Combined Transcranial Direct Current Stimulation and Virtual Reality for PTSD

创伤后应激障碍(PTSD)是一种非常普遍的慢性精神障碍，它会施加 给我们归来的退伍军人带来了巨大的健康负担。此外，创伤后应激障碍与显著的职业和 社会功能障碍，以及高度的精神和医学共病。尽管它很流行，而且 尽管造成了毁灭性的影响，但包括循证心理治疗在内的现有治疗方法还不够 很有效。因此，退伍军人迫切需要治疗创伤后应激障碍的创新干预措施 患有创伤后应激障碍。 非侵入性神经调节技术在神经科学领域的应用正在迅速发展。 精神病学。新设备的可获得性，加上对潜在神经电路的更多了解 与精神疾病相关，为经济优势和创新的临床应用奠定了基础 创伤后应激障碍康复技术。此外，啮齿动物模型和我们之前的初步研究表明 无创脑刺激结合暴露治疗创伤后应激障碍的治疗潜力。然而，到 要确定脑刺激与暴露相结合的实际效用，有必要研究如何 这种结合可以减少创伤后应激障碍症状，提高生活质量或社会和职业功能 (QOL/SOF)。 这项拟议的研究的目的是检验非侵入性脑刺激是否可以 结合标准化的基于虚拟现实(VR)的暴露作为对退伍军人创伤后应激障碍的干预。这 研究将使用经颅直流电刺激(Tdcs)针对涉及创伤后应激障碍的脑区， 在VR过程中提供的刺激。TDCS+VR为创伤后应激障碍带来了特别的希望，因为这种组合利用了 这两种干预措施的潜在效果，并提供了一种标准化的暴露方案，可以 经过系统评估。此应用程序建立在我们的试点工作的基础上，展示了 Tdcs+VR，提出了一项动力充足的随机对照试验tdcs+VR，90名退伍军人 在VR期间，患有创伤后应激障碍的患者将被随机接受活动的tDCs或假的治疗。三个具体目标将是 评估：1)前瞻性检查tdcs+VR对患有慢性创伤后应激障碍的退伍军人的疗效，2)检查 创伤后应激障碍相关心理生理学、创伤后应激障碍症状与生活质量/生活质量的关系 神经回路改变、创伤后应激障碍与生活质量/生活质量的关系。解决这些目标将提供 指导实施tDCS+VR减轻创伤后应激障碍症状研究的必要数据和经验 改善生活质量/生活质量。归根结底，这一系列研究有望产生重要的积极影响 为了实现我们将神经调节整合到创伤后应激障碍治疗中的长期目标， 改善退伍军人生活的实用、易用的选择。 好了！ 好了！

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. ! !