Virtual confrontation, real-life recovery: A feasibility pilot for a novel virtual reality exposure therapy in military personnel

Abstract

Military personnel diagnosed with posttraumatic stress disorder (PTSD) often demonstrate reduced responsiveness to standard trauma-focused treatments compared to civilian populations. This diminished efficacy could be attributed to heightened levels of avoidance behavior. Virtual Reality (VR) has emerged as a promising technique to counteract this avoidance and enhance therapeutic engagement during exposure-based interventions. In response, a novel VR trauma-focused exposure therapy, IMMERSE, was developed. This treatment integrates multisensory exposure via a head-mounted display, combining olfactory, tactile, and auditory stimuli while viewing and discussing traumatic imagery. These sensory elements are individually calibrated to optimize immersion while minimizing the risk of overwhelming the patient. Moreover, the therapist monitors physiological distress in real-time to further facilitate exposure intensity. This study evaluates the feasibility and acceptability of the IMMERSE VR exposure therapy in Dutch military personnel and veterans with PTSD (n = 16). Feasibility was measured through post-treatment interviews and a feasibility questionnaire to assess subjective experiences of the VR exposure therapy. Additionally, simulator sickness was monitored. To examine preliminary treatment effects, both self-report and clinician-rated measures of PTSD symptoms, depressive symptoms, and well-being were assessed. Results support that the treatment is feasible and acceptable, as satisfaction was high and the burden of simulator sickness was minimal. Furthermore, the treatment was accompanied by a reduction in PTSD and depressive symptoms and an increase in well-being. Aside from its potential as a stand-alone treatment, the IMMERSE treatment could also be implemented as a tool within established trauma-focused therapies, enhancing engagement and multisensory exposure.