***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Virtual reality (VR)-based therapy has emerged as a potentially useful means to treat  post-traumatic stress disorder ( PTSD ) , but r and omized studies have been lacking for Service Members from Iraq or Afghanistan . This study documents a small , r and omized , controlled trial of VR- grade d exposure therapy ( VR-GET ) versus treatment as usual ( TAU ) for PTSD in Active Duty military personnel with combat-related PTSD . Success was gauged according to whether treatment result ed in a 30 percent or greater improvement in the PTSD symptom severity as assessed by the Clinician Administered PTSD Scale ( CAPS ) after 10 weeks of treatment . Seven of 10 participants improved by 30 percent or greater while in VR-GET , whereas only 1 of the 9 returning participants in TAU showed similar improvement . This is a clinical ly and statistically significant result ( χ(2 ) = 6.74 , p < 0.01 , relative risk 3.2 ) . Participants in VR-GET improved an average of 35 points on the CAPS , whereas those in TAU averaged a 9-point improvement ( p < 0.05 ) . The results are limited by small size , lack of blinding , a single therapist , and comparison to a relatively uncontrolled usual care condition , but did show VR-GET to be a safe and effective treatment for combat-related PTSD Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field Eleven Vietnam veterans with war-related posttraumatic stress disorder ( PTSD ) were r and omly assigned to 10 sessions of either virtual reality exposure ( VRE ) therapy within a computer-generated virtual Vietnam environment or present-centered therapy ( PCT ) that avoided traumatic content and utilized a problem-solving approach . Participants were assessed at pretreatment , posttreatment , and 6 months posttreatment by an independent assessor blind to treatment condition . Nine participants completed treatment with one dropout per condition . No significant differences emerged between treatments , likely due to insufficient power . Although comparison of mean changes in PTSD symptoms for the VRE and PCT conditions yielded a moderate effect size ( d = 0.56 ) in favor of VRE at 6 months posttreatment , changes in PTSD scores were more variable , and therefore less reliable , within the VRE condition . The utility of VRE with older veterans with PTSD is discussed Numerous reports indicate that the growing incidence of posttraumatic stress disorder ( PTSD ) in returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom ( OIF ) military personnel is creating a significant health care and economic challenge . These findings have served to motivate research on how to better develop and disseminate evidence -based treatments for PTSD . Virtual reality-delivered exposure therapy for PTSD has been previously used with reports of positive outcomes . The current paper will detail the development and early results from use of the Virtual Iraq/Afghanistan exposure therapy system . The system consists of a series of customizable virtual scenarios design ed to represent relevant Middle Eastern context s for exposure therapy , including a city and desert road convoy environment . The process for gathering user-centered design feedback from returning OEF/OIF military personnel and from a system deployed in Iraq ( as was needed to iteratively evolve the system ) will be discussed , along with a brief summary of results from an open clinical trial using Virtual Iraq with 20 treatment completers , which indicated that 16 no longer met PTSD checklist-military criteria for PTSD after treatment BACKGROUND Virtual reality ( VR ) integrates real-time computer graphics , body-tracking devices , visual displays , and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion . VR exposure ( VRE ) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder ( PTSD ) . METHOD This report presents the results of an open clinical trial using VRE to treat Vietnam combat veterans who have DSM-IV PTSD . In 8 to 16 sessions , 10 male patients were exposed to 2 virtual environments : a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle . RESULTS Clinician-rated PTSD symptoms as measured by the Clinician Administered PTSD Scale , the primary outcome measure , at 6-month follow-up indicated an overall statistically significant reduction from baseline ( p = .0021 ) in symptoms associated with specific reported traumatic experiences . All 8 participants interviewed at the 6-month follow-up reported reductions in PTSD symptoms ranging from 15 % to 67 % . Significant decreases were seen in all 3 symptom clusters ( p < .02 ) . Patient self-reported intrusion symptoms as measured by the Impact of Event Scale were significantly lower ( p < .05 ) at 3 months than at baseline but not at 6 months , although there was a clear trend toward fewer intrusive thoughts and somewhat less avoidance . CONCLUSION Virtual reality exposure therapy holds promise for treating PTSD in Vietnam veterans Posttraumatic stress disorder ( PTSD ) and mild traumatic brain injury ( mTBI ) are signature illnesses of the Iraq and Afghanistan wars , but current diagnostic and therapeutic measures for these conditions are suboptimal . In our study , functional magnetic resonance imaging ( fMRI ) is used to try to differentiate military service members with : PTSD and mTBI , PTSD alone , mTBI alone , and neither PTSD nor mTBI . Those with PTSD are then r and omized to virtual reality exposure therapy or imaginal exposure . fMRI is repeated after treatment and along with the Clinician-Administered PTSD Scale ( CAPS ) and Clinical Global Impression ( CGI ) scores to compare with baseline . Twenty subjects have completed baseline fMRI scans , including four controls and one  mTBI  only ; of 15 treated for PTSD , eight completed posttreatment scans . Most subjects have been male ( 93 % ) and Caucasian ( 83 % ) , with a mean age of 34 . Significant improvements are evident on fMRI scans , and corroborated by CGI scores , but CAPS scores improvements are modest . In conclusion , CGI scores and fMRI scans indicate significant improvement in PTSD in both treatment arms , though CAPS score improvements are less robust CONTEXT In 2004 , the American Psychiatric Association 's Committee on Research on Psychiatric Treatments appointed a subcommittee to investigate the status of empirical evidence with regard to  psychodynamic psychotherapy .  OBJECTIVE As a part of this effort , the committee developed a rating scale design ed to assess the quality of r and omized controlled trials ( RCTs ) of psychotherapy . DATA SOURCES A 25-item RCT of  Psychotherapy Quality Rating Scale was generated by expert consensus . Interrater reliability , internal consistency , and validity testing were undertaken using 7 trained raters . STUDY SELECTION A PubMed search was conducted to locate all RCTs of psychotherapies identified by their authors as being " psychodynamic " or " psychoanalytic " in origin and implementation . DATA EXTRACTION A total of 69 RCTs were independently rated by 2 raters . DATA SYNTHESIS The scale was found to have good interrater reliability ( total score intraclass correlation = 0.76 ) , internal consistency ( Cronbach alpha = .87 ) , and external validity . CONCLUSIONS This scale establishes a new st and ard for the design and execution of psychotherapy RCTs and provides a systematic empirical method for evaluating the quality of published RCTs 
    Output:
    
Dropout rates do not seem to be lower than in traditional exposure treatment .
Preliminary data suggest that  VRET is as efficacious as traditional exposure treatment and can be especially useful in the treatment of patients who are resistant to traditional exposure