VR and psychedelics could prove a game changer in workers’ compensation PTSD treatments — but acceptance of these modalities must come first.

By: Nina Luckman

As the growth of the wellness industry can attest, America is in the midst of a mental health crisis.

An estimated one in five adults in the U.S. suffer from a mental health illness or disorder in any given year, according to the National Alliance on Mental Illness. Post-traumatic stress disorder (PTSD) is far less prevalent, about 5% of adults across the country experience PTSD symptoms in a given year, according to the Veterans Administration.

However, the intensity of PTSD symptoms in severe cases are debilitating, and PTSD diagnoses are on the rise.

For workers’ compensation professionals, new treatment modalities like virtual reality and psychedelic-assisted therapy can offer hope for patients where standard treatment has failed.

PTSD in Workers’ Comp

PTSD and other mental health disorders can be rife with issues for both the adjuster and claimant, most notably, stubborn assumptions about malingering — a relic of the pre-holistic method in workers’ comp when adjusters were instructed to avoid “taking on the psych” for a claim for fear that doing so would increase the length of time the claimant stayed on the roles.

Most of the industry has now acknowledged that treating the whole person achieves better results.

A natural extension of this is novel treatment for PTSD symptoms when such characteristics are accepted as compensable on a claim. Two promising modalities are virtual reality and psychedelic treatments.

Virtual Reality Exposure Therapy (VRET) has been shown in randomized controlled clinical trials to reduce trauma, depression and interrelated symptoms like anger, sleep and appetite dysregulation.

“In the case of treating PTSD, it’s critically important to ensure that patients are not inadvertently retraumatized, and that any virtual interventions are employed with the utmost clinical discretion, closely monitored by trauma-trained therapist,” said David Vittoria, chief behavioral health officer at Carisk.

Tyler Wilson, sheriff’s deputy and PTSD survivor who was treated under Harvard MedTech’s protocol, using a VR headset at home with a clinical guide, explained that his experience made him a believer in the utility of virtual reality in PTSD treatment.

“It is both viable and far less invasive and dangerous than prescription or experimental pharmaceutical intervention,” he said, noting that VR doesn’t hold the same risk of addiction like other pharmaceutical treatments.

“Limiting factors would be combating the strangle hold held by the huge pharmaceutical companies.”

While VR is accepted by numerous payers in the workers’ comp system, novel drug therapies like psilocybin, MDMA and ketamine are far less common, however, increasingly acceptance of the drugs in the clinical community, and their presence in the post-pandemic zeitgeist, makes these treatments a new frontier for the treatment of PTSD.

“I’ve seen — and the mental health community and research data supports — that psychedelics have shown promise as a therapeutic option for some PTSD patients, usually in combination with traditional psychotherapy,” said Vittoria.

Indeed, large scale reviews of the current treatment landscape indicate that psychedelics can be extremely effective and warrant further study, especially those with a sustained effect, like ketamine and MDMA.

The administration of these drugs occurs in a monitored and controlled setting with a licensed clinician.

“While we don’t fully understand how or why, it seems like the drugs induce a state of plasticity, basically making it easier for people to autonomically rewire their brains and allow for certain treatments to become more effective,” Vittoria said.

“What we don’t yet know are the long-term effects of these, still novel, treatments; they just haven’t been studied long enough. These psychoactive substances make patients exceptionally vulnerable, and that’s very risky.”

Vittoria estimated that it will take three to five years before the FDA recognizes the interventions as safe and effective.

Despite its status with the FDA, some companies are moving forward with the new drug therapies, citing the need to meet employees’ increasing mental health burden.

Psychedelics in Action

Mental health services company Enthea and soapmaker Dr. Bronner’s began offering ketamine-assisted therapy (KAT) as an ancillary benefit in January 2022.

Enthea’s services allowed Dr. Bronner’s to become the first company to add KAT to its existing employer-sponsored health insurance plan.

“The decision for Dr. Bronner’s to partner with us came at a critical time, as the mental health crisis in America was exacerbated by the pandemic, leaving lasting paralyzing effects on the struggling workforce,” said Sherry Rais, CEO & cofounder of Enthea.

Dr. Bronner’s added ketamine-assisted therapy as an employee benefit for employees who wanted an alternative way to treat depression, post-traumatic stress syndrome and generalized anxiety disorder.”

Rais added all treatments under the Dr. Bronner’s-sponsored benefit were provided by San Diego based Flow Integrative, Enthea’s flagship Credentialed Provider, which partnered with Enthea to pilot this model.

According to Rais, the utilization rate for the Dr. Bronner’s program was 7%.

Program participants with a PTSD diagnosis reported an average of 86% symptom reduction, participants with a major depressive disorder (MDD) diagnosis reported an average of 67% symptom reduction, and those with a generalized anxiety disorder diagnosis reported an average of 65% symptom reduction.

Rais noted that though the results themselves are impressive, she believes there are many barriers to treatment that must be overcome.

“I am both a personal and professional advocate for the approval of MDMA and psilocybin-assisted therapies. I’m very hopeful that the FDA will approve these safe, effective and life-changing forms of treatment for mental health conditions in the near future, specifically in the next two to three years, especially since the FDA has granted both MDMA and Psilocybin Breakthrough Therapy Status.”

The approval of CPT codes for psychedelic-assisted therapy, which will go into effective January 1, 2024, was a major milestone for both the health care and psychedelics industry as a whole.

“I’m also aware that miseducation on use cases and adverse effects in recreational settings could be a barrier to streamlined approval from legislators,” Rais said.

“Either way, Enthea’s mission will remain the same as we aim to bring innovative treatments to all employees across the U.S. and beyond.”

What the Future Holds

As the need grows to treat PTSD and its attendant comorbidities, the body of research will dictate the FDA’s next move on psychedelics, but more is certainly on the horizon.

VR will likely become a bigger component of many workers’ comp programs as its economies of scale and safety make it an attractive option for payers.

Regardless of what comes next, the workers’ comp industry should prepare now for a sea change in PTSD treatment within its compensable population.

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