Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms
Abstract
Objective The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel. Methods Active duty army soldiers (N = 162) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of posttraumatic stress disorder (PTSD) stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. PTSD symptoms, depressive symptoms, and SI were included in an autoregressive cross-lagged panel model to examine mechanistic pathways. Results Analyses revealed that PE/VRE had a lower probability of post-treatment suicidal ideation (OR = 0.23, 95% CI [0.06, 0.86]) compared to the waitlist control. Mediation analyses revealed a significant indirect effect from treatment condition to post-treatment PTSD symptoms through mid-treatment SI (Estimate = -1.420, 95% CI -3.559, -0.223]). Baseline suicidal ideation did not interact with treatment condition to predict PTSD symptom change at mid-treatment (p = .231) or post-treatment (p = .672). Conclusion PE/VRE successfully reduced SI, and the presence of SI at baseline did not affect PTSD symptom reduction, promoting the utility of using PE/VRE to address suicidality among individuals…
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Norr et al. (2018) showed reduction in suicidal ideation and PTSD symptomatology.
“Reduction in suicidal ideation and PTSD symptomatology”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Norr et al. (2018)
In active-duty U.S. military personnel with PTSD, PE and VRET produced a statistically significant reduction in symptoms and suicidal ideation compared with wait-list control.
“a statistically significative reduction was observed in the patients treated with PE and VR in comparison with the waitlist control”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Norr, Smolenski & Reger (2018)
Norr et al. (2018) did not compare measurements between the VR exposure group and the group that received only prolonged exposure.
“this study did not compare the measurements between the group treated with VR exposure and the group that received only prolonged exposure.”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Norr, Smolenski & Reger (2018)
In Norr et al. (2018), it was not possible to determine the temporality of the reductions in symptomatology.
“It must also be noted that it was not possible to determine the temporality of the reductions in symptomatology.”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Norr, Smolenski & Reger (2018)
Cites
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A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD
Becker, C. B., Zayfert, C., & Anderson, E. (2004) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00138-4 · Cited by 759 · see citing works
Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300307 · Cited by 368 · see citing works
Effectiveness of national implementation of prolonged exposure therapy in Veterans affairs care
Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A., & Karlin, B. E. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.36 · Cited by 338 · see citing works
Does Suicidal Ideation as Measured by the PHQ-9 Predict Suicide Among VA Patients?
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Reger, G. M., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K. M., Rothbaum, B. O., Difede, J., Rizzo, A. A., Edwards-Stewart, A., Skopp, N. A., et al. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000134 · Cited by 226 · see citing works
Self-citationReducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder
Cox, K. S., Mouilso, E. R., Venners, M. R., Defever, M. E., Duvivier, L., Rauch, S. A. M., Strom, T. Q., Joiner, T. E., & Tuerk, P. W. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.05.011 · Cited by 57 · see citing works
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Virtual reality therapy in mental health
Emmelkamp, P. M. G., & Meyerbröker, K. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081219-115923 · Cited by 363 · see citing works
Kangaslampi, S., & Peltonen, K. (2022) · Current Psychology · doi:10.1007/s12144-019-00478-5 · Cited by 45 · see citing works
“Finally, we found two studies suggesting reductions in depressive symptoms may drive PTSS reduction during PE, but also that earlier changes in PTSS may affect later depressive symptoms (McLean et al. 2017; Norr et al. 2018).”
BackgroundGómez-Busto, F. J., & Ortiz, M. I. (2020) · PubMed Central · doi:10.36131/cnfioritieditore20200606 · Cited by 12 · see citing works
- Authors
- Norr, A. M., Smolenski, D. J., & Reger, G. M.
- Affiliations
- University of Washington (US)
- Defense Health Agency (US)
- Corresponding author
- Reger, Greg M.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 103
- Pages
- 69-74
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2801442530
- Cited by
- 44
- References
- 8
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 11 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 8
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Army Medical Research and Materiel Command Military Operational Medicine Research Program
- Department of Veterans Affairs Office
- Department of Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- suicidal ideation, prolonged exposure therapy, virtual reality exposure therapy, post-traumatic stress disorder, active duty military personnel, military personnel, Iraq and Afghanistan deployment, depressive symptoms, PTSD symptom reduction, suicidality
- MeSH terms
- Virtual Reality, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Military Personnel, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, United States, Treatment Outcome, Suicidal Ideation
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