Post-traumatic Stress Disorder (PTSD), Addiction, and Virtual Reality
Condition: Substance Use Disorders; Posttraumatic Stress Disorder
MeSH terms: Substance-Related Disorders; Stress Disorders, Traumatic; Behavior, Addictive; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Eligible veterans, National Guardsmen & Reservists with post-traumatic stress disorder (PTSD)
      and problems with addiction will be randomly assigned to one of two treatment conditions. All
      participants will undergo exposure therapy, a gold standard behavioral treatment for PTSD for
      10 weeks. In addition to exposure therapy, some participants will be randomly assigned to
      receive (1) virtual reality (VR)-based exposure to cues for marijuana, cocaine, heroin,
      cigarette, and/or alcohol use, and (2) cellular phone-based reminders of learning (extinction
      reminders, or, ERs) to VR exposure (available 24 hours per day/7 days per week) to high-risk
      contexts for drug use. The main hypothesis is that those participants who receive exposure
      therapy + VR/ERs will demonstrate less substance use and lower PTSD symptoms during
      treatment, at post-treatment, and at follow-up than those participants who only receive
      exposure therapy. At study completion, a total of 123 subjects signed consent.
    

Detailed description: 
      Veterans, National Guardsmen, & Reservists with post-traumatic stress disorder (PTSD) and
      problems with addiction need a wider array of treatment options than what is currently
      available. The present project offers the promise of a complementary approach that uses
      computer-based interventions to augment exposure therapy for veterans with both PTSD and use
      alcohol, nicotine and/or other substances. If this new intervention is found to be
      efficacious in the present project, it would provide an alternative to standard treatment for
      a growing number of veterans who are at risk for lifetime problems with PTSD and addiction,
      but who may be unwilling to begin usual psychotherapy. This direct way of training new
      behavior in the clinic and extending learning into the real world is missing in treatments
      for many medical and psychiatric conditions. As such, the impact of this project could extend
      into treatment of a wide variety of other chronic conditions for which more powerful new
      treatments are needed. Veterans will be recruited from the Durham Veterans Affairs Medical
      Center (Durham VAMC) and local community.

      Participants (N = 60) meeting full criteria for current diagnoses of both PTSD and at least
      one SUD were to be recruited through the Durham Veterans Affairs Medical Center (Durham
      VAMC). 100 participants were to be enrolled (sign the consent form) in order to identify 60
      who meet inclusion/exclusion criteria. Actually 123 subjects signed consent and 38 subjects
      are considered ITT (intent to treat-met inclusion/exclusion criteria, randomized and showed
      to their first therapy session). Participants were randomly assigned to one of two treatment
      conditions-exposure therapy alone or exposure therapy + virtual reality (VR)-based exposure
      to cues for marijuana, cocaine, heroin, cigarette, and/or alcohol use, and (2) cellular
      phone-based reminders of learning (extinction reminders, or, ERs) to VR exposure. Matching
      between treatment groups was based on age, gender, severity of PTSD and substance use. In
      addition, to control for differential dropout and other changes in treatment due to cell
      phone use in the VR/ER condition, participants in the control condition also carried cell
      phones, and were randomly called three times a day via the automated server (same as the
      VR/ER condition). These calls were completed for assessment only, to obtain real time
      self-reports of substance use and cravings (without the ER). Comprehensive assessments were
      conducted at pre-treatment, 10 weeks (post-treatment), and at a 6-month follow-up.

      The goals of this project are to examine the acceptability and feasibility of the
      complementary treatment and evaluate the effects of the complementary intervention on PTSD
      and substance use.
    

Intervention name(s): Prolonged Exposure Therapy; Prolonged Exposure therapy + VR/ER
Intervention type(s): Behavioral; Behavioral
Intervention description(s): These treatments include repeated exposure to intrusive trauma-related memories in a safe and structured manner designed to reduce emotional arousal and facilitate processing of trauma-related memories.; The therapy includes repeated exposure to intrusive trauma-related memories in a safe and structured manner designed to reduce emotional arousal and facilitate processing of trauma-related memories and adding in virtual reality (VR)-based exposure to cues for marijuana, cocaine, heroin, cigarette, and/or alcohol use & CER used outside treatment sessions in response to VR exposure (available 24 hours per day/7 days per week) to high-risk contexts for drug use
Other intervention name(s): Exposure Therapy; virtual reality; exposure therapy; CER; VR; cell-phone based computerized extinction reminder
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Addiction; Posttraumatic Stress; substance abuse and posttraumatic stress