Virtual Reality and Post Traumatic Stress

Summary

Northern Ireland has a legacy of trauma-related mental health problems and a higher estimated prevalence of post-traumatic stress disorder (PTSD) than other comparable post-civil conflict societies. Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is an effective treatment for PTSD and is currently recommended by the National Institute For Health and Social Care Excellence (NICE) as the first line of clinical treatment. During therapy, clients with PTSD revisit the trauma memory to process what has occurred. This technique is known as Imaginal Exposure (IE) which can be a difficult process. Clients can be highly avoidant and emotionally distant from trauma memories, making it challenging to engage with the exposure process. When trauma has occurred several decades previously, traumatic memories may be difficult to access, resulting in poor treatment outcomes.

Technology such as Virtual Reality (VR) can aid this process, as patients can enter a world that exposes them to the traumatic memory in a controlled therapeutic way which has shown to be effective in the treatment of PTSD. VR is yet to be used in routine clinical settings. The investigators are proposing to create low-cost VR environments via 360° video and a new process called VR Photoscan, which will allow a clinical setting to use this beneficial tool to support patients who are receiving TF-CBT to treat PTSD.

This is a three-arm intervention feasibility study using a mixed methods evaluation framework designed to explore the acceptability of low-cost VR as an adjunct within existing TF-CBT therapy.

Participants will be split into 3 groups of 5:

Group one (N=5) to use 360° Video alongside standard TF-CBT. Group two (N=5) to use VR Photo Scan alongside standard TF-CBT. Group three (N=5) is a control group that will only receive TF-CBT.

The individuals selected for the technological interventions will be offered the opportunity of a personalized 360° video / VR Photoscan environment to aid their therapy session. Pre and post-measures will be collected from participants and semi-structured interviews will be held with participants at the end of their therapy and with the clinicians who have delivered the intervention. This protocol aims to investigate the potential of low-cost VR technology in supporting PTSD treatment, addressing both the practical and theoretical challenges of immersive trauma therapy. By examining the feasibility of 360° video and VR Photoscan, the study hopes to contribute valuable insights into VR's applicability in clinical mental health settings.

Conditions

• PTSD - Post Traumatic Stress Disorder

Interventions

BEHAVIORAL

360 Video

360° Video consists of video recordings, made with a camera to simultaneously capture and combine scenes in a 360 degrees perspective such as Instant Google Street View Instant Google Street View (instantstreetview.com). When uploaded to a VR headset, 360° videos may provide a more cost-effective method for rapidly creating virtual environments in which users can experience a sense of immersion and the viewer can control and change the viewing angle at any stage through head movement. While photorealism may be superior, this option is known to be less interactive as the viewer can't move or walk around within the virtual space. In addition, the landscape and imagery may have been changed or developed meaning the recordings captured do not match the traumatic memory. Despite these limitations, the use of 360° video has been trialled in clinical mental health settings showing positive outcomes for both user and clinician.

BEHAVIORAL

VR Photoscan

VR Photoscan creates immersive virtual environments by transforming real-world imagery into detailed 3D models. Using high-resolution images captured from a smartphone, these images are processed in 3D graphics software to sculpt realistic virtual scenes. The resulting 3D models are imported into a game engine, adding VR functionality, allowing users to navigate freely with six degrees of freedom. Interactive content, such as animated cars and people, can be added in real-time, while menu systems guide users through the experience. Environmental factors like lighting, weather, and time of day can be adjusted to simulate real conditions. Spatial 360° audio enhances immersion, providing sounds from various directions. This VR environment creation process is efficient and cost-effective, requiring no specialised equipment, and ensuring high-quality immersive experiences at minimal production time and cost.

BEHAVIORAL

Standard TF-CBT

Ehlers and Clark's model follows the general style of reliving (recommended by NICE) suggested by Foa and Rothbaum with some fluidity and in vivo exposure (i.e., trauma site visit). During the treatment process of reliving, clients are asked to close their eyes and intentionally recall the traumatic memories, i.e., relive the trauma in their mind in detail and narrate their experience in present tense, including recalling images, sensory experiences, thoughts, and feelings. VR-based PTSD treatments can promote emotional engagement and the process of trauma via providing visual, auditory, and haptic sensory cues.

Sponsors & Collaborators

• South Eastern Health and Social Care Trust

  collaborator OTHER

• Queen's University, Belfast

  lead OTHER

Principal Investigators

• Dr Best, MSc in CBT · Queen's University, Belfast

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-06-10

Primary Completion

2025-10-10

Completion

2025-12-31

Countries

• United Kingdom

Study Locations