Summary: Researchers demonstrated promising    results for PTSD treatment in military veterans by combining    brain stimulation with virtual reality exposure therapy. The    clinical trial showed significant reductions in PTSD symptoms    among participants who received low electrical current brain    stimulation during virtual reality sessions designed to    simulate warzone experiences.  
    This innovative approach, which outperformed traditional    exposure therapy in both efficacy and participant retention,    represents a novel method of addressing the complex challenge    of treating PTSD. The study underscores the potential of    integrating neuroscientific interventions with psychological    therapy to enhance treatment outcomes for individuals    struggling with PTSD, offering new pathways for recovery.  
    Key Facts:  
    Source: Brown University  
    Combining two treatments could be a promising option    for people, especially military veterans, whose lives are    negatively affected by post-traumatic stress disorder, a new    study shows.  
    In a clinical trial conducted among U.S. military veterans at    the Providence Veterans Affairs Medical Center, participants    who received brain stimulation with a low electrical current    during sessions of virtual reality exposure reported a    significant reduction in PTSD symptom severity.  
    The results were reportedon March 6 inJAMA    Psychiatry.  
    Study author Noah Philip, a professor of psychiatry and human    behavior at Brown Universitys Warren Alpert Medical School,    said the findings are exciting considering existing challenges    in treating patients with PTSD.  
    This is a different and innovative way of approaching    treatment where were combining the best aspects of    psychotherapy, neuroscience and brain stimulation to help    people get better, said Philip, who leads mental health    research at the Providence V.A. Center for Neurorestoration and    Neurotechnology.  
    Theres a lot of promise here, and that offers hope.  
    PTSD is a common psychiatric disorder characterized by    intrusive thoughts and recollections, avoidance of    trauma-related stimuli, hyperarousal and disturbed mood, the    study noted. Initial PTSD treatments often include    trauma-focused exposure therapy and medication.  
    Yet PTSD is particularly difficult to treat in military    veterans, Philip said. Medications have significant adverse    effects, and exposure therapy can be difficult to tolerate,    since it involves describing highly traumatic experiences    repeatedly. Up to 50% 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, an associate professor of psychiatry and human    behavior (research) at the Warren Alpert Medical School 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, said van t    Wout-Frank, an investigator at the V.A. Providence 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 brains 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 said.  
    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 said. 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.  
    To test the combined treatment, the researchers expanded a    previous pilot study to conduct a larger, more robust,    double-blind study of 54 U.S. military veterans with chronic    PTSD. Participants were randomly assigned to receive    transcranial direct current stimulation or a sham experience    that provided some sensation but not a significant amount or    duration of electrical current.  
    In the patients receiving transcranial direct current    stimulation, a low (2 milliamp) amount of electricity was    targeted to the ventromedial prefrontal cortex during six    25-minute sessions of standardized warzone virtual reality    exposure, delivered over two to three weeks.  
    Participants in the active transcranial direct current    stimulation group reported a superior reduction in    self-reported PTSD symptom severity at one    month.While all participants had meaningful    reductions in PTSD symptoms (attributed to the VR procedure),    active transcranial direct current stimulation significantly    accelerated psychological and physiological adjustment to the    virtual reality events between sessions compared with the sham    treatment patients.  
    In the experiment, the virtual reality was generalized to    include trauma-inducing elements, but didnt replicate any one    participants personal experience.  
    It can be difficult for patients to talk about their personal    trauma over and over, and thats one common reason that    participants drop out of psychotherapy, Philip said. This VR    exposure tends to be much easier for people to handle.  
    In just two weeks, the combination of electric stimulation plus    VR treatment accelerated a process that happens normally during    prolonged exposure therapy, but usually takes around 12 weeks    to show effects.  
    Whats more, Philip added, the effects continued to build over    time.  
    What we found was that people continued to get better after    they were done with the treatment, and we started seeing the    biggest effects one month later, Philip said.  
    The team is continuing to review the study results to better    understand how the treatment caused brain changes over time.    Future studies would explore a larger group of study    participants, a longer follow-up time, and perhaps even the    effects of re-treatment.  
    Other Brown researchers involved with this study included    Amanda R. Arulpragasam, M. Tracie Shea and Benjamin D.    Greenberg.  
    Funding: This studywas supported by    grants from the U.S. Department of Veterans Affairs (I01    RX002450, I50 RX002864)  
    Author: Corrie Pikul    Source: Brown University    Contact: Corrie Pikul  Brown University    Image: The image is credited to Neuroscience    News  
    Original Research: Open access.    Virtual Reality and    Transcranial Direct Current Stimulation for Posttraumatic    Stress Disorder A Randomized Clinical Trial by Noah Philip    et al. JAMA Psychiatry  
    Abstract  
    Virtual Reality and Transcranial Direct Current    Stimulation for Posttraumatic Stress Disorder A Randomized    Clinical Trial  
    Importance  
    Posttraumatic stress disorder (PTSD) is a common psychiatric    disorder that is particularly difficult to treat in military    veterans. Noninvasive brain stimulation has significant    potential as a novel treatment to reduce PTSD symptoms.  
    Objective  
    To test whether active transcranial direct current stimulation    (tDCS) plus virtual reality (VR) is superior to sham tDCS plus    VR for warzone-related PTSD.  
    Design, Setting, and Participants  
    This double-blind randomized clinical trial was conducted among    US military veterans enrolled from April 2018 to May 2023 at a    secondary care Department of Veterans Affairs hospital and    included 1- and 3-month follow-up visits. Participants included    US military veterans with chronic PTSD and warzone-related    exposure, recruited via referral and advertisement. Patients in    psychiatric treatment had to be on a stable regimen for at    least 6 weeks to be eligible for enrollment. Data were analyzed    from May to September 2023.  
    Intervention  
    Participants were randomly assigned to receive 2-mA anodal tDCS    or sham tDCS targeted to the ventromedial prefrontal cortex,    during six 25-minute sessions of standardized warzone VR    exposure, delivered over 2 to 3 weeks.  
    Main Outcomes and Measures  
    The coprimary outcomes were self-reported PTSD symptoms,    measured via the PTSD checklist    forDSM-5(PCL-5), alongside quality of    life. Other outcomes included psychophysiological arousal,    clinician-assessed PTSD, depression, and social/occupational    function.  
    Results  
    A total of 54 participants (mean [SD] age, 45.7 [10.5] years;    51 [94%] males) were assessed, including 26 in the active tDCS    group and 28 in the sham tDCS group. Participants in the active    tDCS group reported a superior reduction in self-reported PTSD    symptom severity at 1 month    (t=2.27,P=.02;    Cohend=0.82). There were no significant    differences in quality of life between active and sham tDCS    groups. Active tDCS significantly accelerated    psychophysiological habituation to VR events between sessions    compared with sham tDCS    (F5,7689.8=4.65;P<.001).    Adverse effects were consistent with the known safety profile    of the corresponding interventions.  
    Conclusions and Relevance  
    These findings suggest that combined tDCS plus VR may be a    promising strategy for PTSD reduction and underscore the    innovative potential of these combined technologies.  
    Trial Registration  
    ClinicalTrials.gov Identifier:NCT03372460  
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