PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record

Exposure therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD), but research evaluating its effectiveness with active duty service members is limited. This report examines the effectiveness of virtual reality exposure therapy (VRE) for active duty soldiers (N = 24) seeking treatment following a deployment to Iraq or Afghanistan. Relative to their pretreatment self-reported symptoms on the PTSD Checklist, Military Version (M = 60.92; SD = 11.03), patients reported a significant reduction at posttreatment (M = 47.08; SD = 12.70; p < .001). Sixty-two percent of patients (n = 15) reported a reliable change of 11 points or more. This study supports the effectiveness of exposure therapy for active duty soldiers and extends previous research on VRE to this population.

Prolonged exposure (PE) is an empirically supported treatment that is being disseminated broadly to providers in the Department of Veterans Affairs and Department of Defense. Innovative methods are needed to support the implementation, dissemination, and patient and provider adherence to PE. The PE Coach is a smartphone application (app) designed to mitigate barriers to PE implementation. PE Coach is installed on the patient's phone and includes a range of capabilities for use during the PE session and after each session to support the treatment. Functions include the ability to audio record treatment sessions onto the patient's device, to construct the in vivo hierarchy on the device, to record completed homework exercises, to review homework adherence, and to track symptom severity over time. The app also allows sessions and homework to be scheduled directly in the app, populating the device calendar with patient reminder notifications. In the final session, a visual display of symptom improvement and habituation to items on the in vivo hierarchy is presented. These capabilities may significantly improve convenience, provider implementation and adherence, and patient compliance with treatment. Future research is needed to test whether PE Coach is useful and effective.

Only a minority of service members with posttraumatic stress disorder (PTSD) access care despite growing availability of evidence-based and innovative treatments. Although preferences for military personnel have not been established, previous research on civilian populations with PTSD suggest treatment preferences for exposure-based treatments over medications. There are also unique stressors in the deployed environment that may impact treatment preferences, such as close living proximity to peers and leaders, and limited access to typical coping strategies. Soldiers deployed to Iraq (n ϭ 174) were provided a written hypothetical scenario about difficulties after combat exposure and were provided descriptions of Prolonged Exposure (PE), virtual reality exposure (VRE), and FDA-approved medications for PTSD. Soldiers completed a Treatment Reactions Scale for each treatment type. Responses were significantly more favorable for both PE and VRE relative to medications (p Ͻ .001). Relative to both exposure therapies, soldiers reacted to medications with significantly stronger agreement to scales reflecting embarrassment/shame for seeking a particular form of treatment, negative occupational/career impact, and perceived debasement for seeking the treatment. Relative to PE, soldiers were significantly less willing to recommend medication treatment and had significantly less confidence/belief in the efficacy of medications. These findings can help inform provider education of treatment options and demonstrate the importance of considering patient reactions to a treatment plan, as preferences may impact adherence.

Post Traumatic Stress Disorder (PTSD) is reported to be caused by exposure to an extreme traumatic stressor involving direct personal experience of (or witnessing/learning about) an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Such incidents would be distressing to almost anyone, and are usually experienced with intense fear, horror, and helplessness. Initial data suggests that at least 1 out of 5 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) delivered exposure therapy for PTSD has been previously used with reports of positive outcomes. The current paper will present the rationale and description of a VR PTSD therapy application (Virtual Iraq/Afghanistan) and present initial findings from a number of early studies of its use with active duty service members. Virtual Iraq/Afghanistan consists of a series of customizable virtual scenarios designed to represent relevant Middle Eastern VR contexts for exposure therapy, including a city and desert road convoy environment. User-centered design feedback needed to iteratively evolve the system was gathered from returning Iraq War veterans in the USA and from a system deployed in Iraq and tested by an Army Combat Stress Control Team. Results from an open clinical trial using Virtual Iraq with 20 treatment completers indicated that 16 no longer met PTSD diagnostic criteria at post-treatment, with only one not maintaining treatment gains at 3 month follow-up.