Dennis Patrick Wood, Ph.D., ABPP (CAPT, MSC, USN-ret) Brenda K. Wiederhold, Ph.D., MBA The Virtual Reality Medical Center, San Diego www.vrphobia.com COMBAT RELATED POST TRAUMATIC STRESS DISORDER: A REPORT EMPLOYING VIRTUAL REALITY GRADED EXPOSURE THERAPY WITH PHYSIOLOGICAL MONITORING (VRGET) CYBERTHERAPY 13 SAN DIEGO, CALIFORNIA
48
Embed
Dennis Patrick Wood, Ph.D., ABPP (CAPT, MSC, USN-ret) Brenda K. Wiederhold, Ph.D., MBA The Virtual Reality Medical Center, San Diego COMBAT.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Dennis Patrick Wood, Ph.D., ABPP(CAPT, MSC, USN-ret)
Brenda K. Wiederhold, Ph.D., MBAThe Virtual Reality Medical Center, San Diego
www.vrphobia.com
COMBAT RELATED POST TRAUMATIC STRESS DISORDER: A REPORT EMPLOYING VIRTUAL
REALITY GRADED EXPOSURE THERAPY WITH PHYSIOLOGICAL MONITORING (VRGET)
CYBERTHERAPY 13SAN DIEGO, CALIFORNIA
COMBAT RELATED POST TRAUMATIC STRESS DISORDER: A REPORT EMPLOYING VIRTUAL
REALITY GRADED EXPOSURE THERAPY WITH PHYSIOLOGICAL MONITORING (VRGET)
Disclaimer:Disclaimer: The views in this presentation are those of The views in this presentation are those of the individual authors, and do not necessarily the individual authors, and do not necessarily represent those of the Department of the Navy, represent those of the Department of the Navy, Department of Defense, the Department of Veterans Department of Defense, the Department of Veterans Affairs, or the U.S. Government. Research described Affairs, or the U.S. Government. Research described has been approved by the Institutional Review Board has been approved by the Institutional Review Board at the Naval Medical Center San Diego. The at the Naval Medical Center San Diego. The information in this presentation was approved under information in this presentation was approved under the NMCSD Institutional Review Board. This study the NMCSD Institutional Review Board. This study was sponsored by the ONR Contract (#N00014-05-C-was sponsored by the ONR Contract (#N00014-05-C-0136) to Virtual Reality Medical Center, San Diego, 0136) to Virtual Reality Medical Center, San Diego, CA.CA.
ABC Video Clip: PTSD & VRMC/ONR ABC Video Clip: PTSD & VRMC/ONR Funded VRGETFunded VRGET
Psychiatric Diagnoses Related to Psychiatric Diagnoses Related to Combat in Iraq and AfghanistanCombat in Iraq and AfghanistanPsychiatric Diagnoses Related to Psychiatric Diagnoses Related to Combat in Iraq and AfghanistanCombat in Iraq and Afghanistan
Following OIF and OEF, PTSD, Following OIF and OEF, PTSD, Depression and Anxiety rates for Depression and Anxiety rates for warriors were:warriors were:
15 – 17 % for Iraqi combat veterans15 – 17 % for Iraqi combat veterans11.2% for Afghanistan combat 11.2% for Afghanistan combat
veteransveterans (Hoge et al., 2004)(Hoge et al., 2004)
PTSD and the War on TerrorismPTSD and the War on Terrorism
““It is anticipated that the rate of PTSD It is anticipated that the rate of PTSD will be higher among troops who have will be higher among troops who have been to Iraq more than once”. (COL been to Iraq more than once”. (COL Elspeth Ritchie, July 19, 2006)Elspeth Ritchie, July 19, 2006)
PTSD rates, among soldiers PTSD rates, among soldiers hospitalized following serious combat hospitalized following serious combat injury, was 12% at 7 months following injury, was 12% at 7 months following hospitalization (Grieger et al, 2006) hospitalization (Grieger et al, 2006)
PTSD and the War on TerrorismPTSD and the War on Terrorism
““Soldiers who deploy longer (i.e., greater Soldiers who deploy longer (i.e., greater than 6 months) or who had deployed than 6 months) or who had deployed multiple times were more likely to multiple times were more likely to screen positive for a mental health screen positive for a mental health issue”.issue”.
(DOD, Mental Health Advisory Team (DOD, Mental Health Advisory Team (MHAT-IV) Survey: 04 May 2007)(MHAT-IV) Survey: 04 May 2007)
PTSD and the War on TerrorismPTSD and the War on Terrorism
6 – 11% of OEF combat veterans have 6 – 11% of OEF combat veterans have PTSDPTSD
12 – 20% of OIF combat veterans have 12 – 20% of OIF combat veterans have PTSDPTSD
VA should VA should aggressivelyaggressively prevent and treat prevent and treat PTSDPTSD(Report on the President’s Commission on Care for (Report on the President’s Commission on Care for America’s Returning Wounded Warriors, July 2007)America’s Returning Wounded Warriors, July 2007)
PTSD and the War on TerrorismPTSD and the War on Terrorism
Mild Traumatic Brain Injury in Soldiers Returning from Iraq: 5% of 2,500 Soldiers DX with Mild TBI; 48% of the Soldiers with Mild TBI DX with PTSD
- Analysis: with the exception of headache, PTSD & Depression accounted for all other health outcomes or symptoms
(Hoge et al, 2008)
PTSD and the War on TerrorismPTSD and the War on Terrorism
Early Treatment for PTSD:- “Early recognition and treatment may be key for
our newest veterans returning with combat-related PTSD” (Hooten et al, 2008)
- Early treatment is imperative in order to maintain personnel on active duty and to reduce the future burden for the Veterans Administration Health Care System (Ritchie & Owens, 2004; Wain et al, 2005; Forsten & Schneider, 2005)
PTSD and the War on TerrorismPTSD and the War on Terrorism
PTSD Treatment With Virtual Reality Graded Exposure Therapy with Physiological Monitoring (VRGET):
- “VR has been shown to improve treatment efficacy for PTSD in survivors of MVA, war veterans and those involved in the 9/11 World Trade Center attacks” (Wiederhold et al., 2006).
- Efficacy of combined physiological and psychological VRGET for a number of phobias & PTSD documented (Wiederhold & Wiederhold, 1998).
Naval Medical Center San Diego Naval Medical Center San Diego Navy Hospital, Marine Corps Navy Hospital, Marine Corps
Base Camp PendletonBase Camp PendletonFunded by Office of Naval Funded by Office of Naval
Research (ONR)Research (ONR)Funded by TATRCFunded by TATRC
Combat Support Personnel (i.e., Corpsmen, Combat Support Personnel (i.e., Corpsmen, Seabees, non-infantry Marines)Seabees, non-infantry Marines)
Evaluation: qualifying assessment, including two Evaluation: qualifying assessment, including two interviews, completion of self-report measures interviews, completion of self-report measures and objective questionnaires, & and objective questionnaires, & psychophysiological measures assessmentpsychophysiological measures assessment
Wood et al., Combat Related PTSD: A Case Wood et al., Combat Related PTSD: A Case Report Using VRGET with Physiological Report Using VRGET with Physiological Monitoring. Monitoring. CyberTherapy & Behavior, CyberTherapy & Behavior, 10 (2), 10 (2), 2007.2007.
VRGET Sessions 1 & 2: VRGET Sessions 1 & 2: Meditation Training, Meditation Training, exposure to SUDs, CBT, review of Sentinel exposure to SUDs, CBT, review of Sentinel EventEvent
VRGET Sessions 2 – 10: VRGET Sessions 2 – 10: Individualized VRGET Individualized VRGET focused on increasing the intensity of the combat focused on increasing the intensity of the combat “elements”, immersion in the combat “elements”, immersion in the combat environment, eliciting SUDs & effecting environment, eliciting SUDs & effecting “habituation”“habituation”
ReassessmentReassessment following 10 VRGET Sessions following 10 VRGET Sessions
CONCLUSIONS:CONCLUSIONS:1.1. Pt reported presence of improved life-Pt reported presence of improved life-
management skillsmanagement skills2.2. New VRGET Therapy for combat New VRGET Therapy for combat veterans DX with PTSD successfully veterans DX with PTSD successfully developeddeveloped3.3. Currently soliciting input from Currently soliciting input from Treated Treated Warriors concerning the PROS Warriors concerning the PROS and and CONS of their VRGETCONS of their VRGET
4.4. 20 VRGET sessions, with sessions20 VRGET sessions, with sessions twice a week, may be more effective twice a week, may be more effective
5.5. Homework being “framed” usingHomework being “framed” using results from PCL-M administered results from PCL-M administered between re-evaluationsbetween re-evaluations
6. Compare the treatment outcomes for 6. Compare the treatment outcomes for the Warriors’ first 10 VRGET sessions the Warriors’ first 10 VRGET sessions against their treatment outcomes for against their treatment outcomes for their second 10 VRGET sessions.their second 10 VRGET sessions.
Why VR ?Advantages and illustrations
Why VR ?Advantages and illustrations
Not dependent upon patients’ Not dependent upon patients’ imagery abilitiesimagery abilities
Provides a structured environmentProvides a structured environment Visual and auditory stimuliVisual and auditory stimuli Can “Can “over-learnover-learn” skills = ” skills =
“habituation” or develop concept of “habituation” or develop concept of “safety”“safety”
Done in the therapist’s officeDone in the therapist’s office Less time consumingLess time consuming Less expensiveLess expensive SaferSafer
[10]Wiederhold BK, Wiederhold MD. (2005) Virtual Reality Therapy for Anxiety Disorders. Washington, DC: American Psychological Association.
[11]Wiederhold BK, Wiederhold MD. A review of virtual reality as a psychotherapeutic tool. CyberPsychology & Behavior 1998; 1(1): 45 – 52.
[12]Walshe D, Lewis E, Kim SI, O’Sullivan K, Wiederhold BK. Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. CyperPsychology & Behavior 2003; 6(3): 329 – 234.
[13]Wood DP, Murphy JA, Center K, McLay R, Reeves D, Pyne J, Shilling R, Wiederhold BK. Combat-related post-traumatic stress disorder: a case report using virtual reality exposure therapy with physiological monitoring. CyberPsychology & Behavior 2007; 10 (2), 309 – 315.
[14]Spira JL, Wiederhold BK, Pyne J, Wiederhold MD. (2007) Treatment Manual: virtual reality physiological monitored, graded exposure therapy in the treatment of recently developed combat-related PTSD. San Diego, CA: Virtual Reality Medical Center.
[15]Wiederhold BK, Wiederhold MD. Three-year follow-up for virtual reality exposure for fear of flying. CyberPsychology & Behavior 2003; 6 (4): 441 – 328.
[16]Wiederhold BK, Jang DP, Kim SI, Wiederhold, MD. Physiological monitoring as an objective tool in virtual reality therapy. CyberPsychology & Behavior 2002; 5(1): 77 – 82.
[17] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
[18]Orr SP, Roth WT. Psychophysiological assessment: clinical applications for PTSD. Journal of Affective Disorders (2000); 61: 225 – 240.