Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).

Reger, Greg M.; Koenen-Woods, Patricia; Zetocha, Kimberlee; Smolenski, Derek J.; Holloway, Kevin M.; Rothbaum, Barbara O.; Difede, JoAnn; Rizzo, Albert A.; Edwards-Stewart, Amanda; Skopp, Nancy A.; Mishkind, Matthew; Reger, Mark A.; Gahm, Gregory A.

doi:10.1037/ccp0000134

Cited by 226Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsSleep and related disorders

Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).

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Reger, Greg M., Koenen-Woods, Patricia, Zetocha, Kimberlee, Smolenski, Derek J., Holloway, Kevin M., Rothbaum, Barbara O., Difede, JoAnn, Rizzo, Albert A. +5 more·2016·Journal of Consulting and Clinical Psychology

DOI 10.1037/ccp0000134

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Abstract

OBJECTIVE: Prolonged exposure (PE) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD) but there is limited research with active-duty military populations. Virtual reality exposure (VRE) has shown promise but randomized trials are needed to evaluate efficacy relative to existing standards of care. This study evaluated the efficacy of VRE and PE for active duty soldiers with PTSD from deployments to Iraq and Afghanistan. METHOD: Active-duty soldiers (N = 162) were randomized to 10-sessions of PE, VRE, or a minimal attention waitlist (WL). Blinded assessors evaluated symptoms at baseline, halfway through treatment, at posttreatment, and at 3- and 6-month follow-ups using the Clinician Administered PTSD Scale (CAPS). RESULTS: Intent-to-treat analyses found that both PE and VRE resulted in significant reductions in PTSD symptoms relative to those in the WL. The majority of patients demonstrated reliable change in PTSD symptoms. There was no difference between PE and VRE regarding treatment drop out before completing 10 sessions (44 and 41% for VRE and PE, respectively). Contrary to hypotheses, analyses at posttreatment did not show that VRE was superior to PE. Post hoc analyses found that PE resulted in significantly greater symptom reductions than VRE at 3- and 6-month follow-up. Both treatments significantly reduced self-reported stigma. CONCLUSIONS: 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

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In the case of PTSD, two recent trials failed to find additional benefits for VR interventions over non-VR treatments such as prolonged exposure, both in terms of primary outcome and drop-out rates, with follow-up results actually better for the non-VR intervention.
“Nonetheless, in the case of one such disorder- post-traumatic stress disorder- two recent trials36,50 failed to find additional benefits for VR interventions over non-VR treatments such as prolonged exposure, both in terms of primary outcome, as well as drop-out rates, with follow-up results actually better for the non-VR intervention.”
From The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis (2018) · cites this paper as [36]

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Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy
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Review of virtual reality treatment in psychiatry: evidence versus current diffusion and use
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Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial
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Therapists make the switch to telepsychology to safely continue treating their patients during the COVID-19 pandemic. Virtual reality telepsychology may be next
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Clinical predictors of cybersickness in virtual reality (VR) among highly stressed people
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How to Treat Depression With Low-Intensity Virtual Reality Interventions: Perspectives on Translating Cognitive Behavioral Techniques Into the Virtual Reality Modality and How to Make Anti-Depressive Use of Virtual Reality–Unique Experiences
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Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders
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Posttraumatic stress disorder treatment dropout among military and veteran populations: a systematic review and meta-analysis
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A meta-analysis of the efficacy of virtual reality and in vivo exposure therapy as psychological interventions for public speaking anxiety
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“Her research interests include increasing accessibility of cognitive-behavioural interventions in particular for presentations of anxiety disorders and PTSD. David Curran is a consultant clinical psychologist working in the NHS and clinical director with the Doctorate in Clinical Psychology programme at Queens Univers…”
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Evidenced-Based Treatment of Posttraumatic Stress Disorder: An Updated Review of Validated Psychotherapeutic and Pharmacological Approaches
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Effects of Virtual Reality-Based Graded Exposure Therapy on PTSD Symptoms: A Systematic Review and Meta-Analysis
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Does virtual reality increase emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy
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Examining the potential of virtual reality to deliver remote rehabilitation
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Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content
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A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders
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Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD
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Agreement Analysis between Vive and Vicon Systems to Monitor Lumbar Postural Changes
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VR Porn as “Empathy Machine”? Perception of Self and Others in Virtual Reality Pornography
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Virtual Reality Exposure Therapy for Armed Forces Veterans with Post-Traumatic Stress Disorder: A Systematic Review and Focus Group
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Virtual reality exposure versus prolonged exposure for PTSD: Which treatment for whom?
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Clinical Virtual Reality: Emerging Opportunities for Psychiatry
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PTSD: Past, present and future implications for China
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Virtual reality exposure therapy on alcohol and nicotine: a systematic review
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Adapting Evidence-Based Treatments for Digital Technologies: a Critical Review of Functions, Tools, and the Use of Branded Solutions
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Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review
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The Impact of Exposure Therapy on Resting Heart Rate and Heart Rate Reactivity Among Active-Duty Soldiers With Posttraumatic Stress Disorder
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Ethical Challenges in Digital Psychology and Cyberpsychology
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The Effectiveness of Immersive Virtual Reality‐Based Treatment for Mental Disorders: A Systematic Review With Meta‐Analysis
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Effectiveness of immersive virtual reality-supported interventions for patients with disorders or impairments: a systematic review and meta-analysis
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Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review
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How does PTSD treatment affect cardiovascular, diabetes and metabolic disease risk factors and outcomes? A systematic review
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Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients
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Developments of prolonged exposure in treatment effect of post‐traumatic stress disorder and controlling dropout rate: A meta‐analytic review
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An Update on Psychotherapy for the Treatment of PTSD
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Does Virtual Reality Increase Simulator Sickness During Exposure Therapy for Post-Traumatic Stress Disorder?
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Posttraumatic Stress Disorder Symptom Cluster Structure in Prolonged Exposure Therapy and Virtual Reality Exposure
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Defining response and nonresponse to posttraumatic stress disorder treatments: A systematic review.
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As far as my eyes can see: Generation Y consumers’ use of virtual reality glasses to determine tourist destinations
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Virtual reality as a psychotherapeutic tool: current uses and limitations
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Feasibility of Virtual Reality Exposure Therapy in the Treatment of Danish Veterans with Post-Traumatic Stress Disorder: A Mixed Method Pilot Study
Folke, S., Roitmann, N. C., Poulsen, S., & Andersen, S. B. (2023) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2022.0236 · Cited by 18 · see citing works
Barriers to VR use in HE
Evans, L. (2019) · IM Publications Open LLP eBooks · doi:10.1255/vrar2018.ch2 · Cited by 17 · see citing works
Management of Post-traumatic Stress Disorder in Veterans and Military Service Members: A Review of Pharmacologic and Psychotherapeutic Interventions Since 2016
Moore, B. A., Pujol, L. A. M., Waltman, S. H., & Shearer, D. S. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-020-01220-w · Cited by 17 · see citing works

Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD
Gahm, G. A., & Reger, G. M. (2010) · doi:10.21236/ada543849 · Cited by 2 · see citing works
Self-citation
Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic
Reger, G. M., Holloway, K. M., Candy, C., Rothbaum, B. O., Difede, J., Rizzo, A. A., & Gahm, G. A. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20574 · Cited by 188 · see citing works
Self-citation
A Multisite, Randomized Clinical Trial of Virtual Reality and Prolonged Exposure Therapy for Active Duty Soldiers with PTSD
Gahm, G. A., Reger, G. M., Ingram, M. V., Reger, M. A., & Rizzo, A. (2012) · doi:10.21236/ada579116 · Cited by 6 · see citing works
Self-citation
Virtual reality exposure therapy for active duty soldiers
Reger, G. M., & Gahm, G. A. (2008) · Journal of Clinical Psychology · doi:10.1002/jclp.20512 · Cited by 124 · see citing works
Self-citation
Virtual Reality Exposure Therapy for Military Veterans with Posttraumatic Stress Disorder: A Systematic Review
Seitz, C. A., Poyrazlı, Ş., Harrisson, M. A., Flickinger, T., & Turkson, M. A. (2014) · The New School psychology bulletin · Cited by 9 · see citing works

Authors: 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., Mishkind, M., Reger, M. A., & Gahm, G. A.
Affiliations: Emory University (US)
Weill Cornell Medicine (US)
University of Southern California (US)
ORCID: Reger, Greg M.
Smolenski, Derek J.
Rothbaum, Barbara O.
Difede, JoAnn
Rizzo, Albert A.
Skopp, Nancy A.
Mishkind, Matthew
Reger, Mark A.
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2016-11
Volume: 84
Issue: 11
Pages: 946-959
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/ccp0000134
OpenAlex: W2517202283
Cited by: 226
References: 67
Citations by year: 2026: 16 · 2025: 13 · 2024: 20 · 2023: 21 · 2022: 17 · 2021: 27 · 2020: 28 · 2019: 49 · 2018: 17 · 2017: 17 · 2016: 1
FWCI: 37.45
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
www.apa.org/pubs/journals/resources/open-access.aspx (am, 311 d)
Locations: Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
PubMed (publishedVersion)
Funders: U.S. Army Medical Research and Materiel Command (W81XWH-08-2–0015)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: prolonged exposure therapy, virtual reality exposure therapy, post-traumatic stress disorder, active duty military personnel, Iraq and Afghanistan deployment, treatment discontinuation, stigma, Clinician-Administered PTSD Scale
MeSH terms: Adult, Female, Humans, Implosive Therapy, Male, Military Personnel, Stress Disorders, Post-Traumatic, Imagery, Psychotherapy, Young Adult, Virtual Reality Exposure Therapy

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Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).

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