“I includes certain types of prescription medication

“I feel stress, anger, road
rage, my heart feels like someone is pinching it”, this is the way Micah
Johnson describes his experience during a mental health checkup one month after
returning to United States of America from Afghanistan in 2014. He also
complained of insomnia, paranoia and panic attacks, all symptoms of
Post-Traumatic Stress Disorder. Two years later on the 7th July of
2016 his life took another tragic turn. During a Black Life’s matter protest in
Dallas, elicited by anger over previous police shooting, Micah Johnson shot
five police officers and was later killed by a bomb attached to a remote
control robot. Situations like this fuel the discussion about the treatment of
PTSD in military veterans and if this tragic incident, or others like it, could
have been prevented. (https://newsone.com/3519268/micah-johnson-displayed-ptsd-after-afghanistan/)

The National Comorbidity Survey Replication (NCS-R),
conducted between February 2001 and April 2003 found that approximately
70% of adults in the United States have experienced a traumatic event at least
once in their life; with 20% of these developing Post-Traumatic Stress Disorder
it can be classified as a serious problem when it comes to mental health. Post-Traumatic Stress
Disorder (PTSD) includes symptoms like distressing memories, dreams or
flashbacks about the specific traumatic event, physiological reactions and even
avoidance behaviour. (Henry
Gleitman, James Gross, Daniel Reisberg. — 8th ed, 2010). Experiencing a
multitude of different situations like natural disasters, sexual violence,
motor vehicle accidents or exposure to war can lead to the development of these
symptoms. (Cristina Botella, Berenice Serrano, Rosa M Baños,
Azucena Garcia-Palacios, 2015). Especially soldiers and other member of the military
are at an increased risk for developing PTSD. Smith et al., 2008 established that combat
deployment to Iraq and Afghanistan increases the risk of PTSD for military
members. Based on these studies it can be concluded that PTSD is a prevalent
disorder that can be brought on by a multitude of different experiences and

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Treatment for PTSD includes certain types of prescription medication or psychotherapeutic
methods, such as Prolonged Exposure Therapy (PE). PE aims to break the
connection between the distressing stimulus and the associated fears by
teaching the patient to maintain a state of relaxation while imagining the
object or situation that is the cause of the anxiety.( Henry Gleitman, James Gross, Daniel Reisberg. — 8th
ed, 2010). Patients start by creating an anxiety hierarchy, which orders
the objects or situations by the intensity of the experienced fear or distress.
During the course of the treatment the patient now imagines themselves in these
situations following the order of the established hierarchy. When the patient
is able to stay calm and comfortable during this imagination, they gradually
move up the hierarchy to the next most anxiety-producing stimulus. This process
ends with in vivo desensitization, in which the patient is exposed to the
anxiety-producing stimulus in real life. While Prolonged- Exposure Therapy has
been shown to be successful in reducing PTSD symptoms (Powers  et al., 2010)
it also has some significant
limitations. As the exposure is purely imaginal it gives the therapist very
little control over the imagined object or situation, there is also no way for
the therapist to see exactly what the patient is imagining. Introducing a new treatment,
that combines PE with new technological inventions, could minimize some of
these limitations.

Over the last
years the development of new and innovative technology has not only impacted
the gaming and entertainment industry but has also had a huge influence on the
treatment of psychological disorders. One of these new inventions is Virtual
Reality (VR), a technology that allows the simulation of a wide range of
real-life situations in a computer generated environment, this allows the user
to interact freely with this environment and creates a strong feeling of
immersion in the specific environment. (Cristina Botella, Berenice
Serrano, Rosa M Baños, Azucena Garcia-Palacios, 2015). Building on this technology is Virtual Reality Exposure
(VRE) or Virtual Reality Exposure Therapy (VRET), a treatment method that
involves the patient being immersed in an environment that might trigger
psychological distress. Advantages of VRE include the high level of immersion,
which makes the situation feel more realistic and the user more involved in the
virtual world. It also allows the therapist more control over the environment,
and therefore the intensity of the stimulus the patient is exposed to (Hamm & Weike, 2005). Virtual
Reality Exposure has been shown to be effective in the treatment in a wide
range of anxiety disorders, including the fear of flying (Krijn et al., 2007) and
the fear of heights (Emmelkamp
et al., 2002). Several studies have also shown a reduction in PTSD
symptoms following Virtual Reality Exposure Treatment in military veterans (e.g. Rothbaum et al.,2014).
Based on these studies it can therefore be concluded that the utilization of new
technology, such as VR, for therapeutic purposes can be very effective in the
treatment of psychological disorders.   

people to participate in any kind of treatment can however be difficult.
Because of the stigma attached to PTSD and mental disorders in general,
sufferers often prefer to keep their problems secret and do not reach out for
help. A study by Charles W.
Hoge,  et al., 2014 found that out of the
229 soldiers that were diagnosed with PTSD only half sought help at a mental
health facility. This
creates an immense importance for preventative methods; creating a treatment
that is done during the exposure to the traumatic situation, e.g. combat
deployment, could prevent the development of PTSD and therefore reduce the rate
and symptom severity of PTSD patients. While multiple studies have shown the
effectiveness of Virtual Reality Exposure in the treatment of PTSD, the studies
exploring the effects of VRE as a preventative method, especially compared to other
existing treatment methods, have been extremely limited.

Research on
the qualities of VRE in the prevention of PTSD has found that treating active
duty soldiers with VRE lead to a significant decrease in reported PTSD symptoms (Reger et al., 2014). Building on this previous research this study aims
to explore the effect of Virtual Reality Exposure Therapy treatment in active
duty soldiers on later onset or development of PTSD related symptoms. Given
that VRET has been shown in multiple different studies to reduce PTSD related
symptoms and considering the advantages that VRET has over PE, most importantly
the ability of the therapist to control the environment the patient is exposed
to, we hypothesize that the treatment with VRE during active deployment will significantly
reduce the severity of PTSD related symptoms.

investigate this 50 active duty soldiers, all working in comparable fields and
therefore all exposed to a similar levels of violence, were divided into two
groups: the experimental group, receiving VRET twice a week; and the control
group, who received the conventional PE treatment also twice a week. Both groups
were assessed with a Pre-Test, administered before the beginning of the treatment,
a Post-Test, administered after the deployment and shortly before returning
home and a Retention-Test, administered five years after the exposure to the
traumatic event. PTSD symptoms were measured using self-report methods as well
as a structured interview with a classified psychologist.

We predict
that both groups will score lower in regards to the prevalence of PTSD symptoms
on the Post-Test compared to the Pre-Test in both the control and the
experimental group. We predict that the experimental group however will show a
greater reduction