Virtual Reality Exposure Therapy Protocol for Post-Traumatic Stress Disorder Treatment in Military Veterans: Cross-Cultural Adaptation of Virtual Exposure Therapy in Ukraine

Abstract

Introduction. The integration of virtual reality technologies into PTSD treatment in Ukraine presents new opportunities for enhancing the mental health of military personnel, veterans, and individuals affected by war-related trauma. During military operations, soldiers often experience intense stress, anxiety, and intrusive memories, which can lead to PTSD. VR therapy uses fully and partially immersive technologies to create a safe virtual environment where patients can explore and process traumatic experiences under the guidance of a qualified specialist. The use of VR technologies for PTSD treatment during the ongoing conflict in Ukraine may become a crucial tool for addressing and healing trauma in both military personnel and civilians. This method provides a structured setting that fosters emotional processing and therapeutic engagement, aiming to alleviate psychological burdens and improve mental health outcomes. Purpose: To conduct a cross-cultural adaptation of the physiologically facilitated Virtual Reality Exposure Therapy (VRET) protocol with gradually increasing exposure, develop a Ukrainian version of the protocol tailored to the specific needs of Ukrainian PTSD patients, create VR technology and content that reflect the unique aspects of the Ukrainian war experience, and pilot test this protocol with a focus group of Ukrainian war veterans diagnosed with PTSD and carrying war-related traumatic memories. Methodology: For the cross-cultural adaptation of the Virtual Reality Exposure Therapy (VRET) protocol, a physiologically facilitated version with gradually increasing exposure was selected. This protocol was translated by two independent translators, followed by synthesis into a single version, back-translation, analysis, and final approval by a working group. The finalized Ukrainian version was prepared for field studies with a focus group of Ukrainian war veterans (n=50). All veterans underwent diagnostic assessments both before and after the VRET intervention, using the following standardized scales: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD evaluation, the Generalized Anxiety Disorder 7-item (GAD-7) scale for anxiety disorders, the Patient Health Questionnaire-9 (PHQ-9) for depression, the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicidal intentions, the Short Form Survey (SF-36) for quality of life, and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol dependence. A series of VR scenarios were developed specifically to address the needs of Ukrainian war PTSD patients, designed to trigger common PTSD responses. A unique administrative panel was also created for therapists to adjust the presence and intensity of various triggers in real time, allowing for personalized tuning of the VR experience throughout the session. Results: Over a 6-month period, 50 Ukrainian war veterans participated in the study to assess the effectiveness of the adapted Ukrainian version of the VRET protocol for PTSD treatment. Comparison of baseline and post-intervention assessments showed significant improvements in clinical outcomes, including reductions in PTSD symptoms, anxiety, depression, and an overall improvement in quality of life. Conclusions: The cross-cultural adaptation and testing of the Virtual Reality Exposure Therapy protocol with a focus group of Ukrainian veterans with PTSD demonstrated reductions in PTSD symptoms, anxiety, and depression, alongside improvements in quality of life. Virtual reality allowed veterans to safely re-experience traumatic events under professional supervision, with gradually increased realism, enhancing the therapy's effectiveness. This method also reduces stigma by offering a confidential setting for therapist interaction, showing substantial promise in helping veterans manage their mental health more effectively