Author: Rothbaum, B.O.; Price, M.; Jovanovic, T.; Norrholm, S.D.; Gerardi, M.; Dunlop, B.; Davis, M.; Bradley, B.; Duncan, E.J.; Rizzo, A.; Ressler, K.J.
Description: OBJECTIVE: The authors examined the effectiveness of virtual reality exposure augmented with D-cycloserine or alprazolam, compared with placebo, in reducing posttraumatic stress disorder (PTSD) due to military trauma.
METHOD: After an introductory session, five sessions of virtual reality exposure were augmented with D-cycloserine (50 mg) or alprazolam (0.25 mg) in a double-blind, placebo-controlled randomized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD.
RESULTS: PTSD symptoms significantly improved from pre- to posttreatment across all conditions and were maintained at 3, 6, and 12 months. There were no overall differences in symptoms between D-cycloserine and placebo at any time. Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment; the alprazolam group showed a higher rate of PTSD (82.8%) than the placebo group (47.8%). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only. At posttreatment, the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes.
CONCLUSIONS: A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans, although there was no control condition for the virtual reality exposure. There was no advantage of D-cycloserine for PTSD symptoms in primary analyses. In secondary analyses, alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning. D-cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo, findings that are consistent with those in the animal literature.
Subject headings: Adult; Afghan Campaign 2001-; Alprazolam/therapeutic use; Anti-Anxiety Agents/therapeutic use; Combined Modality Therapy; Cycloserine/therapeutic use; Double-Blind Method; Extinction, Psychological/drug effects; Female; Humans; Iraq War, 2003-2011; Male; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic/drug therapy/therapy; Treatment Outcome; Veterans/psychology; Virtual Reality Exposure Therapy/methods
Publication year: 2014
Journal or book title: The American Journal of Psychiatry
Volume: 171
Issue: 6
Pages: 640-648
Find the full text: https://www.strategian.com/fulltext/Rothbaum2014.pdf
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Type: Journal Article
Serial number: 1309