Current Treatment Options in Psychiatry

, Volume 4, Issue 3, pp 271–280 | Cite as

Heart Rate Variability Responses to a Standardized Virtual Reality Exposure in Veterans with PTSD

  • Samuel J. Ridout
  • Christopher M. Spofford
  • Mascha van’t Wout-Frank
  • Noah S. Philip
  • William S. Unger
  • Linda L. Carpenter
  • Audrey R. Tyrka
  • M. Tracie Shea
Post-Traumatic Stress Disorders (T Geracioti and K Chard, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Post-Traumatic Stress Disorders

Opinion Statement

Purpose In this article, we present data incorporating heart rate variability (HRV) into a graded virtual reality protocol performed in both a combat environment and an active control (classroom) environment, for combat Veterans with and without PTSD.

Recent Findings Exposure therapy for PTSD has proven effective. There is increasing interest in the use of virtual reality exposure therapy (VRET)-customized environments incorporating auditory, visual, and olfactory sensory modalities, to augment exposure-based treatment for PTSD. Particularly for combat Veterans, VRET may offer the advantage of a more realistic in vivo exposure for treatment. When combined with concurrent psychophysiological data, VRET has the potential to inform PTSD diagnosis, predict therapeutic responsiveness, and provide objective indicators of treatment response. HRV was not different between Veteran with and without PTSD, but our group recently found that Veterans with PTSD had differential skin conductance responses compared with Veterans without PTSD.

Summary Virtual reality is a promising treatment for PTSD. Methodological factors may have influenced the absence of significant findings in the current data. Future research which optimizes the potential use of psychophysiological assessments for the development of biomarkers and prediction of PTSD treatment response, or to inform the process of PTSD treatment, remain important.


PTSD Veterans Heart rate variability Virtual reality 


Compliance with Ethical Standards

Conflict of Interest

Dr. Carpenter reports personal fees from the Brown Department of Psychiatry and Human Behavior, during the conduct of the study.

Dr. Philip reports grants from the US Dept. of Veterans Affairs, during the conduct of the study.

Samuel J. Ridout declares that he has no conflict of interest.

Christopher M. Spofford declares that he has no conflict of interest.

Mascha van’t Wout-Frank declares that she has no conflict of interest.

William S. Unger declares that he has no conflict of interest.

Audrey R. Tyrka declares that she has no conflict of interest.

Tracie Shea reports grants from the US Dept. of Veterans Affairs, during the conduct of the study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


This work was supported by U.S. Department of Defense W81XWH-07-1-0689, R25 MH101076 (SJR) and IK2 CX000724 (NSP). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or National Institutes of Health. The authors report no relevant conflicts of interest.

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Copyright information

© US Government (outside the USA) 2017

Authors and Affiliations

  • Samuel J. Ridout
    • 1
    • 2
  • Christopher M. Spofford
    • 1
    • 3
  • Mascha van’t Wout-Frank
    • 1
    • 2
  • Noah S. Philip
    • 1
    • 2
  • William S. Unger
    • 1
  • Linda L. Carpenter
    • 2
    • 4
  • Audrey R. Tyrka
    • 2
    • 4
  • M. Tracie Shea
    • 1
    • 2
  1. 1.Providence Veteran Affairs Medical CenterProvidenceUSA
  2. 2.Department of Psychiatry and Human Behavior, Warren Alpert Medical SchoolBrown UniversityProvidenceUSA
  3. 3.Department of Psychiatry, Geisel School of MedicineDartmouth UniversityHanoverUSA
  4. 4.Mood Disorders Research Program and Laboratory for Clinical and Translational NeuroscienceButler HospitalProvidenceUSA

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