James Spira

U.S. Department of Veterans Affairs | VA · Department of Psychiatry

Introduction There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. Materials and Methods This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretatio...

Post-traumatic stress and other problems often occur after combat, deployment, and other military operations. Because techniques such as mindfulness meditation show efficacy in improving mental health, our team developed a mobile application (app) for individuals in the armed forces with subclinical psychological problems as secondary prevention of...

Heart rate variability is a physiological measure associated with autonomic nervous system activity. This study hypothesized that lower pre-deployment HRV would be associated with higher post-deployment post-traumatic stress disorder (PTSD) symptoms. Three-hundred-forty-three Army National Guard soldiers enrolled in the Warriors Achieving Resilienc...

The objective of this pilot study was to design, develop, and evaluate a predeployment stress inoculation training (PRESIT) preventive intervention to enable deploying personnel to cope better with combat-related stressors and mitigate the negative effects of trauma exposure. The PRESIT program consisted of three predeployment training modules: (1)...

Physiological assessment of post-traumatic stress disorder (PTSD) presents an additional avenue for evaluating the severity of PTSD symptoms. We investigated whether the presence of a high number of uncommon symptoms attenuated the relation between self-reported PTSD symptoms and heart rate variability (HRV). Participants were 115 Veterans from the...

Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is due to the effects of brain trauma, or purely to emotional factors such as posttraumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobe...

With the emergence of mobile health (mHealth) apps, there is a growing demand for better tools for developing and evaluating mobile health interventions. Recently we developed the Personal Health Intervention Toolkit (PHIT), a software framework which eases app implementation and facilitates scientific evaluation. PHIT integrates self-report and ph...

Important challenges confronting DOD/military medical care are that of maintaining or increasing quality of care and increasing the effectiveness of treatments for warriors diagnosed with Posttraumatic Stress Disorder (PTSD) secondary to their combat deployments to Iraq and/or Afghanistan. Virtual Reality Graded Exposure Therapy with Arousal Contro...

An understanding of human responses to hypoxia is important for the health of millions of people worldwide who visit, live, or work in the hypoxic environment encountered at high altitudes. In spite of dozens of studies over the last 100 years, the basic mechanisms controlling acclimatization to hypoxia remain largely unknown. The AltitudeOmics pro...

Abstract Virtual reality (VR) is an emerging tool to help treat posttraumatic stress disorder (PTSD). Previously published studies have shown that VR graded exposure therapy (VR-GET) treatment can result in improvements in PTSD symptoms. Less is known about the impact on depression, general anxiety, and neuropsychological functioning in patients wi...

In the decade following the attack on the World Trade Center, over 2.3 million American military personnel were deployed to Iraq and Afghanistan. Lengthy tours of duty and multiple re-deployments were characteristic of these operations. Research findings demonstrate that prolonged exposure to combat increases the risk of developing posttraumatic st...

The goal of this effort is to support prevention of psychological health problems through innovation in mobile personal health assessment and self-help intervention (SHI). For the U.S. military, we are developing and evaluating a field-deployable personalized application, PHIT for Duty^TM, to help build resilience in healthy troops and su...

This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 participants completed treatment...

A high percentage of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) combat veterans have been diagnosed with Posttraumatic Stress Disorder (PTSD) during and following their respective combat tours. Virtual Reality (VR) treatment has been documented as an exceptional treatment for anxiety disorders and specifically for PTSD. An O...

Abstract Virtual reality (VR)-based therapy has emerged as a potentially useful means to treat post-traumatic stress disorder (PTSD), but randomized studies have been lacking for Service Members from Iraq or Afghanistan. This study documents a small, randomized, controlled trial of VR-graded exposure therapy (VR-GET) versus treatment as usual (TAU)...

Predeployment stress inoculation training (PRESIT) is designed to help personnel cope with combatrelated stressors and trauma exposure. PRESIT comprises education on combat and operational stress control, attentional retraining and relaxation training, and practice and assessment via a multimedia stressor environment (MSE). Heart rate variability (...

Nowhere is it more important to maintain peek mental functioning than in a combat zone. Conditions ranging from pain to head injury to post-traumatic stress disorder can cause impairments in neuropsychological function and place service members at risk. Medications can sometimes help alleviate these problems, but also have the risk of further slowi...

Behavioral health and occupational health contribute substantially to a healthy military force. To assist commanders in monitoring and supporting their troops, we review the role of behavioral health on military fitness, including substance abuse (alcohol, tobacco, and illicit drugs) and psychophysical behaviors associated with weight and sleep pro...

Virtual-reality (VR) therapy has been distinguished from other psychotherapy interventions through the use of computer-assisted interventions that rely on the concepts of "immersion," "presence," and "synchrony." In this work, these concepts are defined, and their uses, within the VR treatment architecture, are discussed. VR therapy's emphasis on t...

In this report we describe virtual reality graded exposure therapy (VRGET) for the treatment of combat-related post-traumatic stress disorder (PTSD). In addition, we summarize the outcomes of a case study, from an Office Of Naval Research (ONR)-funded project of VRGET with an active duty female Seabee who completed three combat tours to Iraq. Detai...

The U.S. Department of Veterans Affairs (VA) has not only been at the leading edge in the study of the effects of war on warriors deployed to combat, but it has also been recognized as the leader for treatments in Posttraumatic Stress Disorder, Chronic Pain and Stoke. Virtual Reality Therapy (VR) is a new and growing technology that utilizes comput...

Insomnia is a common problem in situations of stress. Some forms of stress, however, may contraindicate the use of traditional, pharmacological interventions. Working in a combat zone is such a situation. Alternative means of improving sleep are clearly needed for Service Members. We report a case involving a medical provider who was serving in a m...

Decreased HRV has been consistently associated with increased cardiac mortality and morbidity in HF patients. The aim of this study is to determine if a 6-week course of heart rate variability (HRV) biofeedback and breathing retraining could increase exercise tolerance, HRV, and quality of life in patients with New York Heart Association Class I-II...

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment for combat-related PTSD. We summarize the outcomes of a VRGET pilot study with 12 participants who completed one to multiple combat tours in support of the War on Terrorism and who were subsequently diagnosed with combat-related PTSD. Details of the collaborative program amon...

Virtual Reality Therapy (VRT) has been shown to be effective in the treatment PTSD in Vietnam Veterans, car-accident victims, September 11th survivors, and PTSD related to Iraq and Afghanistan. Whereas VR has clearly proven a useful tool, assuming that all VRT is identical would be akin to assuming that all therapy that involves a couch is the same...

This study examines risk factors for post-traumatic stress disorder (PTSD), depression, and mental health care use among health care workers deployed to combat settings. Anonymous surveys were administered to previously deployed workers at a military hospital. PTSD and depression were assessed by using the PTSD Checklist and the Patient Health Ques...

Numerous experiences can lead to acute stress disorder or posttraumatic stress disorder (PTSD) in military personnel. Unfortunately, PTSD is a relatively common outcome of combat exposure. The primary focus of this article is the role of experiential psychotherapy treatments which teach skill development to better cope with combat-related PTSD. The...

Post Traumatic Stress Disorder is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 Iraq War veterans are exhibiting symptoms of depress...

This study assessed the stress reactions of a submarine crew forced to abandon their vessel in high seas after flooding and fire damaged their ship. The remaining crew members (n = 22) were surveyed 7 months after the incident regarding exposures, initial emotional responses, peritraumatic dissociation, subsequent life events, current safety apprai...

Forensic experts agree that the doctrine of informed consent now applies to psychotherapy. The optimum level of detail and content in this interaction remains nebulous. This study examines opinions and practices of therapists. The authors administered a survey regarding this subject to 231 psychotherapists. Six scales were constructed from this sur...

This book contains information about the group therapy process, discusses the various experiences of breast cancer patients, and supplies tools that both relatively new and seasoned therapists can rely on while beginning new groups. While providing a clinical framework for health professionals who wish to offer group psychosocial support to breast...

Editor—No one should be surprised when a brief training in cognitive therapy proves ineffective in improving a patient's anxiety or depression after six months.1 As a psychologist, I have taught cognitive therapy interventions in courses for graduate students, psychiatry residents, and primary care doctors. I recognise that none of these courses re...

Family members are an integral part of a patient's cancer care from the moment the diagnosis is delivered to the conclusion of treatment. Family members bring with them a range of emotional reactions, interpersonal dynamics and expectations for the care the patient receives. This study is part of a multi-institutional project to continue to improve...

Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be c...

The activation of ambiguous word senses was investigated by measuring the amount of interference in naming the ink color of a word that was either related or unrelated to one of the meanings of a preceding ambiguous word. In agreement with previous results obtained using this procedure (Conrad, 1974), evidence was obtained that both meanings of the...

This study examined the value of virtual reality graded exposure therapy (VRGET) compared to standard graded exposure therapy using imagery alone for patients with flying phobia. Thirty subjects were randomized into either VRGET with physiological feedback of skin resistance, peripheral skin temperature, heart rate, and respiration; VRGET with no p...

Thesis (Ph. D. in Education)--University of California, Berkeley, December 1991. Includes bibliographical references (leaves 573-609).