A Randomized, Head-to-Head Study of Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder.

Virtual reality exposure therapy (VRET) is one of the few interventions supported by randomized controlled trials for the treatment of combat-related posttraumatic stress disorder (PTSD) in active duty service members. A comparative effectiveness study was conducted to determine if virtual reality technology itself improved outcomes, or if similar results could be achieved with a control exposure therapy (CET) condition. Service members with combat-related PTSD were randomly selected to receive nine weeks of VRET or CET. Assessors, but not therapists, were blinded. PTSD symptom improvement was assessed one week and 3 months after the conclusion of treatment using the clinician-administered PTSD scale (CAPS). A small crossover component was included. Results demonstrated that PTSD symptoms improved with both treatments, but there were no statistically significant differences between groups. Dropout rates were higher in VRET. Of those who received VRET, 13/42 (31%) showed >30% improvement on the CAPS, versus 16/43 (37%) who received CET. Three months after treatment, >30% improvement was seen in 10/33 (30%) of VRET participants and 12/33 (36%) in CET. Participants who crossed over (n = 11) showed no statistically significant improvements in a second round of treatment, regardless of condition. This study supported the utility of exposure therapy for PTSD, but did not support additional benefit by the inclusion of virtual reality.

Importance of Virtual Reality to Virtual Reality Exposure Therapy, Study Design of a Randomized Trial.

Post Traumatic Stress Disorder (PTSD) can be a debilitating problem in service members who have served in Iraq or Afghanistan. Virtual Reality Exposure Therapy (VRET) is one of the few interventions demonstrated in randomized controlled trials to be effective for PTSD in this population. There are theoretical reasons to expect that Virtual Reality (VR) adds to the effectiveness of exposure therapy, but there is also added expense and difficulty in using VR. Described is a trial comparing outcomes from VRET and a control exposure therapy (CET) protocol in service members with PTSD.

Behavioral and neuroanatomical investigation of Highly Superior Autobiographical Memory (HSAM).

A single case study recently documented one woman's ability to recall accurately vast amounts of autobiographical information, spanning most of her lifetime, without the use of practiced mnemonics (Parker, Cahill, & McGaugh, 2006). The current study reports findings based on eleven participants expressing this same memory ability, now referred to as Highly Superior Autobiographical Memory (HSAM). Participants were identified and subsequently characterized based on screening for memory of public events. They were then tested for personal autobiographical memories as well as for memory assessed by laboratory memory tests. Additionally, whole-brain structural MRI scans were obtained. Results indicated that HSAM participants performed significantly better at recalling public as well as personal autobiographical events as well as the days and dates on which these events occurred. However, their performance was comparable to age- and sex-matched controls on most standard laboratory memory tests. Neuroanatomical results identified nine structures as being morphologically different from those of control participants. The study of HSAM may provide new insights into the neurobiology of autobiographical memory.

Cognitive behavioral treatment to improve adherence to hemodialysis fluid restrictions: a case report.

This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.

Replacing overt verbal and gestural prompts with unobtrusive covert tactile prompting for students with autism.

Verbal responses, gestures, and other physical stimuli are often used to prompt children to pay attention to their teacher, participate in group responding, and engage in independent activities in the classroom. Prompts can be intrusive and draw attention to the problem, however. In the present study, unobtrusive vibrating pagers were used to discreetly alert children to attend directly to the teacher or the ongoing activity, thus reducing the number of disruptions the children created in their classrooms. The children were then able to learn more effectively and with less interference to others in the vicinity. Specifically, 5 male children, between 4 and 7 years old, who attended a regular education preschool or regular education first-grade classroom, participated. An alternating baseline and treatment conditions design was used, in which periods of overt traditional prompting were alternated with periods of covert tactile and overt traditional prompting. The data showed that covert tactile prompting was successful in reducing the amount of overt traditional prompting that was needed for attention to a teacher, group responding, and engagement in independent activities.

Accuracy of retrospective memory and covariation estimation in patients with obsessive-compulsive disorder.

Assessment methods relying on biased or inaccurate retrospective recall may distort knowledge about the nature of disorders and lead to faulty clinical inferences. Despite concerns about the accuracy of retrospective recall in general and in particular with obsessive-compulsive disorder (OCD) patients, the accuracy of retrospective recall for one's own symptoms assessed in vivo is unknown in this population. This study used a prospective ecological momentary assessment (EMA) methodology to create a criterion against which to assess recall accuracy in OCD patients. Although results indicated that patients' retrospective recall of OCD symptoms was fairly accurate, they consistently overestimated the magnitude of OCD symptom covariation with non-OCD facets (e.g., sleep duration, contemporaneous stress level, etc.). Findings suggest that even when recall of OCD symptoms is accurate, patients may be inaccurate in estimating symptom covariation. The findings have implications for the research, case conceptualization, and assessment of OCD, and may extend to other disorders.

Acetylcholine-secreting cells improve age-induced memory deficits.

The present study examined whether aged rats with naturally occurring cognitive deficits in spatial learning and memory would benefit from local chronic supplementation of acetylcholine. Aged impaired and aged unimpaired rats were pretested in the water maze to characterize the extent of age-induced cognitive impairment. Groups were matched for extent of deficits. The animals subsequently received implants of either acetylcholine-releasing cells or control cells into the cortical and hippocampal target regions of the basal forebrain. One week postgrafting, spatial learning and memory were retested using the same behavioral procedure. All aged groups acquired the platform position more slowly than young controls. However, aged impaired rats grafted with acetylcholine-releasing cells performed significantly better than aged impaired rats with control grafts, and they did not differ from aged unimpaired groups. A spatial memory probe test revealed that memory for the escape platform location of the acetylcholine-grafted rats was significantly better than that of rats with control grafts and matched the performance of young controls. In vitro, biochemical and electrophysiological analyses of the engineered cells confirmed choline acetyltransferase activity and showed quantal release of acetylcholine from the transduced cells. In vivo, RT-PCR of microdissected grafts indicated that the engineered cells expressed the choline acetyltransferase transgene for up to 40 days postgrafting. These results indicate that locally restricted supplementation of acetylcholine into the two major target regions of the cholinergic basal forebrain of aged impaired rats ameliorates some age-related cognitive deficits.