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Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results

  • Mascha van 't Wout-Frank
    Correspondence
    Corresponding author. Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI, 02908, USA.
    Affiliations
    Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
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  • M. Tracie Shea
    Affiliations
    Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
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  • Victoria C. Larson
    Affiliations
    Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA
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  • Benjamin D. Greenberg
    Affiliations
    Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
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  • Noah S. Philip
    Affiliations
    Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA
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Published:September 20, 2018DOI:https://doi.org/10.1016/j.brs.2018.09.011

      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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