Aveneu Park, Starling, Australia

“I the treatment of Post-Traumatic Stress Disorder

“I feel stress, anger, road
rage, my heart feels like someone is pinching it”, this is the way Micah
Johnson describes his experience during a mental health checkup one month after
returning to The United States of America from Afghanistan in 2014. He also
complained of insomnia, paranoia and panic attacks, all symptoms of
Post-Traumatic Stress Disorder. Two years later, on the 7th July of
2016 his life took a tragic turn. During a Black Life’s matter protest in
Dallas, elicited by anger over previous police
shootings, Micah Johnson shot five police officers and was later killed by a
bomb attached to a remote-control robot (Charise Frazier, 2016).

Situations like this fuel the
discussion about the treatment of Post-Traumatic Stress Disorder (PTSD) in military veterans and if this tragic incident, or
others like it, could have been prevented.

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The National
Comorbidity Survey Replication (NCS-R), conducted between February 2001 and
April 2003 found that approximately 70% of adults in the United States have
experienced a traumatic event at least once in their life; with 20% of these
developing Post-Traumatic Stress Disorder it can be classified as a serious
problem when it comes to mental health. Post-Traumatic Stress Disorder (PTSD)
includes symptoms like distressing memories, dreams or flashbacks about the
specific traumatic event, physiological reactions and even avoidance behaviour.
(Gleitman, Gross & Reisberg, 2010). Experiencing a multitude of different
situations like natural disasters, sexual violence, motor vehicle accidents or
exposure to war, can lead to the development of these symptoms. (Cristina Botella, Berenice Serrano, Rosa M Baños,
Azucena Garcia-Palacios, 2015). Based
on these studies it can be concluded that PTSD is a prevalent disorder that can
be brought on by a multitude of different experiences and traumas.

Treatment for PTSD includes certain types of medication or psychotherapeutic
methods, such as Prolonged Exposure Therapy (PE). PE aims to break the
connection between the distressing stimulus and the associated fears by
teaching the patient to maintain a state of relaxation while imagining the
object or situation that is the cause of the anxiety (Gleitman, Gross & Reisberg, 2010). Patients start by creating an anxiety hierarchy, which
orders the objects or situations by the intensity of the experienced fear or
distress. During the treatment, the patient now imagines themselves in these situations
following the order of the established hierarchy. When the patient is able to
stay calm and comfortable during this imagination, they gradually move up the
hierarchy to the next most anxiety-producing stimulus. This process ends with in
vivo desensitization, in which the patient is exposed to the anxiety-producing
stimulus in real life. While Prolonged- Exposure Therapy has been shown to be
successful in reducing PTSD symptoms (Powers, Halpern, Ferenschak, Gillihan, &
Foa, 2010) it also has some significant limitations. As the exposure is purely
imaginal it gives the therapist very little control over the imagined object or
situation, there is also no way for the therapist to see exactly what the
patient is imagining. Introducing a new treatment, that combines PE with new
technological inventions, could minimize some of these limitations.

Over the last
years the development of new and innovative technology has not only impacted
the gaming and entertainment industry but has also had a huge influence on the
treatment of psychological disorders. One of these new inventions is Virtual
Reality (VR), a technology that allows the simulation of a wide range of
real-life situations in a computer-generated environment, this allows the user
to interact freely with this environment and creates a strong feeling of
immersion in the specific environment. (Cristina Botella, Berenice Serrano, Rosa M Baños, Azucena Garcia-Palacios,
2015). Based on this
technology is Virtual Reality Exposure (VRE) or Virtual Reality Exposure
Therapy (VRET), a treatment method that involves the patient being immersed in
an environment that might trigger psychological distress. Advantages of VRE
include the high level of immersion, which makes the situation feel more
realistic and the user more involved in the virtual world. It also allows the
therapist more control over the environment, and therefore the intensity of the
stimulus the patient is exposed to (Hamm & Weike, 2005). Virtual Reality
Exposure has been shown to be effective in the treatment of a wide range of
anxiety disorders, including acrophobia, the fear of heights (Emmelkamp et al.,
2002) and arachnophobia, the fear of spiders (Garcia-Palacios, Hoffman, Carlin,
Furness, & Botella, 2002). Several studies have also shown a reduction in
PTSD symptoms following Virtual Reality Exposure Treatment in military veterans
(e.g. Rothbaum et al.,2014). Based on these studies it can therefore be
concluded that the utilization of new technology, such as VR, for therapeutic
purposes can be very effective in the treatment of psychological disorders.         

people to participate in any kind of treatment can however be difficult.
Because of the stigma attached to PTSD and mental disorders in general, sufferers
often prefer to keep their problems secret and do not reach out for help. A
study by Charles W. Hoge, et al., 2014 found that out of the 229 soldiers that
were diagnosed with PTSD only half sought help at a mental health facility. This
creates an immense importance for preventative methods. Creating a treatment
that is done during the exposure to the traumatic situation, e.g. combat
deployment, could prevent the development of PTSD and therefore reduce the rate
and symptom severity of PTSD patients. While multiple studies have shown the
effectiveness of Virtual Reality Exposure in the treatment of PTSD, the studies
exploring the effects of VRE as a preventive method, especially compared to other
existing treatment methods, have been extremely limited.

One of these
studies investigating the preventative qualities of VRET has found that
treating active duty soldiers with VRE lead to a significant decrease in
reported PTSD symptoms (Reger et al., 2014). Building on this previous research,
this study aims to explore the effect of Virtual Reality Exposure Therapy in
active duty soldiers on later onset or development of PTSD related symptoms.
Given that VRET has been shown in multiple studies to reduce PTSD related
symptoms, we hypothesize that the treatment with VRE during active deployment
will significantly reduce the severity of PTSD related symptoms. And
considering the advantages that VRET has over PE, most importantly the ability of
the therapist to control the environment the patient is exposed to, we
hypothesize that VRET will show a greater reduction in PTSD symptoms than PE.

investigate this, 50 active duty soldiers, all working in comparable fields and
therefore all exposed to similar levels of violence, were divided into two
groups: the experimental group, receiving VRET twice a week; and the control
group, who received the conventional PE treatment also twice a week. Both
groups were assessed with a Pre-Test, administered before the beginning of the
treatment, a Post-Test, administered after the deployment and shortly before
returning home, as well as a Retention-Test, administered five years after the
exposure to the traumatic event. PTSD symptoms were measured using self-report
methods as well as a structured interview with a classified psychologist.

We predict
that both, the control and the experimental groups will score lower in regard
to the prevalence of PTSD symptoms on the Post- and Retention-Test compared to
the Pre- Test. We predict that the experimental group however will show a
greater reduction PTSD symptoms than the control group.


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