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Combined Therapies Offer Relief for PTSD, Study Shows


VR plus brain stimulation reduces symptoms in veterans—even after the treatment ends.

An innovative combination of two treatments could be an effective, efficient, and enduring way to treat post-traumatic stress disorder in military veterans, a new study shows.

Clinical trial participants who received brain stimulation with a low electrical current during sessions of virtual reality exposure reported a significant reduction in PTSD symptom severity.

Professor of Psychiatry and Human Behavior Noah Philip RES’09 F’11 F’12, MD, senior author of the paper published in JAMA Psychiatry, says the findings are exciting considering existing challenges in treating patients with PTSD.

“This is a different and innovative way of approaching treatment where we’re combining the best aspects of psychotherapy, neuroscience, and brain stimulation to help people get better,” says Philip, who leads mental health research at the Center for Neurorestoration and Neurotechnology at the Providence VA Medical Center. “There’s a lot of promise here, and that offers hope.”

Initial PTSD treatments often include trauma-focused exposure therapy and medication. Yet the disorder is particularly difficult to treat in military veterans, Philip says. Medications have significant adverse effects, and exposure therapy can be difficult to tolerate, since it involves describing highly traumatic experiences repeatedly. Up to 50 percent of patients drop out of traditional exposure therapy, and others decline to even start it.

For the study, Philip, whose background is in psychiatric research of brain simulation, teamed up with Mascha van ‘t Wout-Frank, PhD, an associate professor of psychiatry and human behavior (research) who studies the effect of non-invasive brain stimulation on “fear extinction,” or learning that things that are regarded as harmful can actually be safe and can therefore become tolerable.

“Through exposure therapy, the brain is reprocessing the trauma, and learning that even though the traumatic experience was dangerous, the memories of the traumatic experience, as well as the thoughts and feelings that are conjured up by those memories, are not dangerous—they are safe,” says van ‘t Wout-Frank, an investigator at the Center for Neurorestoration and Neurotechnology. “This results in a decline in conditioned fear response.”

A leading theory of PTSD posits that the effectiveness of exposure as a therapy is impaired due to ineffective top-down control of the brain’s amygdala by the ventromedial prefrontal cortex and other brain regions. Affected individuals thus have impaired safety learning and memory, which in healthy people is supported by intact brain function, van ‘t Wout-Frank says.

Transcranial direct current stimulation, which involves administering a constant, low, pain-free electrical current to a part of the brain, is well-suited to potentially augment trauma-focused exposure therapy, van ’t Wout-Frank says. The non-invasive current may boost neural activity, facilitating top-down control by the ventromedial prefrontal cortex to improve safety learning.

The research team decided to combine transcranial direct current stimulation with virtual reality exposure, which provides a highly immersive sensory experience including visual, tactile, and even olfactory stimuli to simulate real-world environments.

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