title: A randomized, double-blind evaluation of D-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder in Iraq and Afghanistan War veterans.
abstract: OBJECTIVE
  The authors examined the effectiveness of virtual reality exposure augmented with D-cycloserine or alprazolam, compared with placebo, in reducing posttraumatic stress disorder (PTSD) due to military trauma.
  
  
  METHODS
  After an introductory session, five sessions of virtual reality exposure were augmented with D-cycloserine (50 mg) or alprazolam (0.25 mg) in a double-blind, placebo-controlled randomized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD.
  
  
  RESULTS
  PTSD symptoms significantly improved from pre- to posttreatment across all conditions and were maintained at 3, 6, and 12 months. There were no overall differences in symptoms between D-cycloserine and placebo at any time. Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment; the alprazolam group showed a higher rate of PTSD (82.8%) than the placebo group (47.8%). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only. At posttreatment, the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes.
  
  
  CONCLUSIONS
  A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans, although there was no control condition for the virtual reality exposure. There was no advantage of D-cycloserine for PTSD symptoms in primary analyses. In secondary analyses, alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning. D-cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo, findings that are consistent with those in the animal literature.
authors.forename: Barbara Olasov
authors.initials: BO
authors.lastname: Rothbaum
authors.forename: Matthew
authors.initials: M
authors.lastname: Price
authors.forename: Tanja
authors.initials: T
authors.lastname: Jovanovic
authors.forename: Seth D
authors.initials: SD
authors.lastname: Norrholm
authors.forename: Maryrose
authors.initials: M
authors.lastname: Gerardi
authors.forename: Boadie
authors.initials: B
authors.lastname: Dunlop
authors.forename: Michael
authors.initials: M
authors.lastname: Davis
authors.forename: Bekh
authors.initials: B
authors.lastname: Bradley
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Duncan
authors.forename: Albert
authors.initials: A
authors.lastname: Rizzo
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Ressler
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000525:Alprazolam / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003523:Cycloserine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005108:Extinction, Psychological / Q000187:drug effects; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
chemical_list: D014151:Anti-Anxiety Agents; D003523:Cycloserine; D000525:Alprazolam
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