Dexamethasone Plus Virtual Reality Exposure Therapy for PTSD
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 21 - 65 |
| Updated: | 7/14/2018 |
| Start Date: | October 2013 |
| End Date: | June 2017 |
A Pilot Study of the Effects of Dexamethasone Administration on Virtual Reality Exposure Therapy for PTSD
Evidence from preliminary studies suggests that people with PTSD have heightened fear
responses and that cortisol suppression reduces this heightened fear. Research has shown the
drug dexamethasone (DEX), a cortisol suppressor, reduces the startle response in civilians
with PTSD. This current research proposal represents a blinded, randomized,
placebo-controlled efficacy study with the goal of determining whether a drug that suppresses
the stress hormone cortisol will increase the efficacy of exposure therapy. Specifically, it
is proposed that a dose of DEX, given the night before (approximately 10 hours before) each
of 5 to 11 individual virtual reality exposure (VRE) therapy sessions, will significantly
enhance the rate of response and possibly the efficacy of treatment. Participants will be
treated until they have experienced at least a 70% reduction in PTSD symptoms from baseline
or up to 12 sessions or until they and their therapist agree treatment should be terminated,
a minimum of 6 sessions to a maximum of 12 sessions. Comprehensive multi-modal outcomes will
be assessed by independent assessors blind to subject condition on interviews, self-report
measures, and psychophysiological measures. Participants will be assessed pre- and
post-treatment and at a follow-up of 3, 6 and 12 months to assess long term effects.
responses and that cortisol suppression reduces this heightened fear. Research has shown the
drug dexamethasone (DEX), a cortisol suppressor, reduces the startle response in civilians
with PTSD. This current research proposal represents a blinded, randomized,
placebo-controlled efficacy study with the goal of determining whether a drug that suppresses
the stress hormone cortisol will increase the efficacy of exposure therapy. Specifically, it
is proposed that a dose of DEX, given the night before (approximately 10 hours before) each
of 5 to 11 individual virtual reality exposure (VRE) therapy sessions, will significantly
enhance the rate of response and possibly the efficacy of treatment. Participants will be
treated until they have experienced at least a 70% reduction in PTSD symptoms from baseline
or up to 12 sessions or until they and their therapist agree treatment should be terminated,
a minimum of 6 sessions to a maximum of 12 sessions. Comprehensive multi-modal outcomes will
be assessed by independent assessors blind to subject condition on interviews, self-report
measures, and psychophysiological measures. Participants will be assessed pre- and
post-treatment and at a follow-up of 3, 6 and 12 months to assess long term effects.
Inclusion Criteria:
1. Participants will be 60 males and females between ages of 21 and 65.
2. Participants must meet DSM-V criteria for PTSD due to exposure to a trauma while
serving in Operation Iraqi Freedom and/or Operation Enduring Freedom-Afghanistan and
Operation New Dawn.
3. Patients must be literate in English.
4. Patients must be medically healthy or medically stable such that the stress of VR and
DEX are not contraindicated.
5. Participants must comprehend his or her role in the study and the risks involved in
order to be entered.
Exclusion Criteria:
1. Patients with a history of mania, schizophrenia, or other psychoses;
2. Patients with prominent suicidal ideation;
3. Patients with current alcohol or drug dependence;
4. Patients unable to tolerate wearing the VR helmet;
5. Patients unwilling to take study medication;
6. Patients on psychotropic medication(s) must have been on a stable dose for at least 2
weeks prior to beginning the study and must agree not to change their current
medication regimen throughout the course of the study. The concomitant use of
psychotropic medications will be recorded and examined in data analyses.
7. Patients with special medical conditions such as pregnancy, renal insufficiency, or a
history of significant head injury
8. Active medical disorders contributing to psychiatric sx e.g. hypo or hyperthyroidism,
SLE, advanced cirrhosis, etc. (per clinical judgment of study physician)
9. Patients stabilized on potentially data-obscuring medications (glucocorticoids).
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