In the decade following the attack on the World Trade Center, over 2.3 million American military personnel were deployed to Iraq and Afghanistan. Lengthy tours of duty and multiple re-deployments were characteristic of these operations. Research findings demonstrate that prolonged exposure to combat increases the risk of developing posttraumatic stress disorder (PTSD). The current study was a randomized controlled clinical trial designed to assess the effectiveness of a novel intervention to treat combat-related PTSD in returning Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) warfighters. A cognitive behavior treatment approach augmented with virtual reality exposure therapy (VRE) was developed, and administered for 10 treatment sessions over 5 weeks. Comparisons with a control group receiving minimal attention (MA) for 5 weeks revealed that the VRE group had significant reductions in the avoidance/numbing symptoms on the Clinician Administered PTSD Scale (CAPS). The VRE group also had significant reductions in guilt at post-treatment compared to the control group.

Some U.S. Military Health System (MHS) beneficiaries face unique challenges accessing available behavioral healthcare because of the nature of their occupations, deployments to and permanent duty stations in isolated geographies, and discontinuity of services. The use of deployable telehealth centers such as modified shipping containers offers promise as an innovative solution to increase access to behavioral healthcare in remote and otherwise austere environments. The first telehealth modified 20-foot shipping container, known as a relocatable telehealth center (RTeC), was deployed to increase access to care for MHS beneficiaries on American Samoa. The goal of this study was to conduct an exploratory evaluation of patient satisfaction with and usability perceptions of this solution as a place to receive behavioral healthcare services. Twenty-eight beneficiaries participated in this evaluation. Results suggest that the RTeC is safe and private and ultimately an appropriate telebehavioral-originating site. These data provide insight into usability considerations and inform future research and deployable telehealth center development. Additionally, a brief discussion about potential cost offset is provided as cost efficiencies impact RTeC viability.

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War-fighters exposed to combat are at high risk for developing posttraumatic stress disorder (PTSD), a complex and challenging condition to treat. Cognitive behavioral therapies (CBT) have been empirically validated as effective treatments for PTSD resulting from sexual assault, vehicular accidents, and disasters. Exposure, imaginal or in vivo, to the traumatic event is a central component of successful CBT treatment. Early studies indicate that CBT with brief virtual reality exposure (VRE) is beneficial in treating PTSD. The case study examined the effectiveness of brief VRE in treating combat-related PTSD.

: This project assesses the usability and feasibility of a multi-behavioral computerized tailored intervention (CTI) or expert system delivered via the Internet for veterans with Post-Traumatic Stress symptoms. Three behavioral health risk factors, (1) smoking, (2) depression, and (3) stress, that are associated with PTSD, will be included in the CTI system. The project will adapt and modify a CTI system based on the Transtheoretical Model of Behavior Change (TTM) that has been successfully utilized with general adult populations to be relevant to a veteran population. The study will utilize methods that are characteristic of a product development project. Each of the four project phases are sequential and will build upon the results of the previous phase. Phase 1 focuses on the review of current CTI programs on smoking cessation, stress management, and depression prevention, and integrating them into a multi-behavioral program for application with veterans. Phase 2 will include the development and adaptation of text-based feedback messages and multimedia components for smoking cessation, stress management, and depression prevention. Initial testing of the modified CTI programs will commence in Phase 3. Cognitive and usability testing with veterans will be performed, and additional modifications to the behavioral modules will be made based on the test results. Phase 4 will focus on feasibility testing of the multi-behavioral CTI system with veterans.

Poorly managed anger responses can be detrimental to one's physical and psychosocial well-being. Cognitive behavior therapies (CBT) have been found to be effective in treating anger disorders. A key component of CBT treatment is exposure to the anger arousing stimuli. Virtual reality (VR) environments can elicit potent reactions and may facilitate the treatment of anger. An anger VR environment with six video vignettes was developed by this study to examine the anger arousal potential of VR. Outcome measures included assessment of emotional reactivity, state anger, and presence. The results showed that significant anger arousal occurred during exposure to the VR environment, and arousal was greater when viewed in an immersive HMD than a non-immersive flat screen. In addition, presence was found to moderate the effects of VR. Low presence resulted in low reactivity regardless of the display modality.

Event Abstract Back to Event Immersive Panoramic Video Display Compared to Flat Screen Display: Psychological and Physiological Reactions to Anger Stimuli Raymond Folen1*, S. D. Miyahira2, 3 and M. Stetz1 1 Tripler Army Medical Center, United States 2 VA Pacific Islands Health Care System, United States 3 Pacific Telehealth & Technology Hui, United States Virtual reality (VR) clinical applications are often computer graphics- based which are costly and time-consuming to create. Panoramic immersive video may offer a more efficient, cost-effective alternative to developing immersive virtual environments. Research is needed to assess the potential of this technology for clinical applications in healthcare. This is the first study to examine the psychophysiologic effects of panoramic video display compared to a flat screen display for cue reactivity. Sixty participants viewed video anger vignettes through either a head-mounted display with panoramic viewing capabilities or on a flat-screen computer monitor. Outcome measures included assessment of emotional reactivity, state anger, presence, blood pressure, electrodermal response, heart rate, and respiration. Conference: Annual CyberTherapy and CyberPsychology 2009 conference, Villa Caramora, Italy, 21 Jun - 23 Jun, 2009. Presentation Type: Poster Presentation Topic: Abstracts Citation: Folen R, Miyahira SD and Stetz M (2009). Immersive Panoramic Video Display Compared to Flat Screen Display: Psychological and Physiological Reactions to Anger Stimuli. Front. Neuroeng. Conference Abstract: Annual CyberTherapy and CyberPsychology 2009 conference. doi: 10.3389/conf.neuro.14.2009.06.032 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Mar 2009; Published Online: 19 Mar 2009. * Correspondence: Raymond Folen, Tripler Army Medical Center, Honolulu, United States, sarah.miyahira@va.gov Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Raymond Folen S. D Miyahira M. Stetz Google Raymond Folen S. D Miyahira M. Stetz Google Scholar Raymond Folen S. D Miyahira M. Stetz PubMed Raymond Folen S. D Miyahira M. Stetz Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Event Abstract Back to Event VR Exposure Therapy + D-Cycloserine (DCS) for Treating PTSD in Patients with Combat-Related Burn Injuries Kathryn Gaylord1, H. G. Hoffman2*, Alan Maiers1, C. Maani1, S. D. Miyahira3, A. Garcia-Palacios4, B. Rothbaum5 and J. Difede6 1 U.S. Army Institute of Surgical Research, Brooke Army Medical Center, United States 2 Virtual Reality Research Center, University of Washington, United States 3 Pacific Telehealth & Technology Hui, United States 4 Universitat Jaume I, Spain 5 Emory University, United States 6 Cornell Presbyterian Hospital, United States For soldiers returning from OIF/OEF with severe combat-related burn injuries from IED attacks, approx. 28% may also be affected by PTSD. Virtual Reality Exposure (VRE) is a promising new treatment for PTSD. Most completers show clinically meaningful reductions in PTSD and depression. VRE helps patients process, habituate to, and stop avoiding memories and strong emotions associated with their memories of traumatic events. D-Cycloserine pills can accelerate fear extinction learning, the essence of exposure therapy. Our study explores the feasibility of using VRE combined with D-Cycloserine to augment cognitive behavioral therapy for treating PTSD in soldiers/warfighters healing from combat-related burn injuries. Pre, mid- and several post-treatment CAPS and depression scores measure treatment success. Challenges to treating combat-related PTSD, and special challenging to treating PTSD in patients with severe combat-related burn injuries, will be discussed. With thousands of U.S. soldiers returning from Iraq and Afghanistan with PTSD, a new unusually effective and efficient treatment protocol that is attractive to young video game generation soldiers, and also works with burn patients could prove valuable. A randomized controlled study may be conducted in the future, if warranted by the findings of the current feasibility study and pending funding. Conference: Annual CyberTherapy and CyberPsychology 2009 conference, Villa Caramora, Italy, 21 Jun - 23 Jun, 2009. Presentation Type: Oral Presentation Topic: Oral Presentations Citation: Gaylord K, Hoffman HG, Maiers A, Maani C, Miyahira SD, Garcia-Palacios A, Rothbaum B and Difede J (2009). VR Exposure Therapy + D-Cycloserine (DCS) for Treating PTSD in Patients with Combat-Related Burn Injuries. Front. Neuroeng. Conference Abstract: Annual CyberTherapy and CyberPsychology 2009 conference. doi: 10.3389/conf.neuro.14.2009.06.034 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Mar 2009; Published Online: 19 Mar 2009. * Correspondence: H. G Hoffman, Virtual Reality Research Center, University of Washington, Washington, United States, hunter@HITL.washington.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Kathryn Gaylord H. G Hoffman Alan Maiers C. Maani S. D Miyahira A. Garcia-Palacios B. Rothbaum J. Difede Google Kathryn Gaylord H. G Hoffman Alan Maiers C. Maani S. D Miyahira A. Garcia-Palacios B. Rothbaum J. Difede Google Scholar Kathryn Gaylord H. G Hoffman Alan Maiers C. Maani S. D Miyahira A. Garcia-Palacios B. Rothbaum J. Difede PubMed Kathryn Gaylord H. G Hoffman Alan Maiers C. Maani S. D Miyahira A. Garcia-Palacios B. Rothbaum J. Difede Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Event Abstract Back to Event Treating Combat PTSD with Virtual Reality Exposure Therapy Sarah Miyahira1, 2*, R. A. Folen3, H. G. Hoffman4 and A. Garcia-Palacios5 1 Veterans Affairs Pacific Islands Health Care System, United States 2 Pacific Telehealth & Technology Hui, United States 3 Tripler Army Medical Center, United States 4 University of Washington, United States 5 Universitat Jaume I, Spain Posttraumatic Stress Disorder (PTSD) is one of the most debilitating disorders experienced by soldiers returning from combat. Few empirically validated PTSD treatments are currently available, particularly for combat-related trauma. Virtual reality exposure (VRE) treatment shows promise in treating combat-related PTSD. This ongoing study is a randomized clinical trial to assess the efficacy of a novel VRE intervention for treating warfighters with PTSD. Outcome variables include PTSD severity, psychological and physiologic factors. Conference: Annual CyberTherapy and CyberPsychology 2009 conference, Villa Caramora, Italy, 21 Jun - 23 Jun, 2009. Presentation Type: Oral Presentation Topic: Oral Presentations Citation: Miyahira S, Folen RA, Hoffman HG and Garcia-Palacios A (2009). Treating Combat PTSD with Virtual Reality Exposure Therapy. Front. Neuroeng. Conference Abstract: Annual CyberTherapy and CyberPsychology 2009 conference. doi: 10.3389/conf.neuro.14.2009.06.069 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 20 Mar 2009; Published Online: 20 Mar 2009. * Correspondence: Sarah Miyahira, Veterans Affairs Pacific Islands Health Care System, Honolulu, United States, sarah.miyahira@va.gov Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sarah Miyahira R. A Folen H. G Hoffman A. Garcia-Palacios Google Sarah Miyahira R. A Folen H. G Hoffman A. Garcia-Palacios Google Scholar Sarah Miyahira R. A Folen H. G Hoffman A. Garcia-Palacios PubMed Sarah Miyahira R. A Folen H. G Hoffman A. Garcia-Palacios Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.