The Posttraumatic Stress Disorder (PTSD) is a psychiatric diagnosis with 8 – 40 % of prevalence on Motor Vehicle Accidents (MVA) survivors. This paper reports on a case study about a subject that undergone a VR exposure program designed to reduce PTSD symptomatology which was developed after a violent MVA. The VR world consisted on a 4 lane highway setup with traffic on both ways that was displayed to the patient through a 295 X 225 cm Translucid Screen. In the 4 sessions, the participant, a 42 years old female, was driven through the highway by a therapist. The intensity of anxiety cues was raised throughout sessions. Patient had to overcome events such as traffic intensity variation, tunnels and crossings. From HADS questionnaire, it was reported very high anxiety and depression scores. IES results also indicate a reduction in intrusion and avoidance scores, even though the subject remains within the severe PTSD cohort. Physiological measures such as ECG and GSR pointed out to a reduction on psychophysiological activity.

1. A case-report

2. > 5 Million Drivers
40000 MVA per year (DGV, 2005)
1094 Deaths (2005)
• Highest Death per capita Rate in the Western EU;
• 50000 victims with physical injuries;
• Costs 2-3% of GDP.
Portugal

3.  Possible consequences of MVA (besides physical injuries):
 Phobia;
 Acute Stress Disorder;
 Depression;
 Panic Attacks;
and...
 Post-Traumatic Stress Disorder (PTSD)
MVA and Mental Disorders

4.  MVA victims with PTSD symptoms:
 Albuquerque (2003): 5,6%
 Blanchard & Hickling (1997): 8 – 40%
 Pires & Maia (2006):
55% 31%
7,1% with more
symptoms than
before
MVA and PTSD

5. VRE
TechniquePhobia PTSD
Acrophobia
Arachnophobia
Claustrophobia
Fear of Flying
World Trade Center
Israel
Iraq
Angolan Veteran
MVA ?
Ongoing research about a patient that developed PTSD
after a traumatic MVA
PTSD and Virtual Reality Exposure

6.  Portuguese Woman;
 42 years old;
 DSM-IV Criteria;
 Stable medication (3 months before VRE);
 Psychotherapy.
Methodology - Subject

7. Methodology - Setup

8. Sessions
I II III IV
Description
Driving in a
low intensity
traffic highway
Driving in a
medium
intensity traffic
highway
Driving in a
high intensity
traffic
highway
Driving in a high
intensity traffic
highway with
reduction of field
of view
Duration (min.) 20 22 21 22
Trigger No trigger Horns
Horns +
crossover
Horns + crossover
+ narrowing field
of view
I II III IV
Methodology – VRE Sessions I

9. Sessions
I II III IV
Description
Driving in a
low intensity
traffic highway
Driving in a
medium
intensity traffic
highway
Driving in a
high intensity
traffic highway
Driving in a
high intensity
traffic highway
with reduction
of field of view
Duration
(min.)
20 22 21 22
Trigger No trigger Horns
Horns +
crossover
Horns +
crossover +
narrowing field
of view
1st
Assessment 2nd
Assessment
Methodology – VRE Sessions II

10. Methodology – VR World Highway Movie

11. Methodology – VR World Highway Pictures

12.  Self-report assessments:
 Anxiety and Depression (HADS);
 Intrusion and Avoidance (IES).
 On session assessments:
 ECG and GSR;
 Observational methods.
Methodology – Measures I

13.  Psychophysiological measures:
 ECG (Electrocardiography);
 GSR (Galvanic Skin Response).
 Four different moments of assessment in each session:
(Before VRE) (Beginning) (20 min.)
Methodology – Measures II

14. HADS 1st
assessment 2nd
assessment
Anxiety 13 11
Depression 17 16
Decrease between 1st
and 2nd
assessment
 Anxiety and Depression (HADS)
Results I

15.  PTSD symptoms (IES)
IES 1st assessment 2nd assessment
Intrusion 31 27
Avoidance 31 21
Total score 62 48
Decrease between 1st
and 2nd
assessment
Results II

16. Measures %
Anxiety (HADS) -16
Depression (HADS) -6
IES Total Score -22
Intrusion -13
Avoidance -32
Results III – Scores reduction proportion

17. • No significant differences were found between sessions;
Results IV – ECG between sessions

18. • Significant differences within sessions;
Results V – ECG within sessions

19. • No significant differences were found between and
within sessions;
Results VI - GSR

20.  Slight decrease of the anxiety and depressive symptoms;
 Supported by:
▪ Patient non-verbal behavior;
▪ Predisposition towards driving (4 session).
 Small decrease on PTSD symptoms (Avoidance & Intrusion).
Final considerations I

21.  Heart-rate reduction between sessions;
 Increased activation at the end of sessions.
Possible desensitization?
Possible advantage for restructuring to occur?
Final considerations II