AUTHOR=Knaust Thiemo , Felnhofer Anna , Kothgassner Oswald D. , Höllmer Helge , Gorzka Robert-Jacek , Schulz Holger 

TITLE=Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review

JOURNAL=Frontiers in Psychology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.562506

DOI=10.3389/fpsyg.2020.562506

ISSN=1664-1078

ABSTRACT=Some post-traumatic stress disorder (PTSD) patients do not benefit from imaginal exposure therapy. One possible approach to reach such patients are virtual trauma interventions. Herein, a qualitative scoping review was conducted. Different types of virtual trauma exposure interventions were identified, and for each type of virtual trauma exposure interventions it was examined in detail: (1) the therapeutic frameworks (in sensu trauma exposure approaches transferred into a virtual intervention) of this type of virtual trauma exposure intervention, (2) which hardware and software were used, (3) whether the influence of spatial and social presence on the efficacy of virtual trauma interventions have been measured, and (4) the efficacy of virtual trauma interventions for PTSD patients having imagination difficulties.

These research questions were analyzed qualitatively. Therefore, an extensive literature search was conducted using the databases Web of Science, PsycINFO, LIVIVO, PTSDpubs, and PubMed for scientific articles published between January 2013 and July 2020. Only studies aimed to reduce PTSD symptoms using virtual trauma interventions were included. The literature search was not limited to a specific study design, treatment/intervention method, or a minimum sample size. 

Eighteen studies were identified, which reported three different virtual trauma intervention approaches, namely, virtual reality exposure therapy (VRET), multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), and action-centered exposure therapy (ACET). Seven randomized controlled trials (RCTs), two pilot studies, and one case study were focused on VRET; while two RCTs, one pilot study, and three case studies focused on 3MDR, and two case studies on ACET. 

All VRET studies used head-mounted displays (HMDs) with a virtual version of the Iraq / Afghanistan or the World Trade Center attacks, while 3MDR studies utilized two different versions of a cave automatic virtual environment (CAVE) with personalized trauma-related images, and the ACET studies used HMDs with virtual street scenarios. The influence of spatial or social presence on the efficacy of virtual trauma interventions was not examined in any of the included studies. Similarly, empirical evidence for the efficacy of virtual trauma interventions on PTSD patients having imagination difficulties was lacking. Therefore, such empirical studies are needed to fill these research gaps.