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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).
Open accessAbstract
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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“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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“domly assigned 162 active-duty soldiers to ten sessions of prolonged exposure, VRE, or minimal-attention wait-list.(66) At”
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Metadata
- 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
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2016-11
- Volume
- 84
- Issue
- 11
- Pages
- 946-959
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- 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
- 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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