Action-Centered Exposure Therapy (ACET): A New Approach to the Use of Virtual Reality to the Care of People with Post-Traumatic Stress Disorder

Abstract

Post-Traumatic Stress Disorder (PTSD) can be seen as the result of dysfunctional beliefs that associate stimuli with a danger or a threat leading to anxious reactions. Exposure therapy is so far considered to be the most effective treatment, and research suggests that it is mainly based on a habituation process. Based on learning theories, it appears that a passive systemic exposure to traumatic stimuli should not be the best option for the treatment of PTSD. We hypothesis that an active learning of safer and healthier coping strategies combined with systematic exposure should be more effective in reducing the psychological distress associated with PTSD. In this paper, we describe the theoretical foundations of this approach that focuses on the action and activity of the patient in his or her exposure environment. In this approach, we take advantage of Virtual Reality technologies and learning mechanics of serious games to allow the patient to learn new safe associations while promoting the empowerment. We named this action-centered exposure therapy (ACET). This approach exploits behaviorism, cognitivism, and constructivism learning theories. With the different benefits of virtual reality technologies, this approach would easily integrate with in-virtuo exposure therapy and would allow us to exploit as much as possible the enormous potential of these technologies. As a first step toward validation, we present a case study that supports the ACET approach.

Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review

“…Of the 18 studies, nine (50%) (Difede et al, 2013;Rothbaum et al, 2014;Reger et al, 2016;Beidel et al, 2017a;McLay et al, 2017;Maples-Keller et al, 2018;Van't Wout et al, 2018;Bisson et al, 2020;Van Gelderen et al, 2020) were RCTs with a total of 483 patients (317 received VR treatment, 100 received an active treatment and 66 allocated to waitlist). Six (33.3%) (Vermetten et al, 2013;Arens, 2014;Kengne et al, 2018;Menelas et al, 2018;Nijdam and Vermetten, 2018;Van Gelderen et al, 2018) were case studies examined a total of 10 patients and three (16.6%) (Beidel et al, 2017b;Jetly et al, 2017;Loucks et al, 2018) were non-randomized single-arm trials subsumed to pilot studies with a total of 116 patients.…”

“…Ten studies (55.5%) (Difede et al, 2013;Arens, 2014;Rothbaum et al, 2014;Reger et al, 2016;Beidel et al, 2017a,b;McLay et al, 2017;Loucks et al, 2018;Maples-Keller et al, 2018;Van't Wout et al, 2018) were conducted in North America, three (16.6%) (Jetly et al, 2017;Kengne et al, 2018;Menelas et al, 2018) in Canada, four in the Netherlands (22.2%) (Vermetten et al, 2013;Nijdam and Vermetten, 2018;Van Gelderen et al, 2018, 2020 and one in Wales, United Kingdom (5.5%) (Bisson et al, 2020). Patients were predominantly male (92.7%), and the mean age ranged from 29 (Reger et al, 2016) -51 (Nijdam and Vermetten, 2018).…”

“…15 (83.3%) studies included soldiers or veterans with combat-related PTSD, with one specializing on PTSD after a military sexual trauma (MST) (Loucks et al, 2018). Two studies (11.1%) reported results from civilian truck drivers after an accident (Kengne et al, 2018;Menelas et al, 2018) and one (5.5%) examined civilians with PTSD related to the attack on the World Trade Center (WTC) (Difede et al, 2013). Table 1 summarizes the descriptive analysis of the 18 articles.…”

“…Regarding the main research question, the results indicate that there are three different approaches to a virtual trauma intervention, namely, VRET (Difede et al, 2013;Arens, 2014;Rothbaum et al, 2014;Reger et al, 2016;Beidel et al, 2017a,b;McLay et al, 2017;Loucks et al, 2018;Maples-Keller et al, 2018;Van't Wout et al, 2018), 3MDR (Vermetten et al, 2013;Jetly et al, 2017;Nijdam and Vermetten, 2018;Van Gelderen et al, 2018, 2020Bisson et al, 2020), and action-centered exposure therapy (ACET) (Kengne et al, 2018;Menelas et al, 2018). The following describes the results of all research questions separated based on the application of VRET, 3MDR, and ACET (see Table 2 for the results of the qualitative analysis for each study and Table 3 for an overview of the results).…”

“…Thus, the approach of inhibitory learning in exposure therapy is used. This is the main difference between ACET and VRET, which utilizes the emotional processing theory by creating virtual visualizations to supplement the patients' traumatic recounting (Foa and Kozak, 1986;Foa and McNally, 1996;Rizzo and Shilling, 2017;Kengne et al, 2018;Menelas et al, 2018). It is assumed that these virtual visualizations activate the pathological fear structure more controllably (Leaman et al, 2013).…”