Combined Transcranial Direct Current Stimulation and Virtual Reality for PTSD

创伤后应激障碍（PTSD）是一种高度流行的慢性精神疾病， 我们的退伍军人的主要健康负担。此外，创伤后应激障碍与明显的职业和 社会功能障碍，以及精神和医学上的高度共病。尽管它的流行和 破坏性的影响，现有的治疗，包括循证心理治疗，不足以 灵验。因此，创伤后应激障碍治疗的创新干预措施是迫切需要的退伍军人 患有创伤后应激障碍 非侵入性神经调节技术的应用在神经系统中发展迅速， 精神病学新设备的可用性，加上对潜在神经回路的了解增加， 与精神疾病相关，为经济上有利的创新临床应用奠定了基础 创伤后应激障碍康复的技术。此外，啮齿动物模型和我们以前的试点研究表明， 将非侵入性脑刺激与创伤后应激障碍的暴露相结合的治疗潜力。然而为了 为了确定将大脑刺激与暴露相结合的现实世界效用，必须研究如何 这种组合减少了创伤后应激障碍的症状，改善了生活质量或社会和职业功能 (QOL/SOF）。 这项研究的目的是检查非侵入性脑刺激是否可以 结合标准化的，基于虚拟现实（VR）的暴露作为退伍军人PTSD的干预措施。这 一项研究将使用经颅直流电刺激（tDCS）靶向与创伤后应激障碍有关的大脑区域， 在VR期间提供刺激。tDCS+VR对PTSD有着特别的希望，因为这种组合利用了 这两种干预措施的潜在疗效，并提供了一个标准化的暴露方案， 系统评价。此应用程序建立在我们的试点工作，证明了技术的可行性， tDCS+VR，通过提出一项充分把握度的tDCS+VR随机对照试验，其中90名退伍军人 PTSD患者将在VR期间随机接受活性tDCS或假手术。三个具体目标是 评估：1）Propioneer检查tDCS+VR在患有慢性PTSD的退伍军人中的疗效，2）检查 PTSD相关心理生理学、PTSD症状与QOL/SOF的关系; 神经回路变化、PTSD和QOL/SOF之间的关系。实现这些目标将提供 必要的数据和经验，以指导tDCS+VR的实施研究，以减少PTSD症状， 改善QOL/SOF。最终，这一研究方向有望产生重要的积极影响 为了实现我们的长期目标，将神经调节整合到PTSD治疗中， 实用，方便的选择，以改善我们的退伍军人的生活。 ! !

Posttraumatic Stress Disorder (PTSD) is a highly prevalent, chronic psychiatric disorder that imposes a major health burden on our returning Veterans. Moreover, PTSD is associated with marked occupational and social dysfunction, and high degrees of psychiatric and medical comorbidity. Despite its prevalence and devastating impact, available treatments, including evidence-based psychotherapy, are not sufficiently efficacious. Therefore, innovative interventions for the treatment of PTSD are sorely needed for Veterans suffering from PTSD. The application of non-invasive neuromodulation technologies is developing rapidly across neuro- psychiatry. The availability of new devices, coupled with increased knowledge of underlying neurocircuitry relevant to psychiatric illness, sets the stage for economically advantageous and innovative clinical applications of technologies for PTSD rehabilitation. Furthermore, rodent models and our previous pilot research indicate the therapeutic potential for combining non-invasive brain stimulation with exposure for PTSD. However to determine the real-world utility of combining brain stimulation with exposure, it is essential to examine how this combination reduces PTSD symptoms and improves quality of life or social and occupational function (QOL/SOF). The aim of the proposed research is to examine whether non-invasive brain stimulation can be combined with standardized, virtual-reality (VR) based exposure as an intervention for PTSD in Veterans. This study will use transcranial direct current stimulation (tDCS) targeting brain regions involved in PTSD, with stimulation delivered during VR. tDCS+VR holds particular promise for PTSD as this combination leverages the potential efficacy of both interventions, and provides a standardized exposure regimen that can be systemically evaluated. This application builds on our pilot work, demonstrating the technical feasibility of tDCS+VR, by proposing an adequately powered, randomized controlled trial of tDCS+VR in which 90 Veterans with PTSD will be randomized to receive either active tDCS or sham during VR. Three Specific Aims will be evaluated: 1) Prospectively examine the efficacy of tDCS+VR in Veterans with chronic PTSD, 2) Examine the relationship between PTSD-related psychophysiology, PTSD symptoms and QOL/SOF, and 3) Explore the relationship between changes in neural circuitry, PTSD and QOL/SOF. Addressing these Aims will provide the necessary data and experience to guide implementation research of tDCS+VR to reduce PTSD symptoms and improve QOL/SOF. Ultimately, this line of research can be expected to have an important positive impact toward achieving our long-term goal of integrating neuromodulation into PTSD treatment as a valuable, practical, and accessible option to improve the lives of our Veterans. ! !