceptions of stigma toward seeking behavioral health services.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
The rationale for this study is based on growing evidence demonstrating that VRET is an efficacious treatment for PTSD and holds the potential to improve access to care for Soldiers who would otherwise avoid treatment. Although PE is considered one of the most effective cognitive-behavioral therapies (CBT) for treatments for PTSD, there are reasons why it may not be the most viable option for many Soldiers. First, Prolonged exposure requires a level of emotional engagement during exposure to the trauma that many patients are unable to obtain. Second, stigma and concerns about how Soldiers will be perceived by peers and leadership has a dramatic impact on whether a Soldier will seek care. VRET may address these concerns and may also improve treatment outcomes and access to care by augmenting the patient's re-living of the trauma with a sensory-rich environment and moderating stigma perceptions by offering non-traditional treatment that is a preferable option for many Soldiers who are reluctant to seek out traditional talk therapies. Despite its promise as a viable treatment option, few studies have examined VRET for combat-related PTSD and there are no published studies that have compared VRET to PE in the treatment of combat-related PTSD. Positive results may provide new treatment options for all Soldiers, but should prove to be an especially attractive option for Soldiers who either do not respond to, or are reluctant to engage in other established therapies such as PE.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: Prolonged Exposure Therapy (PE) The PE protocol is based on manualized procedures, which are derived from the theory that effective treatment for PTSD requires that the underlying pathological fear structure be activated and paired with new information that is incompatible with the fear structure. PE involves imaginal exposure and in vivo exposure as the two primary strategies to elicit repeated confrontation of feared but objectively safe thoughts, feelings, situations and events. |
Behavioral: Prolonged Exposure Therapy (PE)
Prolonged exposure therapy will consist of 10 treatment sessions lasting 90 - 120 minutes each, with additional between-session homework assignments.
Other Names:
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Experimental: Virtual Reality Exposure Therapy (VRET) The VRET protocol follows the same procedures as the PE protocol with the primary exception being that all instances of imaginal exposure will be augmented by immersion into Virtual Iraq environments, thus creating a situation known as immersive exposure. |
Behavioral: Virtual Reality Exposure Therapy (VRET)
Virtual Reality Exposure Therapy will consist of 10 treatment sessions lasting 90 -120 minutes with additional between-session homework assignments.
Other Names:
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Placebo Comparator: Waitlist The waitlist (WL) participants will be asked to refrain from psychotherapy during the 5 weeks of study participation. |
Behavioral: Waitlist
This group will refrain from psychotherapy until after the completion of the 5 weeks of study participation
Other Names:
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Outcome Measures
Primary Outcome Measures
- Clinician-Administered PTSD Scale (CAPS) [Screening Visit ( Day 1)]
The CAPS is a structured interview that assesses all DSM-IV PTSD criteria in terms of frequency and intensity. Scores are computed for Intrusion, Avoidance and Hyperarousal symptom clusters, as well as a Total score.
- Clinician-Administered PTSD Scale (CAPS) [2.5 weeks (or after treatment session 5)]
The CAPS is a structured interview that assesses all DSM-IV PTSD criteria in terms of frequency and intensity. Scores are computed for Intrusion, Avoidance and Hyperarousal symptom clusters, as well as a Total score.
- Clinician-Administered PTSD Scale (CAPS) [5 weeks (or after treatment session 10)]
The CAPS is a structured interview that assesses all DSM-IV PTSD criteria in terms of frequency and intensity. Scores are computed for Intrusion, Avoidance and Hyperarousal symptom clusters, as well as a Total score.
- Clinician-Administered PTSD Scale (CAPS) [12 Week follow-up]
The CAPS is a structured interview that assesses all DSM-IV PTSD criteria in terms of frequency and intensity. Scores are computed for Intrusion, Avoidance and Hyperarousal symptom clusters, as well as a Total score.
- Clinician-Administered PTSD Scale (CAPS) [26 Week follow-up]
The CAPS is a structured interview that assesses all DSM-IV PTSD criteria in terms of frequency and intensity. Scores are computed for Intrusion, Avoidance and Hyperarousal symptom clusters, as well as a Total score.
Secondary Outcome Measures
- PTSD Checklist (PCL-C) [Screening Visit (Day 1)]
The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
- Primary Care PTSD Screen (PC-PTSD) [Screening Visit(Day 1)]
The PC-PTSD is a four-item measure designed to screen for PTSD.
- Beck Depression Inventory-II (BDI-II) [Screening Visit(Day 1)]
This self report measure of depression contains 21 items that are rated on a 4 point scale.
- Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [Screening Visit(Day 1)]
The IASMHS is a 24 item assessment of help-seeking attitudes. It includes the following three factors based on components of Ajzen's Theory of Planned Behavior: Psychological Openness, Help-seeking Propensity and Indifference to Stigma.
- Perceived Stigma Measure (PSS) [Screening Visit(Day 1)]
Stigma will be measured using a 5 question assessment scale.
- Suicide Risk Assessment [Screening Visit(Day 1)]
Due to the nature of the questions, this is deemed to be of safety nature.
- Beck Anxiety Inventory (BAI) [Screening Visit(Day 1)]
The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
- BASIS-24 [Screening Visit(Day 1)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- Subjective Units of Distress (SUDs) [Treatment session 1 (week 1)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Side Effects Questionnaire [Treatment session 1(week 1)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- PTSD Checklist (PCL-C) [2.5 weeks (or after treatment session 5)]
The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
- PTSD Checklist (PCL-C) [5 weeks (or after treatment session 10)]
The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
- PTSD Checklist (PCL-C) [12 Week Follow-up]
The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
- PTSD Checklist (PCL-C) [26 Week Follow-up]
The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
- Primary Care PTSD Screen (PC-PTSD) [2.5 weeks (or after treatment session 5)]
The PC-PTSD is a four-item measure designed to screen for PTSD.
- Primary Care PTSD Screen (PC-PTSD) [5 weeks (or after treatment session 10)]
The PC-PTSD is a four-item measure designed to screen for PTSD.
- Primary Care PTSD Screen (PC-PTSD) [12 Week Follow-up]
The PC-PTSD is a four-item measure designed to screen for PTSD.
- Primary Care PTSD Screen (PC-PTSD) [26 Week Follow-up]
The PC-PTSD is a four-item measure designed to screen for PTSD.
- Beck Depression Inventory-II (BDI-II) [2.5 weeks (or after treatment session 5)]
This self report measure of depression contains 21 items that are rated on a 4 point scale.
- Beck Depression Inventory-II (BDI-II) [5 weeks (or after treatment session 10)]
This self report measure of depression contains 21 items that are rated on a 4 point scale.
- Beck Depression Inventory-II (BDI-II) [12 Week Follow-up]
This self report measure of depression contains 21 items that are rated on a 4 point scale.
- Beck Depression Inventory-II (BDI-II) [26 Week Follow-up]
This self report measure of depression contains 21 items that are rated on a 4 point scale.
- Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [2.5 weeks (or after treatment session 5)]
The IASMHS is a 24 item assessment of help-seeking attitudes. It includes the following three factors based on components of Ajzen's Theory of Planned Behavior: Psychological Openness, Help-seeking Propensity and Indifference to Stigma.
- Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [5 weeks (or after treatment session 10)]
The IASMHS is a 24 item assessment of help-seeking attitudes. It includes the following three factors based on components of Ajzen's Theory of Planned Behavior: Psychological Openness, Help-seeking Propensity and Indifference to Stigma.
- Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [12 Week Follow-up]
The IASMHS is a 24 item assessment of help-seeking attitudes. It includes the following three factors based on components of Ajzen's Theory of Planned Behavior: Psychological Openness, Help-seeking Propensity and Indifference to Stigma.
- Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [26 Week Follow-up]
The IASMHS is a 24 item assessment of help-seeking attitudes. It includes the following three factors based on components of Ajzen's Theory of Planned Behavior: Psychological Openness, Help-seeking Propensity and Indifference to Stigma.
- Perceived Stigma Measure (PSS) [2.5 weeks (or after treatment session 5)]
Stigma will be measured using a 5 question assessment scale.
- Perceived Stigma Measure (PSS) [5 weeks (or after treatment session 10)]
Stigma will be measured using a 5 question assessment scale.
- Perceived Stigma Measure (PSS) [12 Week Follow-up]
Stigma will be measured using a 5 question assessment scale.
- Perceived Stigma Measure (PSS) [26 Week Follow-up]
Stigma will be measured using a 5 question assessment scale.
- Suicide Risk Assessment [2.5 weeks (or after treatment session 5)]
Due to the nature of the questions, this is deemed to be of safety nature.
- Suicide Risk Assessment [5 weeks (or after treatment session 10)]
Due to the nature of the questions, this is deemed to be of safety nature.
- Suicide Risk Assessment [12 Week Follow-up]
Due to the nature of the questions, this is deemed to be of safety nature.
- Suicide Risk Assessment [26 Week Follow-up]
Due to the nature of the questions, this is deemed to be of safety nature.
- Beck Anxiety Inventory (BAI) [2.5 weeks (or after treatment session 5)]
The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
- Beck Anxiety Inventory (BAI) [5 weeks (or after treatment session 10)]
The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
- Beck Anxiety Inventory (BAI) [12 Week Follow-up]
The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
- Beck Anxiety Inventory (BAI) [26 Week Follow-up]
The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
- BASIS-24 [Treatment session 1(week 1)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 2(week 1)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 3 (Week 2)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 4(Week 2)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 5 (Week 2.5)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 6 (Week 3)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 7 (Week 4)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 8 (Week 4)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 9 (Week 5)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [Treatment session 10 (Week 5)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [2.5 weeks (or after treatment session 5)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [5 weeks (or after treatment session 10)]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [12 Week Follow-up]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- BASIS-24 [26 Week Follow-up]
To assess overall psychological pain and gives an indicator of overall wellness. Due to the nature of the questions, this is deemed to be of safety nature.
- Subjective Units of Distress (SUDs) [Treatment session 2(week 1)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 3(Week 2)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 4(Week 2)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 5 (Week 2.5)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 6 (Week 3)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 7 (Week 4)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 8 (Week 4)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 9 (Week 5)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Subjective Units of Distress (SUDs) [Treatment session 10 (Week 5)]
Ranging from 1 to 100, Subjective Units of Distress are gathered every 5 mintues during imaginal exposure to determine levels of distress and engagement in the situation.
- Side Effects Questionnaire [Treatment session 2(week 1)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 3(Week 2)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 4(Week 2)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 5(Week 2.5)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 6 (Week 3)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 7 (Week 4)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 8 (Week 4)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 9 (Week 5)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
- Side Effects Questionnaire [Treatment session 10 (Week 5)]
The Side Effects Questionnaire is based on a revised version of the Simulator Sickness Questionnaire (SSQ) that will be used to measure general discomfort in both the VRET and PE conditions of the study.
Eligibility Criteria
Criteria
Inclusion Criteria:
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PTSD diagnosis as assessed by CAPS
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history of deployment in support of OIF/OEF
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non sexually based deployment related trauma
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three or more months since index trauma
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stable on psychotropic medications for 30 days
Exclusion Criteria:
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index trauma in the last three months
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history of schizophrenia, other psychotic or bipolar disorder
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history of organic brain disorder
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suicidal risk or intent or self-mutilating behavior requiring hospitalization in the last 6 months
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ongoing threatening situation
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current drug or alcohol dependence
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history of seizures
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prior history of PE for PTSD
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other current psychotherapy
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physical condition that interferes with proper use of Virtual Reality head mounted display
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history of loss of consciousness since entering active duty service greater than 15 minutes
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | National Center for Telehealth and Technology | Tacoma | Washington | United States | 98431 |
Sponsors and Collaborators
- National Center for Telehealth and Technology
- University of Southern California
Investigators
- Principal Investigator: Gregory A Gahm, PhD, DCoE - National Center for Telehealth and Technology
- Principal Investigator: Greg Reger, PhD, DCoE - National Center for Telehealth and Technology
Study Documents (Full-Text)
None provided.More Information
Publications
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- CDO-09-8014
- W81XWH-08-2-0015