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Post-Traumatic Stress Disorder

Virtual Reality Exposure Therapy for PTSD in the military

A review of promising emerging evidence

PTSD may be the most urgent problem facing the U.S. military today

The personal, social and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to PTSD are major issues facing American society broadly. After decades of research there is still no consensus on the causes, nature or treatment of the psychological and psychosomatic consequences of trauma. Many therapies used in psychiatry reduce the severity of some PTSD symptoms however medications and psychotherapy have limited efficacy. In a review of 55 studies on empirically supported treatments of PTSD high dropout rates or non-response rates (up to 50%) were common. The limitations of current mainstream treatment approaches invite open-minded consideration of the range of promising non-medication approaches aimed at preventing PTSD following exposure to trauma and treating chronic PTSD including natural supplements, yoga, mind-body practices, EEG biofeedback and virtual reality graded exposure therapy (VRGET).

This blog reviews important new research findings on virtual reality graded exposure therapy for PTSD. Future blog posts in this series will review the evidence for other non-pharmacologic approaches used to treat or prevent PTSD.

Virtual reality graded exposure therapy: an effective treatment of PTSD

The following is abstracted from “The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel,” published by the author in Advances in Integrative Medicine. The interested reader is directed to the full article (see link below). Concise reviews of evidence for complementary and alternative therapies for treating and preventing PTSD are available in the author's e-book “Post-traumatic Stress Disorder: The Integrative Solution.”

Virtual reality (VR) technology employs high-end computer graphics, 3D displays and multi-sensory feedback to create the illusion of interacting with a computer-generated environment resulting in intense feelings of ‘immersion’ and ‘presence.’ Sessions are guided by a therapist who regulates the virtual scenario to achieve the appropriate intensity of arousal for the patient. Repeated exposure results in habituation to a particular fear-inducing environment (i.e. reduced autonomic arousal), extinction of fear response and reduction in severity of PTSD symptoms.

Findings of a study on combined multisensory exposure and VRGET reported significant reductions in severity of PTSD symptoms in active duty combatants who had failed to respond to other forms of exposure therapy. Several patients in the study reported significant improvement following only five VRGET sessions however there was considerable variability in the number of VRGET sessions needed to reduce symptom severity to the same level. The findings suggested that brief VR exposure therapy may result in rapid extinction when combined with multisensory exposure and D-cycloserine or other medications. A pilot study in which nine healthy subjects were exposed to stress induced by a virtual bomb explosion investigated combined Virtual Reality (VR) and EEG bio-feedback as a potential treatment of stress-related disorders. Findings of correlations between general stress levels, serum cortisol levels, heart rate variability and mid-frontal alpha EEG asymmetry suggest that real-time neurophysiological data may provide useful inputs for adjusting VRGET protocols to enhance stress resilience or accelerate treatment response

VR applications are being developed to assess the risk of developing PTSD following trauma, and mental resilience training aimed at preventing PTSD in active duty soldiers and other high risk groups. Efforts are ongoing to develop interactive internet and smart-phone applications for VRGET protocols addressing PTSD in this population. Sub-threshold PTSD symptoms may be associated with impaired physical health, mental health, and increased risk of subsequently developing PTSD. In a pilot study newly returning veterans who experienced significant subthreshold symptoms but who did not meet full criteria for PTSD exhibited elevated heart rates in response to a VR paradigm (Virtual Iraq) designed to elicit fear. Stress Inoculation Training (SIT) is a recently developed approach that emphasizes cognitive restructuring and the acquisition and rehearsal of coping skills during graded virtual exposure to stressors that simulate the trauma.

Preliminary findings suggest that pre- or post-deployment stress inoculation training in groups of soldiers may reduce symptoms of autonomic arousal. Some individuals using VRET report mild transient symptoms of disorientation, nausea, dizziness, headache and blurred vision. ‘‘Simulator sleepiness’’ has been defined as feelings of generalised fatigue that sometimes follow exposure to virtual environments. Virtual environments can triggers migraine headaches, seizures, or gait abnormalities and individuals diagnosed with these medical problems should be cautioned about possible adverse effects of exposure to virtual environments.


Lake, J., (2015) The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel, Advances in Integrative Medicine; 2: 13-23.

About the Author
James Lake, MD

James Lake, M.D., a clinical assistant professor at the University of Arizona College of Medicine, works to transform mental health care through the evidence-based uses of alternative therapies.

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