Compressed Virtual Reality Exposure Therapy Used to Habituate a Critical Illness Survivor's Psychological Trauma...

Psychological trauma symptoms develop in at least 25% of all adult critical illness survivors, and trauma therapist-led compressed virtual reality exposure therapy (C-VRET) is a potentially efficacious intervention to achieve habituation of survivors' symptoms.

To achieve symptom habituation in a critical illness survivor with psychological trauma, exhibiting physiological distress and behavioral avoidance.

In this institutional review board-approved pilot study, participants are adults admitted to an intensive care unit (ICU), are on a ventilator and at least 1 month removed from the ICU admission, and are screen positive for at least moderate posttraumatic stress disorder symptoms on the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Survivors are screened for depression (Center for Epidemiologic Studies Depression Scale), physical inactivity (International Physical Activity Questionnaire), and poor resilience (Connor-Davidson Resilience Scale), preintervention and 2 weeks and 3 months after completing the therapy. Therapy sessions last 1 to 1.5 hours and consist of exposure therapy augmented by virtual reality and relapse prevention strategies. Participants agree to complete therapy over 10 consecutive business days, but the therapist may reduce the number of sessions if they deem the survivor's symptoms are no longer elicited by the previously identified traumatic cues. This report is about one case in the study.

The participant was a 46-year-old woman with an extensive cardiac history who had multiple traumatic ICU admissions, including one for cardiac arrest. Her baseline screening revealed she had clinically significant trauma and depressive symptoms, was not engaging in vigorous physical activity, and was struggling with resiliency. After completing the C-VRET pilot, the participant's trauma score declined from a pretreatment score of 51 (on a 0- to 66-point scale) to 2 at 2 weeks posttreatment and 1 at 3-month follow-up. She also had a marked decline in her depression scores and improvement in resiliency. Her physical activity score improved at 2 weeks, but declined at 3 months after being diagnosed with an arthritic condition.

This case report highlights the impact severe trauma symptoms had on the life of one critical illness survivor after an ICU admission and the potential efficacy of C-VRET in habituating symptoms. Additionally, C-VRET may help reduce depressive symptoms and improve physical activity and resiliency in adult critical illness survivors living with trauma. Further study of this intervention is needed with demographically and medically diverse critical illness survivor populations.