Program & Abstract Book - EPFL Latsis Symposium 2009

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EPFL Latsis Symposium 2009: Understanding Violence S-23 50 February 11-13 2009 re-e X p o s u r e t o co m b a t in vi r t u a l re a li t y a s a tr e a t m e n t f o r ptsD (co n t .) Rizzo, Albert Institute for Creative Technologies University of Southern California, USA or before deployment (9.4%). Furthermore, the prevalence of PTSD among SMs deployed to Iraq increased in a linear manner with the number of firefights experienced, such that PTSD rates were 4.5% for those involved in no firefights and increased to 19.3% for those involved in more than five firefights. Hoge et al., [6] in a more recent study analyzed the Post Deployment Health Assessment (PDHA) responses of over 300,000 SMs after deployment to Iraq and Afghanistan. Although the PDHA uses a different screening tool for PTSD, (the Primary Care PTSD screen; PC-PTSD), results were similar to previous research indicating that the PTSD rates for SMs deployed to Iraq were higher than the PTSD rates for SMs deployed to Afghanistan. Also, SMs who screened positive for any mental health concern were more likely to leave military service within a year after deployment, and their mental health concerns are likely to persist. Seal and colleagues [7], in a recent study of 103,788 OIF/OEF veterans seen at VA health facilities, reported that 31% received mental health/or psychological diagnoses and that 16% of veterans who sought treatment at VA facilities between September 2001 and September 2005 met criteria for PTSD. Furthermore, these estimates were made before the violence escalated in the last 2 years, and the number of persons affected is likely to have grown in step with the intensity of the conflict. For example, VA statistics report that there were 19,356 OIF/ OEF veterans receiving compensation for PTSD as of March 2006, while five months after in August 2006, 34,380 discharged soldiers from Iraq and Afghanistan were diagnosed by the VA with PTSD, of the 63,767 diagnosed with a mental disorder with current estimates suggesting approximately 300,000 OIF/OEF Veterans at risk for developing PTSD [8]. These findings highlight the need and potential value in addressing this problem early, intensively and with the best non-stigmatizing treatment tools available for combat veterans still in service as well as upon discharge. Among the many approaches that have been used to treat PTSD, exposure therapy appears to have the best-documented therapeutic efficacy. Such treatment typically involves the graded and repeated imaginal reliving of the traumatic event within the therapeutic setting and is believed to provide a low-threat context where the patient can begin to therapeutically process trauma-relevant emotions as well as de-condition the learning cycle of the disorder via a habituation/extinction process. While the efficacy of imaginal exposure has been established in multiple studies with diverse trauma populations, many patients are unwilling or unable to effectively visualize the traumatic event. To address this problem, researchers have recently turned to the use of Virtual Reality (VR) to deliver exposure therapy by immersing patients in simulations of trauma-relevant environments that allow
EPFL Latsis Symposium 2009: Understanding Violence S-23 Abstracts for Speakers re-e X p o s u r e t o co m b a t in vi r t u a l re a li t y a s a tr e a t m e n t f o r ptsD (co n t .) Rizzo, Albert Institute for Creative Technologies University of Southern California, USA for precise control of stimulus conditions. Since 2004, the University of Southern California Institute for Creative Technologies has spearheaded an extensive scientific program for the development and evaluation of a novel Virtual Reality system for exposure therapy for PTSD. The initial prototype version of this system (Virtual Iraq/ Afghanistan) has undergone successful clinical tests via an open clinical trial at the Naval Medical Center-San Diego and Camp Pendleton and a randomized clinical trial is underway at Ft. Lewis, WA. Direct clinical application and other comparative clinical trials are ongoing at approximately 20+ sites. This talk will present an overview of PTSD exposure therapy, a description of VR and the rationale for how this technology has been applied as a tool to deliver exposure therapy along with a brief review of current research. We then provide a description of the Virtual Iraq/Afghanistan exposure therapy system and treatment protocol and present initial results from an open clinical trial with active duty military personnel. The talk will conclude with a summary of future directions where VR technology can be applied to more comprehensively address a range of issues relevant to the emotional consequences of the violence of war. Background and current results from this project can be found in Rizzo et al., [9-11]. 51
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