David J. Ready

Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). This report presents the results of the first Vietnam combat veteran with PTSD to have been treated with VRE. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-month follow-up.

Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma.

While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.

Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain?

Our primary aim was to document the rate of comorbidity of physician-diagnosed chronic pain conditions in veterans who were seeking treatment for posttraumatic stress disorder (PTSD). Chronic pain diagnoses (e.g., chronic low-back pain and osteoarthritis) were examined with retrospective chart review. Of the patients with PTSD, 66% had chronic pain diagnoses at pretreatment. These findings are consistent with previous studies that documented the high comorbidity of chronic pain and PTSD using samples of pain patients. Our secondary aim was to examine pain ratings before, during, and after PTSD treatment. Using data that were a part of clinical practice, we found that patients with more pain before treatment reported reductions in pain over the course of PTSD treatment and in the 4 months following treatment. While our results must be interpreted cautiously because of multiple confounding factors and the absence of experimental manipulation, they highlight the importance of PTSD and pain comorbidity.

Own-Race Bias in Lineup Construction

The lineup identification of a suspect is often a critical stage in a criminal investigation. One factor which may affect the fairness of a lineup is bias on the part of the person constructing the lineup. the “own-race bias,” the tendency of individuals to perceive more similarity in the appearance of other-race members than in their own, may affect lineup development. Black subjects and white subjects were asked to construct lineups using both black and white “suspects.” On three of four measures, their behavior was very similar while making white lineups but different on black lineups. Relative to their performance on white lineups, white subjects became less selective on black lineups but black subjects became even more selective on black lineups. Both groups displayed own-race bias by being more selective about own-race photos than other-race photos. This lessening of selectivity may make lineups constructed by cross-race lineup constructors less fair than lineups constructed by own-race lineup constructors.

Comparing Virtual Reality Exposure Therapy to Present-Centered Therapy with 11 U.S. Vietnam Veterans with PTSD

Eleven Vietnam veterans with war-related posttraumatic stress disorder (PTSD) were randomly assigned to 10 sessions of either virtual reality exposure (VRE) therapy within a computer-generated virtual Vietnam environment or present-centered therapy (PCT) that avoided traumatic content and utilized a problem-solving approach. Participants were assessed at pretreatment, posttreatment, and 6 months posttreatment by an independent assessor blind to treatment condition. Nine participants completed treatment with one dropout per condition. No significant differences emerged between treatments, likely due to insufficient power. Although comparison of mean changes in PTSD symptoms for the VRE and PCT conditions yielded a moderate effect size (d = 0.56) in favor of VRE at 6 months posttreatment, changes in PTSD scores were more variable, and therefore less reliable, within the VRE condition. The utility of VRE with older veterans with PTSD is discussed.

A virtual environment for the treatment of chronic combat-related post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is one of the most disabling psychopathological conditions affecting the veteran population. An estimated 830,000 U.S. veterans currently have symptoms of chronic combat-related PTSD. No therapeutic approach has proven to be consistently effective in the management of combat-related PTSD. Behavior therapies with an exposure element have proven more effective than most other types of treatment, but a significant number of patients do not seem to benefit from them, possibly because of difficulties imagining, visualizing, or describing their traumatic experiences. In this article, we describe Virtual Vietnam, a set of two virtual environments we have developed for the treatment of combat-related PTSD, and its use as one component of a comprehensive treatment program.

The effects of hypnosis, context reinstatement, and anxiety on eyewitness memory

The effects of hypnosis, context reinstatement, and motivational instructions on accuracy of recall for factual information and facial recognition accuracy following a stressful event were assessed. None of the three techniques had a significant effect on factual memory or susceptibility to suggestion as assessed by true-false and multiple-choice tests. However, participants high in hypnotic susceptibility showed somewhat better memory on the true-false test, and hypnosis affected performance on the two photograph line-ups. In addition, hypnosis appeared to enhance facial recognition accuracy for participants who were low in anxiety, but not for those high in anxiety. Finally, there was evidence of a curvilinear relationship between self-reported anxiety at time of retrieval and facial recognition accuracy.

Combining group-based exposure therapy with prolonged exposure to treat U.S. Vietnam veterans with PTSD: a case study.

Group-based exposure therapy (GBET) of 16-week duration was developed to treat combat-related posttraumatic stress disorder (PTSD) and decreased PTSD symptoms in 3 noncontrolled open trials with low attrition (0%-5%). Group-based exposure therapy has not produced as much PTSD symptom reduction as Prolonged Exposure (PE) within a U.S. Veterans Affairs PTSD treatment program, although PE had more dropouts (20%). This pilot study was of a model that combined key elements of GBET with components of PE in an effort to increase the effectiveness of a group-based treatment while reducing its length and maintaining low attrition. Twice per week, 8 Vietnam combat veterans with PTSD were treated for 12 weeks, with an intervention that included 2 within-group war trauma presentations per participant, 6 PE style individual imaginal exposure (IE) sessions per participant, daily listening to recorded IE sessions, and daily in vivo exposure exercises. All completed treatment and showed Significant reductions on all measures of PTSD with large effect sizes; 7 participants no longer met PTSD criteria on treating clinician administered interviews and a self-report measure at posttreatment. Significant reductions in depression with large effect sizes and moderate reductions in PTSD-related cognitions were also found. Most gains were maintained 6 months posttreatment.

Factitious AIDS in a psychiatric inpatient.

This article reports the case of a 28 year-old female presenting to a psychiatric inpatient unit with depression and a history of acquired immune deficiency syndrome (AIDS). Although medical assessment was negative for AIDS, psychiatric evaluation and psychological testing were consistent with a presentation of factitious disorder. This case illustrates the need to be on the alert for individuals admitted to psychiatric units who report they have AIDS or its related conditions.

A Controlled Study of Group-Based Exposure Therapy with Vietnam-Era Veterans

Abstract Eighty-one Vietnam-era Veterans with PTSD were randomly assigned to either Group-Based Exposure Therapy (GBET) or Present-Centered Group Therapy (PCGT) and assessed blind to treatment condition at post, four months, and one year posttreatment. Both treatments lasted 16 weeks and groups met twice per week in cohorts of 10. GBET includes sharing and reviewing trauma narratives. PCGT included problem solving while avoiding traumatic material. Both treatments produced similar significant lasting reductions in PTSD with few dropouts (10%). GBET produced significantly greater improvement on measures of spirituality, personal meaning, and PTSD-related cognitions. Half of participants seemed to be exaggerating symptoms.