(111) Compressed VR Exposure Therapy Habituates PTSD Symptoms in a Critical Illness Survivor

Introduction: Post-traumatic stress disorder (PTSD) symptoms develop in over 25% of adult critical illness survivors within 6 months of ICU discharge. Compressed Virtual Reality Exposure Therapy (C-VRET) is a 10-day treatment effective in treating PTSD in military personnel. It is being trialed in our trauma-focused clinical research center with adult critical illness survivors who screen positive for at least moderate trauma symptoms on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Using standard exposure therapy and a VR ICU scenario, the therapist guides patients through traumatic events, focused on trauma cues (visual, auditory, & olfactory) to elicit and habituate psychological distress symptoms. Participants are screened for PTSD and depressive symptoms and complete physical activity and resiliency surveys before the intervention and at 2 weeks and 3 months post-therapy.

Description: The participant was a 45-year-old Caucasian female with a history of congenital transposition of the great arteries, open-heart surgeries, and heart failure. In 2021, she cardiac arrested in her kitchen. Post-ICU discharge, she developed persistent severe anxiety, nightmares, diaphoresis, avoidance of public places and her kitchen, and flashbacks triggered by television shows, news stories, and lawnmower sounds that resembled hospital equipment. After C-VRET, her CAPS-5 scores (0-66) improved from 51 (baseline) to 2 (2 weeks) to 1 (3 months). Depression scores on the CES-D Scale (0-60) improved from 40 to 10 to 2. Her physical activity IPAQ scores improved from 1130 to 2070 but declined to 546 at 3 months after a rheumatoid disease diagnosis. Her resilience CD-RISC (0-100) score improved from 45 to 64 to 68.

Discussion: To our knowledge, this is the first known trial of C-VRET for adult critical illness survivors with PTSD symptoms. The participant’s trauma and depressive symptoms and resiliency scores markedly improved and her physical activity improved until it was impacted by a new condition. Consistent with successful habituation to her triggers, she no longer exhibits avoidance behavior. Her outcomes suggest C-VRET may be useful for habituating trauma symptoms in adult critical illness survivors. Further testing with a large, diverse sample is needed.