Transcranial direct current stimulation (tDCS) may augment virtual reality–guided exposure therapy for veterans with posttraumatic stress disorder (PTSD), according to findings published yesterday in JAMA Psychiatry. In the study, veterans with war zone–related trauma had significantly greater improvements in PTSD symptoms when receiving virtual reality combined with tDCS compared with veterans who received virtual reality and sham stimulation.
Mascha van ’t Wout-Frank, Ph.D., of the VA Providence (R.I.) Healthcare System and colleagues recruited 54 participants (94% male; mean age 46 years) from the system who had PTSD related to war zone experiences. Participants were randomized to receive up to six 25-minute sessions of active tDCS plus virtual reality or sham tDCS plus virtual reality over 10 business days, with at least one day between sessions. The stimulation started simultaneously with the virtual reality program, which provided the participants with visual, auditory, haptic, and olfactory immersion into Iraq or Afghanistan war scenes. Participants were presented with 12 virtual reality scenarios, beginning with a low-intensity experience of riding in a mine-resistant ambush-protected vehicle. From there, the exposures became more intense by the addition of a distant gun battle, a Black Hawk flyover, or an improvised explosive device that caused the leading vehicle to flip.
The primary outcomes were self-reported PTSD symptoms as assessed through the PTSD Checklist for DSM-5 (PCL-5) at baseline, after three sessions, after the last session, and at one- and three-month follow-up. A decrease of 10 or more points was defined as clinically meaningful. To measure changes in psychophysiological arousal, the authors measured skin conductance with electrodes on the participants’ nondominant hands.
Average PCL-5 scores did not meaningfully differ between the two groups at baseline (48.6 among the active tDCS group compared with 45 in the sham group). After completing the six virtual reality sessions, participants in the tDCS group had an average PCL-5 score of 36, representing a clinically meaningful reduction in symptoms, compared with an average score of 38.9 in the sham group. At the one-month follow-up, PCL-5 scores fell to 31.4 in the tDCS group compared with 37.9 in the sham group, representing a statistically significant difference.
Further, there were greater reductions in skin conductance across the six sessions in the tDCS group compared with the sham group, suggesting that those in the tDCS group were getting more accustomed to the virtual exposures, the authors wrote.
“This intervention imposed low participant burden, had modest technical cost, and yielded clinically meaningful improvements in an otherwise difficult-to-treat patient population,” the authors concluded. “This reflects an important step forward in the use of combined brain stimulation and contextual control and underscores the innovative capability of these technologies.”
For related information, see the Psychiatric News article “Virtual Exposure Therapy Found Effective for PTSD.”
(Image: Getty Images/iStock/courtneyk)
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