ImportancePosttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms.ObjectiveTo test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR) is superior to sham tDCS plus VR for warzone-related PTSD.Design, Setting, and ParticipantsThis double-blind randomized clinical trial was conducted among US military veterans enrolled from April 2018 to May 2023 at a secondary care Department of Veterans Affairs hospital and included 1- and 3-month follow-up visits. Participants included US military veterans with chronic PTSD and warzone-related exposure, recruited via referral and advertisement. Patients in psychiatric treatment had to be on a stable regimen for at least 6 weeks to be eligible for enrollment. Data were analyzed from May to September 2023.InterventionParticipants were randomly assigned to receive 2-mA anodal tDCS or sham tDCS targeted to the ventromedial prefrontal cortex, during six 25-minute sessions of standardized warzone VR exposure, delivered over 2 to 3 weeks.Main Outcomes and MeasuresThe co–primary outcomes were self-reported PTSD symptoms, measured via the PTSD checklist for DSM-5 (PCL-5), alongside quality of life. Other outcomes included psychophysiological arousal, clinician-assessed PTSD, depression, and social/occupational function.ResultsA total of 54 participants (mean [SD] age, 45.7 [10.5] years; 51 [94%] males) were assessed, including 26 in the active tDCS group and 28 in the sham tDCS group. Participants in the active tDCS group reported a superior reduction in self-reported PTSD symptom severity at 1 month (t = −2.27, P = .02; Cohen d = −0.82). There were no significant differences in quality of life between active and sham tDCS groups. Active tDCS significantly accelerated psychophysiological habituation to VR events between sessions compared with sham tDCS (F5,7689.8 = 4.65; P < .001). Adverse effects were consistent with the known safety profile of the corresponding interventions.Conclusions and RelevanceThese findings suggest that combined tDCS plus VR may be a promising strategy for PTSD reduction and underscore the innovative potential of these combined technologies.Trial RegistrationClinicalTrials.gov Identifier: NCT03372460

中文翻译：

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虚拟现实和经颅直流电刺激治疗创伤后应激障碍

重要性创伤后应激障碍 (PTSD) 是一种常见的精神疾病，对于退伍军人来说尤其难以治疗。无创脑刺激作为减少 PTSD 症状的新型治疗方法具有巨大潜力。目的测试主动经颅直流电刺激 (tDCS) 加虚拟现实 (VR) 是否优于假 tDCS 加 VR 治疗战区相关 PTSD。参与者这项双盲随机临床试验是在 2018 年 4 月至 2023 年 5 月期间在退伍军人事务部医院的二级护理部门入组的美国退伍军人中进行的，包括 1 个月和 3 个月的随访。参与者包括患有慢性创伤后应激障碍和战区相关暴露的美国退伍军人，他们是通过推荐和广告招募的。接受精神科治疗的患者必须接受至少 6 周的稳定治疗才有资格入选。数据分析时间为 2023 年 5 月至 9 月。干预参与者被随机分配接受针对腹内侧前额叶皮层的 2 mA 阳极 tDCS 或假 tDCS，在 2 至 3 周内进行六次每次 25 分钟的标准化战区 VR 暴露过程。结果和测量共同主要结果是自我报告的 PTSD 症状，通过 PTSD 检查表测量帝斯曼-5(PCL-5)，以及生活质量。其他结局包括心理生理唤醒、临床医生评估的 PTSD、抑郁和社交/职业功能。 结果 共有 54 名参与者（平均 [SD] 年龄，45.7 [10.5] 岁；51 [94%] 男性）接受了评估，其中 26 名来自活动 tDCS 组中有 28 名，假 tDCS 组中有 28 名。主动 tDCS 组的参与者报告称，1 个月后自我报告的 PTSD 症状严重程度显着降低（t=−2.27，磷= .02；科恩d=-0.82）。活性 tDCS 组和假 tDCS 组之间的生活质量没有显着差异。与假 tDCS 相比，主动 tDCS 显着加速了会话之间对 VR 事件的心理生理习惯。F5,7689.8= 4.65；磷< .001）。不良反应与相应干预措施的已知安全性一致。结论和相关性这些研究结果表明，tDCS 与 VR 相结合可能是减少 PTSD 的一种有前景的策略，并强调了这些组合技术的创新潜力。试验注册ClinicalTrials.gov 标识符：NCT03372460