Virtual reality-based emotion-to-emotion therapy for post-traumatic stress disorder: Protocol for a randomized controlled trial of efficacy, safety, and cost-effectiveness
8 affiliations
- 1Department of Korean Neuropsychiatry Medicine, College of Korean Medicine, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
- 2Korean Medicine Cognitive Disorder Research Center, College of Korean Medicine, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
- 3Department of Integrative Medicine, Division of Biomedical and Health Service Convergence, Graduate School of Jeonbuk Advanced Bio-convergence Academy (JABA), Wonkwang University, Iksan, Jeonbuk, Republic of Korea
- 4Department of Ophthalmology and Otolaryngology and Dermatology, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam, Republic of Korea
- 5Department of Korean Neuropsychiatry, National Medical Center, Seoul, Republic of Korea
- 6Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- 7Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- 8Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
Abstract
Background: Trauma-focused psychotherapies are recommended first-line treatments for post-traumatic stress disorder (PTSD). Emotion-to-Emotion Therapy (ETE) is a psychotherapy derived from traditional Korean medicine that regulates excessive emotional responses using theoretically opposing emotions. Virtual reality (VR) may support standardized and immersive delivery of the meditation component of ETE. This trial will evaluate the efficacy, safety, and cost-effectiveness of VR-based ETE for PTSD. Methods: This multicenter, randomized, waitlist-controlled, assessor-blinded trial will enroll 72 adults with PTSD and allocate them 1:1:1 to VR-based ETE, standard ETE, or a waitlist control group. Both active groups will receive 16 sessions over 8 weeks; waitlist participants will continue usual activities with scheduled monitoring. The primary endpoint is the between-group difference in the week-8 Korean version of the PTSD Checklist for DSM-5 (PCL-5-K) total score, adjusted for the baseline PCL-5-K score and study site. A week-12 follow-up assessment will examine the durability of treatment effects. Secondary outcomes, assessed at baseline and weeks 8 and 12, include the Core Seven-Emotions Inventory–Short Form, Korean Posttraumatic Growth Inventory, Five Facet Mindfulness Questionnaire–Short Form, Patient Health Questionnaire-15, Hospital Anxiety and Depression Scale, Korean Insomnia Severity Index, Hwa-Byung Scale, Clinical Global Impression scales, quantitative electroencephalography, and heart rate variability. Health-related quality of life and cost data will be collected for a within-trial economic evaluation. Discussion: This trial will provide preliminary randomized evidence on the efficacy, safety, and cost-effectiveness of standard and VR-based ETE for PTSD, and on whether adding VR to the meditation component of ETE offers clinical value beyond standard ETE. Interpretation will need to consider the modest sample size, the absence of participant blinding, and the use of a waitlist rather than an active control condition. Trial registration: Clinical Research Information Service of the Republic of Korea, KCT0007845. Registered on October 18, 2022.
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BibTeX
@article{lee2026virtual,
title = {{Virtual reality-based emotion-to-emotion therapy for post-traumatic stress disorder: Protocol for a randomized controlled trial of efficacy, safety, and cost-effectiveness}},
author = {Do-Eun Lee and Namju Lee and Nam-Kwen Kim and Joohee Seo and Jaeuk U. Kim and In Chul Jung and Moon Joo Cheong and Hyung Won Kang},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357593},
url = {https://doi.org/10.1371/journal.pone.0357593},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Virtual reality-based emotion-to-emotion therapy for post-traumatic stress disorder: Protocol for a randomized controlled trial of efficacy, safety, and cost-effectiveness
AU - Do-Eun Lee
AU - Namju Lee
AU - Nam-Kwen Kim
AU - Joohee Seo
AU - Jaeuk U. Kim
AU - In Chul Jung
AU - Moon Joo Cheong
AU - Hyung Won Kang
PY - 2026
DA - 2026/09/02
JO - PLOS One
DO - 10.1371/journal.pone.0357593
UR - https://doi.org/10.1371/journal.pone.0357593
AB - Background: Trauma-focused psychotherapies are recommended first-line treatments for post-traumatic stress disorder (PTSD). Emotion-to-Emotion Therapy (ETE) is a psychotherapy derived from traditional Korean medicine that regulates excessive emotional responses using theoretically opposing emotions. Virtual reality (VR) may support standardized and immersive delivery of the meditation component of ETE. This trial will evaluate the efficacy, safety, and cost-effectiveness of VR-based ETE for PTSD. Methods: This multicenter, randomized, waitlist-controlled, assessor-blinded trial will enroll 72 adults with PTSD and allocate them 1:1:1 to VR-based ETE, standard ETE, or a waitlist control group. Both active groups will receive 16 sessions over 8 weeks; waitlist participants will continue usual activities with scheduled monitoring. The primary endpoint is the between-group difference in the week-8 Korean version of the PTSD Checklist for DSM-5 (PCL-5-K) total score, adjusted for the baseline PCL-5-K score and study site. A week-12 follow-up assessment will examine the durability of treatment effects. Secondary outcomes, assessed at baseline and weeks 8 and 12, include the Core Seven-Emotions Inventory–Short Form, Korean Posttraumatic Growth Inventory, Five Facet Mindfulness Questionnaire–Short Form, Patient Health Questionnaire-15, Hospital Anxiety and Depression Scale, Korean Insomnia Severity Index, Hwa-Byung Scale, Clinical Global Impression scales, quantitative electroencephalography, and heart rate variability. Health-related quality of life and cost data will be collected for a within-trial economic evaluation. Discussion: This trial will provide preliminary randomized evidence on the efficacy, safety, and cost-effectiveness of standard and VR-based ETE for PTSD, and on whether adding VR to the meditation component of ETE offers clinical value beyond standard ETE. Interpretation will need to consider the modest sample size, the absence of participant blinding, and the use of a waitlist rather than an active control condition. Trial registration: Clinical Research Information Service of the Republic of Korea, KCT0007845. Registered on October 18, 2022.
SN - 1932-6203
ER -