Terapia de Exposição com Realidade Virtual para Transtorno de Estresse Pós-Traumático para bancários: um estudo de caso com o banco virtual

Julia Candia Donat,Marcio Englert Barbosa,Gustavo Ramos Silva,Christian Haag Kristensen

doi:10.4013/ctc.2017.101.02

Julia Candia Donat, Marcio Englert Barbosa + Show 2 more

Open Access

https://doi.org/10.4013/ctc.2017.101.02

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Abstract

Exposure Therapy (ET) is an established treatment for Posttraumatic Stress Disorder (PTSD), in which patients gradually confront trauma memories through mental imagery. Virtual Reality Exposure (VRE) is an alternative for those who have difficulties in recreating such memories. Most studies develop VRE scenarios of war or accidents; however, traumatic events in Brazil are mainly of urban violence. Objective: To evaluate the quality of the Virtual Bank scenario through a pilot case study of a banker with PTSD through a cognitive behavioral therapy protocol. Method: A 39-year-old bank employee diagnosed with PTSD through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) took part on a Cognitive Behavioral Therapy (CBT) protocol including VRE. Patient’s symptoms were assessed through Beck’s anxiety and depression inventories, the Screen for Posttraumatic Stress Symptoms and Posttraumatic Cognitions Inventory. The therapy protocol was comprised of 16 sessions divided into three blocks: (i) psychoeducation; (ii) exposure and (iii) cognitive restructuring and relapse prevention. Reassessments were conducted at the end of each block. The sense of presence in the Virtual Bank was assessed through the Presence Questionnaire (PQ). Results: The patient presented at least 60% of reduction on all instruments and no longer met criteria for PTSD at posttreatment. The greatest reduction on PTSD symptoms scores occurred after the VRE block (-44.8%). The mean score of the PQ was 5.24. Conclusion: CBT protocol with VRE was effective in reducing all measures in this case study. Quality evaluation of the Virtual Bank was positive. Results are promising and similar to those of other innovative case studies using VRE for PTSD. Keywords: Posttraumatic Stress Disorder, Cognitive Behavioral Therapy, Virtual Reality, Trauma, Exposure Therapy.

Highlights

Individuals who survive traumatic events may develop Posttraumatic Stress Disorder (PTSD), a diagnosis encompassing symptoms in the form of intrusions, avoidance of trauma-related stimuli, negative alterations in cognitions and mood and accentuated arousal and reactivity (APA, 2013)
This paper aims to depict a Virtual Reality (VR) scenario and illustrate its use in the treatment of a civilian trauma PTSD patient
Patient reported that the Virtual Bank was able to make her feel like she was in an actual bank branch, due to its visual quality and variety of interactions

Summary

Introduction

Individuals who survive traumatic events may develop Posttraumatic Stress Disorder (PTSD), a diagnosis encompassing symptoms in the form of intrusions, avoidance of trauma-related stimuli, negative alterations in cognitions and mood and accentuated arousal and reactivity (APA, 2013). Virtual Reality Exposure (VRE) is an alternative for those patients, since the visual and auditory stimuli of the Virtual Reality (VR) scenario serve as cues or triggers (e.g., gunfire, vehicle sounds, explosions) to traumatic memories (Difede et al, 2006; Rothbaum et al, 2010). Those cues are usually identified through patients’ trauma accounts and can be selectively and gradually included in the VR environment by the therapist (Difede et al, 2006)

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