Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy (bibtex)
by Seth Davin Norrholm, Tanja Jovanovic, Maryrose Gerardi, Kathryn G. Breazeale, Matthew Price, Michael Davis, Erica Duncan, Kerry J. Ressler, Bekh Bradley, Albert Rizzo, Peter W. Tuerk, Barbara O. Rothbaum
Abstract:
Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either D-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76\% of the variance in CAPS change scores, p \textless 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).
Reference:
Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy (Seth Davin Norrholm, Tanja Jovanovic, Maryrose Gerardi, Kathryn G. Breazeale, Matthew Price, Michael Davis, Erica Duncan, Kerry J. Ressler, Bekh Bradley, Albert Rizzo, Peter W. Tuerk, Barbara O. Rothbaum), In Behaviour Research and Therapy, volume 82, 2016.
Bibtex Entry:
@article{norrholm_baseline_2016,
	title = {Baseline psychophysiological and cortisol reactivity as a predictor of {PTSD} treatment outcome in virtual reality exposure therapy},
	volume = {82},
	issn = {00057967},
	url = {http://linkinghub.elsevier.com/retrieve/pii/S0005796716300663},
	doi = {10.1016/j.brat.2016.05.002},
	abstract = {Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD.
Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either D-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76\% of the variance in CAPS change scores, p {\textless} 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).},
	journal = {Behaviour Research and Therapy},
	author = {Norrholm, Seth Davin and Jovanovic, Tanja and Gerardi, Maryrose and Breazeale, Kathryn G. and Price, Matthew and Davis, Michael and Duncan, Erica and Ressler, Kerry J. and Bradley, Bekh and Rizzo, Albert and Tuerk, Peter W. and Rothbaum, Barbara O.},
	month = jul,
	year = {2016},
	keywords = {MedVR},
	pages = {28--37}
}
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