Moving forward in treatment of posttraumatic stress disorder: innovations to exposure-based therapy

Abstract

The field of treatment of posttraumatic stress disorder (PTSD) has been a pacesetter for the changing face of psychotherapy, as is illustrated in the introduction of Virtual Reality Exposure Therapy. This paper outlines a novel approach that builds on a cognitive-motor interaction in a virtual interactive environment. It is based on the theory of memory reconsolidation and the embodiment of cognition. The framework we envision allows the patient to 'step into the past' by using forward motion as an essential ingredient to augment the impact of exposure to traumatic events. The behavioural response of approaching that is the exact opposite from the avoidance usually applied by patients and the enhancement of divergent thinking are the most prominent hypothesized mechanisms of action. This can contribute to strengthening of personal efficacy and self-reflection that is generated by high emotional engagement, as well as a sense of accomplishment and enhanced recovery as illustrated by a clinical case example. We argue that innovations with personalized virtual reality and motion need to be further investigated and implemented in current therapy settings.

A decennial review of psychotraumatology: what did we learn and where are we going?

“…The last 10 years have seen the rapid proliferation of these new technologies (Olff, 2015b) and the trauma field has been keen to explore this new world, as often reported in this journal. Research into the use of virtual reality has continued to develop (Kothgassner et al, 2019;Rizzo & Shilling, 2017), evolving in recent years to incorporate cognitive-motor components as an innovative element in a personalized virtual interactive intervention, aimed at individuals with treatment-resistant PTSD (Nijdam & Vermetten, 2018).…”

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

“…In a first proof of concept veterans with treatment-resistant PTSD (TR-PTSD) positively evaluated the acceptability of 3MDR [29]. Preliminary findings suggested that 3MDR could lead to clinically meaningful changes, which for some patients were not experienced until 4-6 weeks after the intervention [18,29,30].…”

“…The current study aimed to test the efficacy of 3MDR for veterans with TR-PTSD in a randomized controlled trial (RCT) comparing 3MDR to a non-specific treatment component control group (NTCC), consisting of treatment without trauma-focused elements. Based on the literature reviewed above, we expected the combined arsenal of therapeutic techniques in 3MDR to improve treatment outcomes for veterans who did not respond to prior current evidence-based treatment, and we expected that this effect would occur a few weeks after the 3MDR intervention and increase over time [18,30]. Therefore, our primary hypothesis was that 3MDR would significantly decrease PTSD symptoms at the end point, 16 weeks after start of treatment, as compared to the control intervention.…”

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.…”