Highlights
- •Repeated sessions of combined tDCS + VR exposure is technically feasible.
- •tDCS + VR augmented psychophysiological habituation in PTSD.
- •tDCS + VR resulted in clinically meaningful symptom severity reduction.
- •These results support broader use of tDCS + VR in neuropsychiatric research.
Abstract
Background
Facilitating neural activity using non-invasive brain stimulation may improve extinction-based
treatments for posttraumatic stress disorder (PTSD).
Objective/hypothesis
Here, we examined the feasibility of simultaneous transcranial direct current stimulation
(tDCS) application during virtual reality (VR) to reduce psychophysiological arousal
and symptoms in Veterans with PTSD.
Methods
Twelve Veterans with PTSD received six combat-related VR exposure sessions during
sham-controlled tDCS targeting ventromedial prefrontal cortex. Primary outcome measures
were changes in skin conductance-based arousal and self-reported PTSD symptom severity.
Results
tDCS + VR components were combined without technical difficulty. We observed a significant
interaction between reduction in arousal across sessions and tDCS group (p = .03),
indicating that the decrease in physiological arousal was greater in the tDCS + VR
versus sham group. We additionally observed a clinically meaningful reduction in PTSD
symptom severity.
Conclusions
This study demonstrates feasibility of applying tDCS during VR. Preliminary data suggest
a reduction in psychophysiological arousal and PTSD symptomatology, supporting future
studies.
Keywords
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References
- Posttraumatic stress disorder in the national comorbidity survey.Arch Gen Psychiatr. 1995; 52: 1048-1060
- A multidimensional meta-analysis of psychotherapy for PTSD.Am J Psychiatr. 2005; 162: 214-227
- Meta-analysis of the efficacy of treatments for posttraumatic stress disorder.J Clin Psychiatr. 2013; 74: 478-550
- Aberrant resting-state brain activity in posttraumatic stress disorder: a meta-analysis and systematic review.Depress Anxiety. 2016; 33: 592-605
- Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia.Am J Psychiatr. 2007; 164: 1476-1488
- Fear extinction as a model for translational neuroscience: ten years of progress.Annu Rev Psychol. 2012; 63: 129-151
- Prefrontal mechanisms in extinction of conditioned fear.Biol Psychiatr. 2006; 60: 337-343
- From Pavlov to PTSD: the extinction of conditioned fear in rodents, humans, and anxiety disorders.Neurobiol Learn Mem. 2014; 113: 3-18
- Neural correlates of traumatic memories in posttraumatic stress disorder: a functional MRI investigation.Am J Psychiatr. 2001; 158: 1920-1922
- Transcranial direct current stimulation may modulate extinction memory in posttraumatic stress disorder.Brain and behavior. 2017; 7
- Can transcranial direct current stimulation augment extinction of conditioned fear?.Brain Stimulation. 2016; 9: 529-536
- Prefrontal cortex stimulation enhances fear extinction memory in humans.Biol Psychiatr. 2018; 84: 129-137
- Virtual reality and applied psychophysiology.Appl Psychophysiol Biofeedback. 2005; 30: 183-185
- Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis.Depress Anxiety. 2012; 29: 85-93
- A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans.Am J Psychiatr. 2014; 171: 640-648
- Does physiologic response to loud tones change following cognitive–behavioral treatment for posttraumatic stress disorder?.J Trauma Stress. 2012; 25: 25-32
- Treatment-related changes in cardiovascular reactivity to trauma cues in motor vehicle accident-related PTSD.Behav Ther. 2002; 33: 417-426
- Transcranial direct current stimulation: state of the art 2008.Brain Stimulation. 2008; 1: 206-223
- Measurements and models of electric fields in the in vivo human brain during transcranial electric stimulation.Elife. 2017; 6e18834
- Battery powered thought: enhancement of attention, learning, and memory in healthy adults using transcranial direct current stimulation.Neuroimage. 2014; 85: 895-908
- The effect of repetitive transcranial magnetic stimulation on fear extinction in rats.Neuroscience. 2012; 200: 159-165
- Augmentation of evidence-based psychotherapy for PTSD with cognitive enhancers.Curr Psychiatr Rep. 2015; 17: 39
- The ptsd checklist for dsm-5 (pcl-5).(Scale available from: the National Center for PTSD at)www.ptsd.va.govDate: 2013
- De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder.J Abnorm Psychol. 2000; 109: 290
- Extinction retention and fear renewal in a lifetime obsessive–compulsive disorder sample.Behav Brain Res. 2015; 280: 72-77
- Test of the conditioning model of neurosis: differential aversive conditioning of angry and neutral facial expressions in anxiety disorder patients.J Abnorm Psychol. 1986; 95: 208
- A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation.Int J Neuropsychopharmacol. 2011; 14: 1133-1145
- Low-intensity transcranial current stimulation in psychiatry.Am J Psychiatr. 2017; 174: 628-639
- Size of treatment effects and their importance to clinical research and practice.Biol Psychiatr. 2006; 59: 990-996
- An empirical review of potential mediators and mechanisms of prolonged exposure therapy.Clin Psychol Rev. 2017; 56: 106-121
Article info
Publication history
Published online: September 20, 2018
Accepted:
September 10,
2018
Received in revised form:
August 17,
2018
Received:
April 20,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
