D-cycloserine and Virtual Reality Exposure to Treat Iraq War Veterans With PTSD

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder affecting people who
have witnessed or experienced a traumatic event. Veterans of war are at an increased risk
for developing PTSD because of their experiences with war and combat. Symptoms of PTSD often
include flashbacks or nightmares, depression, anxiety or uneasiness, and feeling emotionally
numb or distant toward others. Fortunately, PTSD can be treated, usually with some
combination of anti-depressants, anti-anxiety medication, and therapy. Virtual reality
exposure (VRE) therapy is a new type of treatment that helps people to overcome anxiety
about trauma by facing situations with the use of virtual reality. D-cycloserine is a
medication that has been found to enhance the effects of psychotherapy in recent studies.
This study will determine the effectiveness of VRE therapy plus D-cycloserine at reducing
PTSD symptoms in Iraq war veterans.

During this study, all participants will undergo one educational session and five VRE
sessions. The first session will involve gathering information, learning common reactions to
trauma, and participating in a breathing relaxation approach. The following five sessions
will involve reviewing memories of Iraq and watching virtual Iraq sequences. Each
participant will wear a head-mounted display during which they will view scenario settings
such as cities, humvee convoys, and scenes related to combat. Participants will be randomly
assigned to receive D-cycloserine, alprazolam (anti-anxiety drug), or placebo one half-hour
before each VRE session.

Prior to the first treatment session, participants will undergo a startle reaction
procedure. This will entail hearing sudden tones that last a fraction of a second, and
viewing virtual reality scenes. Three small electrodes, attached to each participant's face,
will measure the number of eye blinks during the procedure. At several times throughout the
study, heart rate and skin conductance will also be measured with electrodes. Collection of
saliva samples and measurement of blood pressure will also occur several times during this
study. Before, during, and immediately after treatment, participants will complete
questionnaires. Participants will be contacted 3, 6, and 12 months after treatment to assess
symptoms and to schedule a time for an interview, additional questionnaires, and the virtual
reality-based assessment.

Inclusion Criteria:

- Meets DSM-IV criteria for PTSD due to Iraq military trauma

- Speaks English

- Healthy overall

Exclusion Criteria:

- History of mania, schizophrenia, or other psychoses

- Suicidal

- Current alcohol or drug dependence

- Medication free within 2 weeks of study entry for any medication that has been taken
less than daily for the past month and medicine free within 4 weeks of study entry
for any anxiolytic medication that has been taken daily for the last month or more

- Pregnant

- Special medical conditions, such as kidney insufficiency, chronic diseases, or
history of significant head injury

- Stabilized on potentially data obscuring medication such as glucocorticoids