The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer

• Published in: Journal of anxiety disorders 2019-01, Vol.61, p.82-88
• Main Authors: Peskin, Melissa, Wyka, Katarzyna, Cukor, Judith, Olden, Megan, Altemus, Margaret, Lee, Francis S., Difede, JoAnn
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cognition - drug effects; Comorbidity; Cycloserine - therapeutic use; Depression; Depression - drug therapy; Depression - psychology; Depression - therapy; Female; Humans; Implosive Therapy - methods; Male; Middle Aged; Nootropic Agents - therapeutic use; Posttraumatic stress disorder; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic - drug therapy; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Survivors - psychology; Treatment Outcome; Virtual reality exposure therapy; Virtual Reality Exposure Therapy - methods; Young Adult
• ISSN: 0887-6185; 1873-7897
• DOI: 10.1016/j.janxdis.2018.03.001

•Posttraumatic and depressive symptoms change reciprocally in virtual reality exposure.•Virtual reality exposure mainly reduces posttraumatic symptoms, which in turn drives subsequent reductions in depressive symptoms.•DCS may augment the strength of the relationship between decreases in posttraumatic symptoms and successive decreases in depressive symptoms during virtual reality exposure. Two studies suggest that reductions in posttraumatic symptoms (Aderka et al., 2013) and cognitions (Zalta et al., 2014) precede reductions in depressive symptoms during prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in female assault survivors. The present study explored the temporal relationship between posttraumatic and depressive symptoms in a randomized trial of D-Cycloserine (DCS) versus placebo augmented virtual reality exposure (VRE) therapy for chronic World Trade Center-related PTSD following the September 11, 2001 terrorist attacks. Twenty-five male and female participants were randomly assigned to receive either 100 mg DCS (N = 13) or placebo (N = 12) 90 min before 12 weekly VRE sessions. Participants contributed a total of 280 weekly PTSD Checklist (PCL; Weathers et al., 1993) and Beck Depression Inventory-second edition (BDI-II; Beck et al., 1996) symptom scores. Two sets of mediation analyses for longitudinal mixed models assessed the effects of 1) lagged PCL on BDI-II (Model 1), and 2) lagged BDI-II on PCL (Model 2) in the VRE-DCS and VRE-Placebo treatment groups, respectively. Results revealed reciprocal relations between posttraumatic and depressive symptoms during VRE treatment, although reductions in posttraumatic symptoms led to subsequent reductions in depressive symptoms to a greater extent than the converse. These effects were stronger in the DCS-enhanced group. Findings suggest that VRE primarily decreases posttraumatic symptoms, which in turn leads to decreased depressive symptoms, and that DCS may strengthen these effects.