The effectiveness of VR exposure therapy for PTSD in returning warfighters

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.

Use of immersive virtual reality for treating anger

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.

Effectiveness of brief VR treatment for PTSD in war-fighters: a case study

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.

The receptiveness of stress management techniques by military personnel

Many military service members suffer from stress. Sixty Soldiers participated in a study designed to test receptivity to stress management techniques. Preliminary analyses of surveys and a focus group suggested that participants not only liked practicing relaxation techniques but would also continue practicing these after completion of the present study.

Prescribing non-psychopharmacological agents: a new potential role for psychologists in primary care settings and specialty clinics

At least 10 years have passed since the Department of Defense Psychopharmacology Demonstration Project graduated its first class of psychologists. All graduates of that program were credentialed to prescribe and the program received promising external reviews and audits. The profession has since moved well beyond the initial question, "Can and should psychologists prescribe?" posed over two decades ago. A number of professional schools and training institutions have implemented postdoctoral psychopharmacology training programs and over 20 states are actively pursuing legislative agendas. Given recent initiatives to provide health psychology services within the primary care arena, the authors introduce a new role in the scope of psychology's prescribing activities. They propose that psychopharmacological agents are not the only medications psychologists should be trained to prescribe and psychopharmacology training should include course work and supervision related to treatment within a primary care patient setting in addition to a traditional psychiatric one. The authors provide the rationale for primary care clinical health psychology training as the appropriate mechanism for psychopharmacology education and practice. Public health needs and epidemiological data provide the rationale for health psychologists additionally prescribing non-psychopharmacological agents.

Clinical effectiveness of sustained-release bupropion and behavior therapy for tobacco dependence in a clinical setting

Despite decades of public education, cigarette smoking remains a serious health problem. The treatment approach at Tripler Army Medical Center is a unique collaboration of family practice physicians and health psychologists providing combination therapy to patients attempting to quit smoking. This article discusses a program evaluation of the Tripler Army Medical Center smoking cessation program. Patients attempting to quit smoking were assisted with a combination of cognitive-behavioral group therapy and sustained-release bupropion hydrochloride. At 6 months postintervention, patients who attended the smoking cessation programs were contacted via telephone and asked to complete a survey regarding their smoking status. One hundred forty-four participants completed the survey. Thirty-five percent of all contacted attendees remained abstinent from smoking at 6 months after intervention. A significantly greater percentage of men quit than women. There were no significant differences of abstinence rates by any other demographic characteristic or smoking history variable. Family practice physicians and health psychologists providing a combination of pharmacological and group cognitive-behavior therapy for nicotine dependence are effective in promoting abstinence from smoking.

Autogenic Feedback Training Exercise and pilot performance: enhanced functioning under search-and-rescue flying conditions

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group contained 4 pilots from HC-130 Hercules aircraft and 4 HH-65 Dolphin helicopter pilots; the control group contained 3 pilots of HC-130s and 6 helicopter pilots. During an initial flight, physiological data were recorded on each crewmember and an instructor pilot rated individual crew performance. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training Exercise (AFTE). The remaining participants received no training. During a second flight, treatment participants showed significant improvement in performance (rated by the same instructor pilot as in pretests) while controls did not improve. The results indicate that AFTE management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Biofeedback using telemedicine: clinical applications and case illustrations

Telecommunications technology is dramatically changing our world, allowing healthcare professionals to offer medical healthcare, in the form of consultation, assessment, and treatment, through the use of new communications media. In behavioral medicine, advances in telecommunications have brought about new ways of offering services by expanding healthcare to patients located all over the world and simultaneously reducing costs and improving outcome efficacy. This article describes the use of biofeedback to treat various pain and psychophysiological disorders through telemedicine technology. The authors provide a description of "off-the-shelf," low-cost, and low-bandwidth telemedicine equipment used to deliver clinical biofeedback treatment when the patient and provider are in two different locations. In addition, the authors discuss practical issues of behavioral telehealth.

Biofeedback via telehealth: a new frontier for applied psychophysiology

Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed services via a telehealth venue. Such capability significantly improves access to care, particularly for patient's located at considerable distance from the provider. As the telecommunications infrastructure in rural and remote areas is often quite basic, such a system must be capable of operating within these limited parameters. The system developed by the authors provides real-time video and audio interactivity and allows the therapist to monitor and control biofeedback equipment located at the remote site. The authors discuss the clinical applications, the technology, and relevant practical and ethical issues.

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Acute and post-traumatic stress disorder after spontaneous abortion

When a spontaneous abortion is followed by complicated bereavement, the primary care physician may not consider the diagnosis of acute stress disorder or post-traumatic stress disorder. The major difference between these two conditions is that, in acute stress disorder, symptoms such as dissociation, reliving the trauma, avoiding stimuli associated with the trauma and increased arousal are present for at least two days but not longer than four weeks. When the symptoms persist beyond four weeks, the patient may have post-traumatic stress disorder. The symptoms of distress response after spontaneous abortion include psychologic, physical, cognitive and behavioral effects; however, patients with distress response after spontaneous abortion often do not meet the criteria for acute or post-traumatic stress disorder. After spontaneous abortion, as many as 10 percent of women may have acute stress disorder and up to 1 percent may have post-traumatic stress disorder. Critical incident stress debriefing, which may be administered by trained family physicians or mental health practitioners, may help patients who are having a stress disorder after a spontaneous abortion.

A conceptual overview of a proactive health psychology service: the Tripler Health Psychology Model

The military patient population, the demanding environment in which medical services are provided, and the rigors of the operational environment create a unique challenge for service members as well as military health care providers. Within the military medical system, the subspecialty of clinical health psychology may provide patient care and consultation interventions necessary to meet the demands of the unique Army medical and military communities. As funding and other resources decrease, military health psychologists can provide high-quality care to difficult-to-manage patients while increasing outcome efficacy and decreasing costs to the hospital. This paper provides a definition of clinical health psychology and a description of its unique interventions and applications and how these unique skills augment medical services. Moreover, we offer a conceptual model for an innovative health psychology program that will assist other military treatment facilities in designing programs to increase outcome efficacy and concurrently reduce costs and utilization of services.

The Tripler LE3AN Program: a two-year follow-up report

This paper provides a review of 2-year follow-up data on the Tripler Army Medical Center LE3AN Program. The LE3AN Program (emphasizing healthy Lifestyles, reasonable Exercise, realistic Expectations, Emotions, and Attitudes, and Nutrition) provides active duty service members a treatment strategy that involves a reasonable low-intensity exercise regimen, behavior modification, intensive nutritional counseling healthy meal planing, relapse prevention strategies, cognitive coping strategies, and healthy lifestyle principals to lose weight and maintain weight loss. Based on the 2-year data and additional clinical findings, we expand upon earlier preliminary reports. The 2-year follow-up data suggest that the program is a safe and efficacious treatment program.

The Tripler Tobacco-Cessation Program: predictors for success and improved efficacy

This study analyzed differences in baseline, course of treatment, and post-quit variables of participants in a tobacco-cessation program to identify factors predictive of outcome that could be used as a focus for intervention. The program offered a 10-week course of transdermal nicotine replacement combined with education and cognitive/behavioral therapy in a group format at a major military medical center. Demonstrated differences were found among abstainers, early relapsers, and late relapsers in age-initiated tobacco use, use of liquor, levels of exhaled carbon monoxide at intake, tobacco use during the program, and perceived reasons for relapse. The abstinence rate at follow-up was 27%. Based on our findings, we discuss recommendations to improve treatment. This information is offered as a model to evaluate and improve the efficacy of established clinic-based tobacco-cessation programs.

The Tripler Army Medical Center LEAN Program: a healthy lifestyle model for the treatment of obesity

This paper provides an overview of the Tripler Army Medical Center LEAN Program for the treatment of obesity, hypercholesterolemia, and essential hypertension. The LEAN Program, a multi-disciplinary prevention program, emphasizes healthy Lifestyles, Exercise and Emotions, Attitudes, and Nutrition for active duty service members. The treatment model offers a medically healthy, emotionally safe, and reasonable, low-intensity exercise program to facilitate weight loss. We will discuss the philosophy behind the LEAN Program and the major components. Thereafter, we will briefly discuss the preliminary results.

EEG biofeedback as a treatment for chronic fatigue syndrome: a controlled case report

EEG neurofeedback has been identified as a potential diagnostic and treatment protocol with chronic fatigue syndrome (CFS) symptoms. In the present case study, the authors applied an EEG neurofeedback biofeedback paradigm as a treatment modality with a CFS patient. Baseline data were acquired using the Wechsler Adult Intelligence Scale-Revised and qualitative and subjective ratings of cognitive improvement. Test results and clinical findings revealed improvements in the patient's cognitive abilities, functional skill level, and quality of life. The patient showed significant differences in pre- and posttest levels on the Wechsler scale.

Autogenic feedback training improves pilot performance during emergency flying conditions

Studies have shown that autonomous mode behavior (AMB) is one cause of aircraft fatalities caused by pilot error. In AMB cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. The following study, conducted under the auspices of the U.S. National Aeronautics and Space Administration's (NASA) Ames Research Center, examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours.

The cosleeping habits of military children

Cosleeping is a topic frequently of concern to parents; however, little objective evidence exists to support the historical prohibition against children sleeping in the same bed with their parents. Surveys from the parents of 86 children in the clinics of pediatrics and child psychiatry were analyzed to describe patterns of cosleeping in a group of military dependents aged 2 to 13 years. Shown is a significant increase in cosleeping with father absence and that cosleeping is less frequent in the psychiatric subpopulation.