You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
A Randomized, Controlled Trial of Virtual Reality-Graded Exposure Therapy for Post-Traumatic Stress Disorder in Active Duty Service Members with Combat-Related Post-Traumatic Stress Disorder
Abstract 1:
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


Title 2:
Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration.
Abstract 2:
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


Title 3:
Comparing Virtual Reality Exposure Therapy to Present-Centered Therapy with 11 U.S. Vietnam Veterans with PTSD
Abstract 3:
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


Title 4:
Development and early evaluation of the Virtual Iraq/Afghanistan exposure therapy system for combat-related PTSD.
Abstract 4:
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


Title 5:
Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder.
Abstract 5:
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


Title 6:
Improvement in cerebral function with treatment of posttraumatic stress disorder.
Abstract 6:
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


Title 7:
A new scale for assessing the quality of randomized clinical trials of psychotherapy.
Abstract 7:
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
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