By Lisa Collier Cool | Posted November 11 2010
High-Tech Psychotherapy Shows Promise for Post-Traumatic Stress Disorder
An estimated 300,000 veterans of the Iraq and Afghanistan wars–nearly 20 percent of the total returning troops–suffer from post-traumatic stress disorder (PTSD) or major depression. Also called “shell shock” or “battle fatigue,” PTSD is an anxiety disorder sparked by life-threatening danger or other terrifying events, such as violent crimes, natural disaster, car crashes and military combat. Five million Americans are haunted by its devastating symptoms, which include recurring nightmares, flashbacks, phobias, angry outbursts, insomnia, jumpiness and emotional numbness.
Adding to their anguish, soldiers returning from the Middle East wars with PTSD are also afflicted with a higher rate of physical ailments, with female veterans at particularly high risk, a study of more than 90,000 VA patients by the Department of Veterans Affairs and Stanford University reported in September. Female Iraq and Afghanistan war vets with PTSD had a median of seven medical conditions, such as lower back disorders, headaches and knee problems, versus 4.5 for women without a mental health diagnosis. Men with PTSD had a median of five disorders, compared to four for male veterans without a mental health diagnosis.
New hope may be on the horizon for veterans suffering from the invisible wounds of war. Researchers at Emory University are testing the combination of virtual reality therapy and the drug d-cycloserine (DCS) to treat PTSD. The goal is to defuse the intense fear that underlies the disorder to help affected veterans find inner peace, explains Barbara Rothbaum, Ph.D., ANPP, the study’s principal investigator, professor of psychiatry and director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine. “Although the traumatic memories will never go away, we believe that virtual reality exposure therapy and DCS will make it easier for patients to cope with these memories,” which people with PTSD relive over and over through terrifying flashbacks and nightmares.
The new treatment is a high-tech twist on a widely used type of cognitive behavior therapy for phobias and anxiety disorders, including PTSD, called exposure therapy. It’s based on the idea that patients can gradually gain control of their fear through confronting it repeatedly under the supervision of an experienced therapist. “The usual approach is for patients to close their eyes and imagine the event is occurring,” says Rothbaum. “In our study, the patients’ eyes are open and they wear ear phones and a strappy headset with TV screens, allowing the therapist to match what they’re imagining with a virtual reality environment.”
Using a Virtual Iraq module developed by Dr. Skip Rizzo and colleagues at the Institute for Creative Technologies and School of Gerontology at the University of Southern California, the researchers can create such scenarios as a Humvee driving down an Iraqi highway and hitting an ICD or battles that include simulated explosions, the sounds of bullets, and the roar of Black Hawk helicopters, adds Rothbaum. “We can even introduce smells like burning rubber, diesel fuel, Middle Eastern spices, and cordite, because odors are linked to the strongest memories going back to the amygdala, the brain’s fear center.”
Earlier research by Emory and Yerkes neuroscientist, Michael Davis, Ph.D., have shown that DCS, an antibiotic commonly used for tuberculosis, enhances the extinction of fear, and a small study in Australia also reported encouraging results when DCS was combined with cognitive behavior therapy to treat young adults with social anxiety. Patients receiving the virtual reality and DCS in the veterans study therapy can move around and view the simulated scenes, which are like 3-D movies, in 360 degrees. “When they turn their head, the scene changes because the headset has positional sensors,” adds Rothbaum, who reports that after four sessions, the first participant in the study had a 56 percent reduction in symptoms.
The study, which is continuing to enroll veterans with PTSD, involves six sessions and will ultimately test the treatment on 76 patients. “PTSD is a disorder in which people engage in avoidant behaviors, such as avoiding situations and places that might trigger their traumatic memories, but the exact thing they don’t want to—confront the fear—is what they most need to do,” says Rothbaum. “It’s the only way to the other side of the pain.”
CONNECT THE DOTS
To learn more about the study, visit Emory University’s website, which provides a contact for enrolling in the Iraq and Afghanistan veterans study. The Department of Veterans Affairs National Center for PTSD has fact sheets, videos, and information on how to get help. In July, the VA issued new rules to make it easier for veterans from any era with PTSD to qualify for disability benefits, a move President Barack Obama has called “a long overdue step.”
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