Response to Smith

摘要

Dr. Smith asks an important question, namely if "D-cycloserine augmentation of virtual reality exposure therapy appeared to be associated with worse outcomes for the subset of patients experiencing little response or worsening of subjective distress during the treatment." The figure and analysis to which Dr. Smith refers are implied from a mixed-effect model that included all participants (N=156). Different outcomes were discovered based on different measures in this study. The most robust beneficial effects of D-cycloserine were seen in the more objective measures of psychophysiological startle and salivary cortisol, consistent with the animal literature on the facilitation of extinction by D-cycloserine. Less consistent were the posttraumatic stress disorder (PTSD) clinical measures that were all based on patient self-report. Even though the Clinician Administered PTSD Scale is a clinical interview, it is based on patient self-report of PTSD symptoms. Even more subjective is the Subjective Units of Distress Scale, which the analysis of emotional learning within and between sessions (to which Dr. Smith refers) is based.