Objective To determine the effectiveness of Virtual Reality Exposure (VRE) augmented with D-cycloserine (50mg) or alprazolam (0.25mg), compared to placebo, in reducing PTSD due to military trauma in Iraq and Afghanistan. Method A double-blind, placebo-controlled randomized clinical trial comparing augmentation methods for VRE for subjects (n= 156) with PTSD was conducted. Results PTSD symptoms significantly improved from pre- to post-treatment over the 6-session VRE treatment (p<.001) across all conditions and were maintained at 3, 6, and 12 months follow-up. There were no overall differences between the D-cycloserine group on symptoms at any time-point. The alprazolam and placebo conditions significantly differed on the post-treatment Clinician Administered PTSD scale (p = .006) and the 3-month post-treatment PTSD diagnosis, such that the alprazolam group showed greater rates of PTSD (79.2% alprazolam vs. 47.8% placebo). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only (p<.005). At post-treatment, the D-cycloserine group was the lowest on cortisol reactivity (p<.05) and startle response during VR scenes (p<.05). Conclusions A small number of VRE sessions were associated with reduced PTSD diagnosis and symptoms in Iraq/Afghanistan veterans, although there was no control condition for the VRE. Overall, there was no advantage of D-cycloserine on PTSD symptoms in primary analyses. In secondary analyses, benzodiazepine use during treatment may impair recovery, and D-cycloserine may enhance VRE in patients who demonstrate within-session learning. D-cycloserine augmentation treatment in PTSD patients may reduce cortisol and startle reactivity compared to the alprazolam and placebo treatment, consistent with the animal literature.

D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR;Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans (Hoge et al., 2004). Due to the nature of this conflict, the war in Iraq presents unique and chronic stressors, including civilian threats such as guerilla warfare and terrorist actions (Hoge et al., 2004). Soldiers and Marines need to maintain constant vigilance to deal with unpredictable threats like roadside bombs, and to discern safe civilians from potential combatants (Litz, 2005). Additionally, an unprecedented number are now surviving serious wounds (Bilmes, 2007 (Schnurr, Lunney, & Sengupta, 2004). Because this is a disorder which, once manifested, often results in a chronic course, early and efficient intervention options must be identified. Presenting treatment in a brief form that is acceptable to military personnel is also a priority, as concern about the stigma of treatment remains an issue which prevents soldiers from seeking the help they may require (e.g., Hoge et al., 2004).Reviews of research and empirical evidence have found cognitive behavior therapy, including exposure therapy, to be a most effective treatment for PTSD (e.g., Bradley, Greene, Russ, Dutra, & Westen, 2005;Van Etten & Taylor, 1998). According to the emotional processing model proposed by Foa and Kozak (1986), the fear structure must be activated and modified to allow for the processes of habituation and extinction of fear to occur, which results in the feared stimuli no longer eliciting anxiety. A specific form of exposure therapy, virtual reality exposure (VRE) therapy, is a human-computer interaction medium in which patients can be immersed in a virtual environment which gives the user a sense of presence, and is proposed to effectively elicit the fear structure and aid the emotional processing of fears (Rothbaum et al., 1995). The virtual reality simulation allows for precise delivery and control of trauma-relevant exposure stimuli in a safe environment. A controlled study is currently underway to evaluate the effe...

Anxiety disorders, including phobias and post-traumatic stress disorder, are common and disabling disorders that often involve avoidance behavior. Cognitive-behavioral treatments, specifically imaginal and in vivo forms of exposure therapy, have been accepted and successful forms of treatment for these disorders. Virtual reality exposure therapy, an alternative to more traditional exposure-based therapies, involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. In this article, we review evidence on the application of virtual reality exposure therapy to the treatment of specific phobias and post-traumatic stress disorder and discuss its advantages and cautions.

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