Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, serious accident, terrorist act, war/combat, rape, or other violent personal assault (American Psychiatric Association, 2017). It affects approximately 3.5 percent of U.S. adults. An estimated one in 11 people will be diagnosed with PTSD in their lifetime. Of the 3.5%, a large portion affected by PTSD are past and present military members (American Psychiatric Association, 2017).
From February 2000 to February 2018, about 223,000 active-duty service members were diagnosed with PTSD, of that, 75 percent were diagnosed following a deployment of 30 days or longer. According to the Department of Veteran Affairs, between 11-20 out of every 100 Veterans who served in Operations Iraqi Freedom and Enduring Freedom have PTSD in a given year, about 12 out of every 100 Gulf War Veterans have PTSD in a given year, and an estimated 30 out of every 100 Vietnam Veterans have had PTSD in their lifetime (U.S. Department of Veterans Affairs, 2018).
Some symptoms associated with PTSD include; long lasting, intense disturbing thoughts and feelings, reliving the event through flashbacks or nightmares, feelings of sadness, fear, anger, detachment from others, and avoiding people and situations that may remind them of their traumatic experience. Generally, symptoms begin within days up to three months following the event. Individuals suffering from PTSD tend to be significantly distressed or have problems functioning (American Psychiatric Association, 2017). If these negative effects and reactions are left untreated, they may become a threat to themselves or someone else.
With the growing number of individuals diagnosed with PTSD, there have been several studies done to assist in the treatment of Post-traumatic Stress Disorder. Currently there are three known treatment options that assist in the improvement of symptoms associated with PTSD. They consist of Psychotherapy, Medication, or a combination of both. In more recent years, there has been an increase in the success of Exposure Therapy (ET), in the treatment of PTSD. Exposure Therapy is a type of behavioral therapy that helps individuals safely face both situations and memories that are frightening, it teaches the person to cope with their feelings more effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares.
A more modern ET approach uses virtual reality programs to re-enter the patient into the environment that left them with PTSD. Virtual Reality Exposure Therapy (VRET) employs virtual reality (VR) technology in order to mediate exposure therapy controlled by a therapist. It elicits fear-related responses in an objectively safe context which resembles real-life situations and enables a patient to interact with three-dimensional virtual scenarios in the same manner as with the real environment. Although this may sound like it could be detrimental to the treatment process, it has shown great success. This study will test the effectiveness of Virtual Reality Exposure Therapy in the prevention of PTSD, specifically when administered to Active Duty military members in a deployed combat setting.
Because Virtual Reality is a newer approach in exposure therapy, there have been fewer studies performed on the success. However, there has been a tremendous amount of studies on the success of Exposure therapy. In a 2008 study, 90 Patients were randomly assigned to receive 5 weekly 90-minute sessions of either imaginal and in vivo exposure (n=30), cognitive restructuring (n=30), or assessment at baseline and after 6 weeks (waitlist group; n=30). The intent-to-treat analyses indicated that at posttreatment, fewer patients in the exposure group had PTSD than those in the cognitive restructuring or wait-list groups. The study concluded that Exposure-based therapy leads to a greater reduction in subsequent PTSD symptoms in patients with Acute Stress Disorder when compared with cognitive restructuring. It also determined that Exposure therapy should be used in early intervention for people who are at high risk for developing PTSD (Bryant et al “Treatment of Acute Stress Disorder”).
However, it was not administered on past or prior military members. In a similar 2017 randomized study testing both ET and VRET in an attempt to determine which is more successful in the treatment of PTSD. The participants were all active duty military members with established diagnoses of PTSD. Although the study determined that both the samples symptoms improved with ET and VRET, there was no significant difference between the two ((McLay, R., Baird, A., Webb-Murphy, J., Deal, W., Tran, L., Anson, H., Klam, W., & Johnston, S., 2017). It should be noted though, that Dr. Mclay had assisted in a very similar study preformed at the Combat Stress Clinic of Fallujah Emergency facility of Camp Fallujah, a marine base located in Iraq. The Parallel Case Series was conducted in 2010 and tested the success level of both VRET and ET. There wasn’t any significant difference between the two. Of the six patients in VR, all showed improvements in their PCL-M scores.
Five of six showed improvements to the point that they would no longer meet DSM criteria for PTSD by the end of treatment. He did note that being in a combat zone could have made a difference in the successful outcome. So, it is understandable that he would preform a very similar study with individuals in their normal environment (McLay, R., McBrien, C., Wiederhold, M., & Wiederhold, B., 2010). Another supporting study was conducted short-term virtual reality exposure treatment of PTSD, an Operation Iraqi Freedom veteran received VRET using a computer-generated view of a Virtual Iraq environment. It was delivered in four, 90-minute individual sessions conducted once weekly over 4 weeks. It resulted in a substantial decrease in the patient’s self-reported PTSD symptoms. Treatment. The patient’s post-treatment CAPS score decreased by 56%.
However, the small sample size of only one must be taken into consideration. Lastly ,a small study, comparing Virtual Reality Exposure Therapy to Present-Centered Therapy with 11 U.S. Vietnam Veterans with PTSD. The five VRE treatment completers experienced a mean CAPS improvement of 31.8 (SD¼39.1) from pretreatment to posttreatment and of 25.0 (SD¼28.1) from pretreatment to follow-up (Ready, D., Gerardi, R., Backscheider, A., Mascaro, N., & Olasov Rothbaum, B., 2010) .
The purpose of this study is to test if the chances of developing PTSD would lessen if Virtual Reality Exposure Therapy is administered on military members who are exposed to traumatizing experiences in a combative war zone compared to their fellow soldiers who did not receive VRET. With the reported success of administering interventions early, the lowered PCL and CAPS scores, and the success with utilizing VRET and ET techniques on both active duty military and veterans in their element and outside of their element (ie. Combat zone) leads the team to ask the question: If Virtual Reality Exposure Therapy were administered at the onset of a traumatic experience, could it lessen the chances of developing PTSD?
A mixed method approached will be used as the research method. The decision was made because it provides more supportive data. The choice was made to use to CAPS-5 The research design that will be utilized to collect data is This study will view two groups, they will be called Group A and Group B. Both groups will be a part of the same command in a combat deployed setting.
Classical Experimental Design with a semi-structured data collection tool (CAPS-5) the LEC-5 will also be utilized prior to the CAPS-5 to determine the level of trauma the individual has received, if any.
Group A will be deployed military members in Afghanistan on a 9-month deployment. It will consist of 10 males of different ethnicities. Group A will not receive Virtual Reality Exposure Therapy. To ensure that none of the members in Group A have PTSD prior to the deployment they will be administered the Clinician- Administered PTSD Scale for DSM-5 (CAPS-5) during their in-processing when they arrive in Afghanistan. The CAPS-5 will be administered in a quite office located in the Behavioral Health Department on base. Once the PCL-M has been administered Group A will not be reevaluated until their final week of deployment. During the final week of deployment, Group A will come back into Behavioral Health and they will again be administered the CAPS-5 in a quite environment. Because it can take up to 3 months to show signs of PTSD,
Group B: Infantryman 17-24 no prior deployment a part of the same command, will also be deployed military members in Afghanistan on the same 9-month deployment. It will consist of 10 males of different ethnicities. However, they will receive Virtual Reality Exposure Therapy in a once weekly sessions lasting for 45 minutes. To ensure that none of the members in Group B have PTSD prior to the deployment they will be administered the Clinician- Administered PTSD Scale for DSM-5 (CAPS-5) during their in-processing when they arrive in Afghanistan. The CAPS-5 will be administered in a quite office located in the Behavioral Health Department on base. Once the CAPS-5 has been administered, Group B will receive their once weekly 45-minute session of Virtual Reality Exposure Therapy. During the final week of deployment, Group B will not receive Virtual Reality Exposure Therapy, but will come back into Behavioral Health and again be administered the CAPS-5 in a quite environment.
The data collected from both Group A and B will be analyzed utilizing an AB Descriptive Design. Demographic statistics. Means, standard errors, percentages, and ranges are reported Age, Gender, Enlisted/Officer, Prior deployments, Number of sessions, Length of Time, Beginning Deployment-CAPS-5, Ending-Deployment-CAPS-5, and 1-month CAPS-5-Change.
Classical Experimental Design with a semi-structured data collection tool (CAPS-5) the LEC-5 will also be utilized prior to the CAPS-5 to determine the level of trauma the individual has received, if any.
Group A and B: As part of the qualitative portion of the study, one-month post-deployment, the members will have a face to face interview at the Behavioral Health Clinic at Fort Knox Army Base, Fort Knox, KY. They will all be administered the LEC-5 and CAPS-5 and the verbal portion of the interview will be evaluated.
Data Analysis- Demographic statistics were gathered for AB Descriptive Design purposes. Means, standard errors, percentages, and ranges are reported Age, Gender, Enlisted/Officer, Prior deployments, Number of sessions, Length of Time, Pre-CAPS-5, Post-CAPS-5, CAPS-5-Change
The data collected from both Group A and B will be analyzed utilizing an AB Descriptive Design. Demographic statistics. Means, standard errors, percentages, and ranges are reported Age, Gender, Enlisted/Officer, Prior deployments, Number of sessions, Length of Time, Beginning Deployment-CAPS-5, Ending-Deployment-CAPS-5, and 1-month CAPS-5-Change.
