干旱区生态环境知识资源中心(Arid): Initial results from the ViRTICo trial: virtual reality therapy and imaging in combat veterans

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	Initial results from the ViRTICo trial: virtual reality therapy and imaging in combat veterans
	Roy, Michael J.; Francis, Jennifer; Friedlander, Joshua; Banks-Williams, Lisa; Lande, Raymond G.; Taylor, Patricia; Blair, James; Vythlingam, Meena; McLellan, Jennifer; Law, Wendy; Patt, Ivy; Difede, Joann; Rizzo, Albert; Rothbaum, Barbara
通讯作者	Roy, MJ
来源期刊	ANNUAL REVIEW OF CYBERTHERAPY AND TELEMEDICINE
ISSN	1554-8716
EISSN	2352-927X
出版年	2008
卷号	6 页码:49-54
英文摘要	Many wars have a signature illness or two for which they are remembered, such as "Soldier's Heart" after the American Civil War or Shell Shock and mustard gas injuries after World War I. Vietnam introduced posttraumatic stress disorder (PTSD) to our lexicon, and Desert Storm wrought "Gulf War Syndrome". War also spawns innovative medical responses that in turn spur significant medical advances with society-wide benefits. The American War of Independence introduced litters for carrying wounded soldiers, Napoleon's forces added specific litter-bearing teams, and the American Civil War saw the advent of horse-drawn "ambulances". World War II fostered burgeoning medical specialization, a trend that continues today. Amputations are one face of Operation Iraqi Freedom, because body armor protects the torso, while rapid response medical and surgical care and superb air transport casualty care greatly improve survival following severe limb injuries. This is driving major advances in wound care and prosthetics. In addition, the nature of the conflict in Iraq, with suicide bombers, improvised explosive devices (IEDs), and no clear battle lines or safe zones, is responsible for high rates of both PTSD and traumatic brain injury (TBI). This provides an opportunity to improve the diagnosis and treatment of PTSD and TBI and we hope the work we describe here will contribute to that discussion. PTSD has been identified in 10-20% of veterans of recent wars. However, diagnosis relies on self report, and multiple factors lead some to under-report symptoms while others over-endorse. The best validated instrument, the 17-page Clinician-Administered PTSD Scale (CAPS), takes a trained professional (usually a psychologist, often in short supply) an hour to administer'. Self-administered alternatives such as the 17-item PTSD Checklist (PCL) lack the accuracy of the CAPS. Since PTSD is associated with poorer physical and mental health, functional impairment in multiple domains, and higher healthcare costs(2-4), validation of an objective diagnostic tool could reduce stigma, enable more expeditious treatment and direct compensation appropriately. An imaging technique such as functional magnetic resonance imaging (fMRI), while not inexpensive, might still be cost-effective compared to hiring and training psychologists to administer the CAPS. The diagnosis of TBI is straight-forward with unequivocal loss of consciousness, but obstacles to making an objective diagnosis of mild TBI are even greater than for PTSD. There are no standardized criteria for diagnosing mild TBI in the absence of loss of consciousness; proposed criteria include immediate reactions such as feeling dazed or confused, or not remembering the injury, and later symptoms including memory or concentration problems, irritability, sleep difficulties, and headaches. The initial reactions are hard to establish a threshold for, as surprise and confusion are nearly universal in an unexpected explosion. The later symptoms are non-specific, and frequently reported with PTSD and depression, so it is no surprise that extensive overlap has been reported between mild TBI and PTSD5. In this study, we use "blast exposure" as a surrogate for mild TBI, yet even this has ambiguity. Functional MRI is a potent, novel method which might objectively assess the impact of trauma on the central nervous system, by measuring oxygenation, most influenced by blood flow, to key areas of the brain. Patients with PTSD exposed to various stimuli have been shown to have greater activation in the amygdala, with lesser activation in the anterior cingulate gyrus, than controls(6-8). Our study utilizes the Affective Stroop which has shown efficacy in distinguishing those with PTSD from trauma-exposed controls (9-10) -as well as a novel stimulus (virtual reality) we hope will prove superior at sorting out PTSD and TBI in OIF/OEF veterans. Improved identification of PTSD and TBI is a key first step, but more effective treatment is also imperative. Successful treatment of PTSD should improve quality of life and functional status, decrease symptom severity, and reduce vulnerability to subsequent stress. A recent Institute of Medicine report concluded that cognitive behavioral therapy (CBT) with exposure therapy is the only therapy with sufficient evidence to recommend it(11). Imaginal exposure is the most widely employed exposure method, requiring the patient to repeatedly recount their traumatic experience to their therapist in progressively greater detail. However, avoidance of trauma reminders is a defining feature of PTSD, so many patients have difficulty with this, establishing a need for another method to engage patients in order to expand the application and efficacy of exposure therapy. Virtual reality (VR) has significant promise in this regard; the treatment phase of our study is therefore designed to establish that the efficacy of VR exposure therapy (VRET) is comparable to that of Prolonged Exposure (PE), the best-evidenced form of imaginal exposure.
类型	Article
语种	英语
开放获取类型	DOAJ Gold
收录类别	ESCI
WOS记录号	WOS:000216907500005
WOS类目	Computer Science, Cybernetics
WOS研究方向	Computer Science
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/329056
作者单位	[Roy, Michael J.; Francis, Jennifer; Friedlander, Joshua; Banks-Williams, Lisa; Lande, Raymond G.; Taylor, Patricia; Law, Wendy] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA; [Roy, Michael J.; Francis, Jennifer; Friedlander, Joshua; Banks-Williams, Lisa; Lande, Raymond G.; Taylor, Patricia; Law, Wendy] Walter Reed Army Med Ctr, Washington, DC USA; [Blair, James; Vythlingam, Meena; McLellan, Jennifer] NIMH, NIH, Bethesda, MD 20892 USA; [Difede, Joann] Cornell Univ, Weill Med Coll, New York, NY 10021 USA; [Rizzo, Albert] Univ Southern Calif, Inst Creat Technol, Los Angeles, CA USA; [Rothbaum, Barbara] Emory Univ, Sch Med, Atlanta, GA 30322 USA
推荐引用方式 GB/T 7714	Roy, Michael J.,Francis, Jennifer,Friedlander, Joshua,et al. Initial results from the ViRTICo trial: virtual reality therapy and imaging in combat veterans[J],2008,6:49-54.
APA	Roy, Michael J..,Francis, Jennifer.,Friedlander, Joshua.,Banks-Williams, Lisa.,Lande, Raymond G..,...&Rothbaum, Barbara.(2008).Initial results from the ViRTICo trial: virtual reality therapy and imaging in combat veterans.ANNUAL REVIEW OF CYBERTHERAPY AND TELEMEDICINE,6,49-54.
MLA	Roy, Michael J.,et al."Initial results from the ViRTICo trial: virtual reality therapy and imaging in combat veterans".ANNUAL REVIEW OF CYBERTHERAPY AND TELEMEDICINE 6(2008):49-54.