Abstract
The use of Information and Communication Technologies, such as virtual reality, has been employed in the treatment of anxiety disorders with the goal of augmenting exposure treatment, which is already considered to be the first-line treatment for Post-traumatic Stress Disorder (PTSD). To evaluate the efficacy of virtual reality exposure therapy (VRET) in the treatment of PTSD, we performed a systematic review of published articles using the following electronic databases: Web of Science, PubMed, PsycINFO, and PILOTS. Eligibility criteria included the use of patients diagnosed with PTSD according to DSM-IV, the use of cognitive behavioral therapy (CBT) and the use of virtual reality for performing exposure. 10 articles were selected, seven of which showed that VRET produced statistically significant results in comparison to the waiting list. However, no difference was found between VRET and exposure treatment. Of these 10, four were randomized, two were controlled but not randomized and four were non-controlled. The majority of the articles used head-mounted display virtual reality (VR) equipment and VR systems specific for the population that was being treated. Dropout rates do not seem to be lower than in traditional exposure treatment. However, there are a few limitations. Because this is a new field of research, there are few studies in the literature. There is also a need to standardize the number of sessions used. The randomized studies were analyzed to assess the quality of the methodology, and important deficiencies were noted, such as the non-use of intent-to- treat-analysis and the absence of description of possible concomitant treatments and comorbidities. Preliminary data suggest that VRET is as efficacious as traditional exposure treatment and can be especially useful in the treatment of patients who are resistant to traditional exposure.
Highlights
Post-traumatic stress disorder (PTSD) involves a constant feeling of fear generated by inadequate consolidation of the autobiographical trauma memory [1]
Of the 300 articles obtained through the electronic search summed from all the databases searched, 27 were excluded for using samples including non-PTSD disorders or using patients with subclinical PTSD, 36 were excluded for being case studies, 192 were excluded for being theoretical articles, reviews or trials that did not include cognitive behavioral therapy (CBT), two were excluded for using outcome measures that did not include symptoms of PTSD and seven were excluded for using a sample compiled and used in a later study
A study conducted by Meyerbroker & Emmelkamp [5] included a systematic review of virtual reality exposure therapy (VRET) in various anxiety disorders including PTSD
Summary
Post-traumatic stress disorder (PTSD) involves a constant feeling of fear generated by inadequate consolidation of the autobiographical trauma memory [1]. Foa & Kozak [2] suggested that for there to be adequate processing of the traumatic memory and the consequent extinction of the fear, the memory must be activated and safe components must be inserted. Prolonged Exposure Therapy, proved to be highly eficacious in the treatment of PTSD, aims to access the traumatic memory, including information about the traumatic situation and related emotions, thoughts and behaviors. It enables the patient to achieve a realistic perspective on the traumatic event and its aftermath [3]. Despite the fact that exposure therapy stimulates emotional engagement during imaginal exposure, some patients find it difficult to immerse themselves in the traumatic scene and, may quit the treatment. The use of Information and Communication Technologies may facilitate exposure for avoidant patients
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