Is Virtual Reality Exposure Therapy Effective for Combat-Related PTSD?
Concern over the best methods to prevent and treat combat-related post-traumatic stress disorder (PTSD) in military service members and veterans has been of particular interest with the resurgence of military service members who are serving multiple tours. The stigma within the military of a PTSD diagnosis prevents many service members from seeking treatment. The preferred treatment for anxiety disorders is exposure therapy (Powers & Emmelkamp, 2007). A relatively new exposure-based treatment for PTSD that has gained attention in the media and therapeutic community is the use of virtual reality programs. Virtual Reality Exposure Therapy (VRET) has been tested with persons experiencing PTSD symptoms in multiple trials and with many different causes of anxiety (Gerardi, Cukor, Difede, Rizzo & Rothbaum, 2010; Pull, 2005). This review assesses studies of the effectiveness of VRET in treating service members and military veterans diagnosed with combat-related PTSD.
A search of fourteen databases yielded six studies with experimental or quasi-experimental designs where VRET was used with active duty service members or veterans diagnosed with combat-related PTSD. Three studied the use of VRET with active duty soldiers and another three the use of VRET with veterans. Three included random assignment to VRET treatment or a control/treatment as usual group, and three studies used a quasi-experimental design.
Despite small sample sizes, the studies tended to support the effectiveness of VRET for this population. The nature of the treatment itself appears to be difficult for veterans to either comprehend or trust. It is suspected the current generation of service members may be reacting more positively to using virtual reality as a method of treatment because they were raised in a generation more familiar with this type of technology. The amount of time that has lapsed between onset and treatment for veterans may also be affecting veterans’ willingness or ability to relive the traumatic event in the virtual environment. High dropout rates in studies where participants are active duty service members (McLay et al., in press) could be attributed to difficulties in balancing treatment with military duties, the time commitment of treatment sessions (90-120 minutes twice weekly for 8-12 weeks), and the possibility of transfers occurring mid-treatment.
Conclusions and Implications
Overall, the studies in this review found VRET to be beneficial to both active duty service members and veterans experiencing combat-related PTSD. Each group has a different set of difficulties preventing them from seeking or receiving treatment, evidenced by small sample sizes and high levels of attrition. More studies are needed that include larger sample sizes, stronger experimental design, and a longer period of follow up of two or more years. Cost of equipment, need of training, and concerns over using technology in the therapeutic setting may deter the use of VRET from becoming a regular treatment method. If positive distal effects of the treatment can be more readily established, the benefits of VRET would perhaps balance out the difficulties seen in implementing it on a wide-scale basis.