Comparing Virtual Reality Exposure Therapy to Prolonged Exposure (VRPE Extension)

• ClinicalTrials.gov Identifier: NCT01459705
• Recruitment Status: Completed
• First Posted: October 26, 2011
• Results First Posted: December 14, 2015
• Last Update Posted: December 14, 2015
• Sponsor: National Center for Telehealth and Technology
• Collaborator: The Geneva Foundation
• Information provided by (Responsible Party): National Center for Telehealth and Technology

Study Description

Brief Summary:

This study is evaluating the efficacy of virtual reality 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 hypothesis 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
Stress Disorders; Post-Traumatic Stress Disorder	Behavioral: Prolonged Exposure Therapy (PE); Behavioral: Virtual Reality Exposure Therapy (VRET); Behavioral: Waitlist	Not Applicable

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

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 162 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers With Post Traumatic Stress Disorder (PTSD)
• Study Start Date: October 2011
• Actual Primary Completion Date: May 2014
• Actual Study Completion Date: May 2014

Arms and Interventions

Arm	Intervention/treatment
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 Name: PE
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: VRE; VRET
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: WL; Waitlist Control Group

Outcome Measures

Primary Outcome Measures :

1. Clinician-Administered PTSD Scale (CAPS) [ Time Frame: Screening Visit (Day 1) ]
   The CAPS is a structured interview that assesses all Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) PTSD criteria in terms of frequency and intensity. We used total scores as the primary outcome. Minimum possible score was 0, maximum possible score was 136. Higher scores indicated higher levels of symptoms.
2. Clinician-Administered PTSD Scale (CAPS) [ Time Frame: 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.We used total scores as the primary outcome. Minimum possible score was 0, maximum possible score was 136. Higher scores indicated higher levels of symptoms.
3. Clinician-Administered PTSD Scale (CAPS) [ Time Frame: 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.We used total scores as the primary outcome. Minimum possible score was 0, maximum possible score was 136. Higher scores indicated higher levels of symptoms.
4. Clinician-Administered PTSD Scale (CAPS) [ Time Frame: 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.We used total scores as the primary outcome. Minimum possible score was 0, maximum possible score was 136. Higher scores indicated higher levels of symptoms.
5. Clinician-Administered PTSD Scale (CAPS) [ Time Frame: 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.We used total scores as the primary outcome. Minimum possible score was 0, maximum possible score was 136. Higher scores indicated higher levels of symptoms.

Secondary Outcome Measures :

1. PTSD Checklist- Civilian (PCL-C) [ Time Frame: Screening Visit (Day 1) ]
   The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
2. Primary Care PTSD Screen (PC-PTSD) [ Time Frame: Screening Visit (Day 1) ]
   The PC-PTSD is a four-item measure designed to screen for PTSD.
3. Beck Depression Inventory-II (BDI-II) [ Time Frame: Screening Visit(Day 1) ]
   This self report measure of depression contains 21 items that are rated on a 4 point scale.
4. Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [ Time Frame: 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.
5. Perceived Stigma Measure (PSS) [ Time Frame: Screening Visit(Day 1) ]
   Stigma will be measured using a 5 question assessment scale.
6. Suicide Risk Assessment [ Time Frame: Screening Visit(Day 1) ]
   Due to the nature of the questions, this is deemed to be of safety nature.
7. Beck Anxiety Inventory (BAI) [ Time Frame: Screening Visit(Day 1) ]
   The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
8. Behavior and Sympton Identification Scale (BASIS-24) [ Time Frame: 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.
9. Intent to Attend [ Time Frame: Screening Visit (Day 1) ]
   This is a measure to assess the intent to complete study procedures.
10. Subjective Units of Distress (SUDs) [ Time Frame: 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.
11. Side Effects Questionnaire [ Time Frame: 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.
12. BASIS-24 [ Time Frame: 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.
13. Intent to Attend [ Time Frame: Treatment session 1 (week 1) ]
    This is a measure to assess the intent to complete study procedures.
14. PTSD Checklist (PCL-C) [ Time Frame: 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.
15. PTSD Checklist (PCL-C) [ Time Frame: 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.
16. Primary Care PTSD Screen (PC-PTSD) [ Time Frame: 2.5 weeks (or after treatment session 5) ]
    The PC-PTSD is a four-item measure designed to screen for PTSD.
17. PTSD Checklist (PCL-C) [ Time Frame: 12 week follow up ]
    The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
18. PTSD Checklist (PCL-C) [ Time Frame: 26 week follow up ]
    The PCL-C is a self report measure that evaluates att 17 PTSD criteria using a 5 point Likert scale.
19. Primary Care PTSD Screen (PC-PTSD) [ Time Frame: 5 weeks (or after treatment session 10) ]
    The PC-PTSD is a four-item measure designed to screen for PTSD.
20. Primary Care PTSD Screen (PC-PTSD) [ Time Frame: 12 Week follow up ]
    The PC-PTSD is a four-item measure designed to screen for PTSD.
21. Primary Care PTSD Screen (PC-PTSD) [ Time Frame: 26 Week follow up ]
    The PC-PTSD is a four-item measure designed to screen for PTSD.
22. Beck Depression Inventory-II (BDI-II) [ Time Frame: 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.
23. Beck Depression Inventory-II (BDI-II) [ Time Frame: 5 weeks (or after treatment session 10) ]
    This self report measure of depression contains 21 items that are rated on a 4 point scale.
24. Beck Depression Inventory-II (BDI-II) [ Time Frame: 12 Week follow up ]
    This self report measure of depression contains 21 items that are rated on a 4 point scale.
25. Beck Depression Inventory-II (BDI-II) [ Time Frame: 26 Week follow up ]
    This self report measure of depression contains 21 items that are rated on a 4 point scale.
26. Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [ Time Frame: 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.
27. Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [ Time Frame: 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.
28. Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [ Time Frame: 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.
29. Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) [ Time Frame: 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.
30. Perceived Stigma Measure (PSS) [ Time Frame: 2.5 weeks (or after treatment session 5) ]
    Stigma will be measured using a 5 question assessment scale.
31. Perceived Stigma Measure (PSS) [ Time Frame: 5 weeks (or after treatment session 10) ]
    Stigma will be measured using a 5 question assessment scale.
32. Perceived Stigma Measure (PSS) [ Time Frame: 12 week follow up ]
    Stigma will be measured using a 5 question assessment scale.
33. Perceived Stigma Measure (PSS) [ Time Frame: 26 week follow up ]
    Stigma will be measured using a 5 question assessment scale.
34. Suicide Risk Assessment [ Time Frame: 2.5 weeks (or after treatment session 5) ]
    Due to the nature of the questions, this is deemed to be of safety nature.
35. Suicide Risk Assessment [ Time Frame: 5 weeks (or after treatment session 10) ]
    Due to the nature of the questions, this is deemed to be of safety nature.
36. Suicide Risk Assessment [ Time Frame: 12 Week follow up ]
    Due to the nature of the questions, this is deemed to be of safety nature.
37. Suicide Risk Assessment [ Time Frame: 26 Week follow up ]
    Due to the nature of the questions, this is deemed to be of safety nature.
38. Beck Anxiety Inventory (BAI) [ Time Frame: 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.
39. Beck Anxiety Inventory (BAI) [ Time Frame: 5 weeks (or after treatment session 10) ]
    The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
40. Beck Anxiety Inventory (BAI) [ Time Frame: 12 week follow up ]
    The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
41. Beck Anxiety Inventory (BAI) [ Time Frame: 26 week follow up ]
    The BAI is a self report measure consisting of 21 items designed to discriminate anxiety from depression.
42. BASIS-24 [ Time Frame: 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.
43. BASIS-24 [ Time Frame: 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.
44. BASIS-24 [ Time Frame: 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.
45. BASIS-24 [ Time Frame: 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.
46. BASIS-24 [ Time Frame: 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.
47. BASIS-24 [ Time Frame: 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.
48. BASIS-24 [ Time Frame: 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.
49. BASIS-24 [ Time Frame: 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.
50. BASIS-24 [ Time Frame: 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.
51. BASIS-24 [ Time Frame: 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.
52. BASIS-24 [ Time Frame: 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.
53. BASIS-24 [ Time Frame: 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.
54. BASIS-24 [ Time Frame: 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.
55. Subjective Units of Distress (SUDs) [ Time Frame: 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.
56. Subjective Units of Distress (SUDs) [ Time Frame: 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.
57. Subjective Units of Distress (SUDs) [ Time Frame: 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.
58. Subjective Units of Distress (SUDs) [ Time Frame: 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.
59. Subjective Units of Distress (SUDs) [ Time Frame: 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.
60. Subjective Units of Distress (SUDs) [ Time Frame: 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.
61. Subjective Units of Distress (SUDs) [ Time Frame: 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.
62. Subjective Units of Distress (SUDs) [ Time Frame: 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.
63. Subjective Units of Distress (SUDs) [ Time Frame: 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.
64. Side Effects Questionnaire [ Time Frame: 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.
65. Side Effects Questionnaire [ Time Frame: 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.
66. Side Effects Questionnaire [ Time Frame: 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.
67. Side Effects Questionnaire [ Time Frame: 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.
68. Side Effects Questionnaire [ Time Frame: 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.
69. Side Effects Questionnaire [ Time Frame: 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.
70. Side Effects Questionnaire [ Time Frame: 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.
71. Side Effects Questionnaire [ Time Frame: 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.
72. Side Effects Questionnaire [ Time Frame: 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.
73. Intent to Attend [ Time Frame: Treatment session 2 (week 1) ]
    This is a measure to assess the intent to complete study procedures.
74. Intent to Attend [ Time Frame: Treatment session 3 (week 2) ]
    This is a measure to assess the intent to complete study procedures.
75. Intent to Attend [ Time Frame: Treatment session 4 (week 2) ]
    This is a measure to assess the intent to complete study procedures.
76. Intent to Attend [ Time Frame: Treatment session 5 (week 2.5) ]
    This is a measure to assess the intent to complete study procedures.
77. Intent to Attend [ Time Frame: Treatment session 6 (week 3) ]
    This is a measure to assess the intent to complete study procedures.
78. Intent to Attend [ Time Frame: Treatment session 7 (week 4) ]
    This is a measure to assess the intent to complete study procedures.
79. Intent to Attend [ Time Frame: Treatment session 8 (week 4) ]
    This is a measure to assess the intent to complete study procedures.
80. Intent to Attend [ Time Frame: Treatment session 9 (week 5) ]
    This is a measure to assess the intent to complete study procedures.
81. Intent to Attend [ Time Frame: Treatment session 10 (week 5) ]
    This is a measure to assess the intent to complete study procedures.
82. Intent to Attend [ Time Frame: 2.5 weeks (or after treatment session 5) ]
    This is a measure to assess the intent to complete study procedures.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• PTSD diagnosis as assessed by CAPS
• history of deployment in support of Operation Iraqi Freedom/ Operation Enduring Freedom(OIF/OEF)
• non sexually based deployment related trauma
• three or more months since index trauma
• stable on psychotropic medication for 30 days

Exclusion Criteria:

• index trauma in the last three months
• history of schizophrenia, other psychotic or bipolar disorder
• history of organic brain disorder
• suicidal risk or intent or self-mutilating behavior requiring hospitalization in the last 6 months
• ongoing threatening situation
• current drug or alcohol dependence
• history of seizures
• prior history of PE for PTSD
• other current psychotherapy
• physical condition that interferes with proper use of Virtual Reality head mounted display
• history of loss of consciousness since entering active duty service greater than 15 minutes history of schizophrenia, other psychotic or bipolar disorder

Contacts and Locations

Locations

United States, North Carolina

Womack Clinical Psychology Service

Fort Bragg, North Carolina, United States, 28307

Sponsors and Collaborators

National Center for Telehealth and Technology

The Geneva Foundation

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

More Information

Publications of Results:

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Difede J, Cukor J, Jayasinghe N, Patt I, Jedel S, Spielman L, Giosan C, Hoffman HG. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry. 2007 Nov;68(11):1639-47.

Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004 Jul 1;351(1):13-22.

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Simms LJ, Watson D, Doebbeling BN. Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnorm Psychol. 2002 Nov;111(4):637-47.

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Other Publications:

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Rothbaum BO, Hodges LF, Ready D, Graap K, Alarcon RD. Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatry. 2001 Aug;62(8):617-22.

Koenen KC, Stellman JM, Stellman SD, Sommer JF Jr. Risk factors for course of posttraumatic stress disorder among Vietnam veterans: a 14-year follow-up of American Legionnaires. J Consult Clin Psychol. 2003 Dec;71(6):980-6.

Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RD. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J Consult Clin Psychol. 2003 Aug;71(4):706-12.

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Sherman JJ. Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials. J Trauma Stress. 1998 Jul;11(3):413-35.

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003388. Review. Update in: Cochrane Database Syst Rev. 2007;(3):CD003388.

Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002 Aug;70(4):867-79.

Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986 Jan;99(1):20-35.

Delahanty DL, Raimonde AJ, Spoonster E. Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims. Biol Psychiatry. 2000 Nov 1;48(9):940-7.

Shalev AY, Sahar T, Freedman S, Peri T, Glick N, Brandes D, Orr SP, Pitman RK. A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. Arch Gen Psychiatry. 1998 Jun;55(6):553-9.

Mason J, Southwick S, Yehuda R, Wang S, Riney S, Bremner D, Johnson D, Lubin H, Blake D, Zhou G, et al. Elevation of serum free triiodothyronine, total triiodothyronine, thyroxine-binding globulin, and total thyroxine levels in combat-related posttraumatic stress disorder. Arch Gen Psychiatry. 1994 Aug;51(8):629-41.

Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002 Jan 10;346(2):108-14. Review.

Yehuda R, Siever LJ, Teicher MH, Levengood RA, Gerber DK, Schmeidler J, Yang RK. Plasma norepinephrine and 3-methoxy-4-hydroxyphenylglycol concentrations and severity of depression in combat posttraumatic stress disorder and major depressive disorder. Biol Psychiatry. 1998 Jul 1;44(1):56-63.

Morgan CA 3rd, Grillon C, Southwick SM, Davis M, Charney DS. Exaggerated acoustic startle reflex in Gulf War veterans with posttraumatic stress disorder. Am J Psychiatry. 1996 Jan;153(1):64-8.

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• Responsible Party: National Center for Telehealth and Technology
• ClinicalTrials.gov Identifier: NCT01459705
• Other Study ID Numbers: 112226; W81XWH-11-2-0007 ( Other Grant/Funding Number: USMRMC )
• First Posted: October 26, 2011
• Results First Posted: December 14, 2015
• Last Update Posted: December 14, 2015
• Last Verified: November 2015

Keywords provided by National Center for Telehealth and Technology:

Combat Disorders; Exposure Therapy; Army Personnel

Additional relevant MeSH terms:

Disease; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Pathologic Processes; Trauma and Stressor Related Disorders; Mental Disorders