Augmenting virtual reality exposure for PTSD with physical activity: study protocol of a randomised controlled trial.

Background

Physical activity is increasingly incorporated in trauma-focused treatments as an augmentation strategy to improve treatment outcome. In a novel VR exposure treatment known as 3MDR (Multi-modal Motion-assisted Memory Desensitization and Reconsolidation), patients engage in low-intensity physical activity by walking on a treadmill throughout the therapy session, approaching trauma-related pictures that progressively enlarge until fully displayed in a VR environment. Physical activity is considered a key augmentation strategy in this treatment, with the proposed mechanism that walking toward a trauma-related picture facilitates the reduction of trauma-related avoidance, thereby improving treatment outcome. However, neither the specific effect of walking during this treatment nor the proposed working mechanism have been scientifically examined yet.

Objective

In this paper we describe the rationale and study design of a randomised controlled trial (RCT) to examine the specific effect of walking toward trauma-related stimuli during VR exposure on treatment outcome. In addition, we will test whether walking toward trauma-related pictures facilitates a greater reduction in trauma-related avoidance.Method: Patients with PTSD (N = 158) are randomised to two treatment conditions: walking (VR exposure while walking) or stationary (VR exposure without walking), while keeping all other treatment aspects constant. Participants in both conditions receive two preparatory treatment sessions, 6 or 12 VR exposure sessions, and one closure session. The primary outcome is clinician-rated PTSD symptom severity. Secondary outcomes are both clinician-rated- and self-reported trauma-related avoidance symptom severity, as well as self-reported PTSD symptom severity. Assessments take place pre- and after 6 and 12 VR exposure sessions (posttreatment), and at 3-, 6-, 12- and 18- months follow-up.

Conclusion

This RCT aims to examine whether incorporating walking during trauma-focused treatment in a VR exposure environment augments the treatment of patients with PTSD.