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Research Highlights
Durham study to probe benefits
of guided imagery for PTSD
July 21, 2007
Guided imagery—a relaxation and mental-visualization
technique aimed at promoting relaxation and well-being—has been clinically shown to help headaches, post-surgery
pain, nausea from chemotherapy, and other conditions. Can
it also ease the symptoms of posttraumatic stress disorder
(PTSD)?
That question is at the core of a new VA study involving
up to 36 women veterans who developed PTSD as the
result of sexual trauma in the military. Some studies show
that as many as 4 in 10 women were raped or otherwise
Durham study to probe benefits
of guided imagery for PTSD sexually assaulted during their service, and to date more than
25,000 women in the U.S. with military sexual trauma have been
identified, says principal investigator Jennifer Strauss, PhD, a
psychologist and health-services researcher at the Durham VA
Medical Center and Duke University.
The Durham study has already enrolled about 20 women, most
of whom served in the Vietnam era and have been receiving some
form of therapy—medication, counseling, or both—for decades,
but without substantial improvement. "They’re treatment-resistant.
They’ve been through individual and group therapy, they’re on
medication, and they still have symptoms," said Strauss.
Social workers will aid home-based intervention
Volunteers in the study will use personal digital assistants
(PDAs) at home to listen to audio instructions and soothing music
designed to help them relax and tap into their innate capacity for
healing and growth. A control group will listen to the music but
not the narrative, which was specially produced to target PTSD.
Both groups will meet with a clinical social worker twice during
the 12-week study. They’ll also receive weekly 10-minute “coaching”
calls from the social worker.
Regarding the audio narrative, Strauss said: "It’s a metaphor—it has to be generic enough to appeal to everybody in this group.
It takes them through experiencing how [the trauma] is affecting
them now. It focuses on the present, and moving forward. What
are some of the strengths you can derive from this experience?
How can you grow from it? It’s designed to increase self-confidence,
motivation and hope. In essence, it’s designed to move
them from victim to survivor."
The approach is different from prolonged exposure therapy, a
well-established PTSD treatment in which counselors help
patients safely and gradually recall their traumas and work on
changing the thoughts, feelings and behaviors surrounding the
memories. Despite—or perhaps because of—the contrasts
between the two approaches, Strauss believes guided imagery may
prove an effective adjunct for exposure therapy. "I actually think
the two can work very well together." She adds that the guidedimagery
intervention she is testing is, to a large extent, rooted in
cognitive behavioral therapy.
"It’s very much grounded in cognitive behavioral techniques
and principles of change. It’s not that dissimilar to what I was
taught to do in individual therapy. By completing the exercises,
women learn that they can replace trauma-related emotions with
positive imagery and healthier emotions, thereby reducing PTSD
symptoms and negative emotions."
Functional MRIs, blood tests to help measure results
While guided imagery might sound "touchy feely" to some, the new
VA study will take advantage of medical technology to help provide
hard data on outcomes. Participants will undergo functional MRIs
before and after treatment to document how their brains react to stress.
The fMRI protocols were developed by study collaborator Rajendra
Morey, MD, director of the Neuroimaging Core at VA’s Durham-based
Mid-Atlantic Mental Illness Research and Clinical Center.
Along with this, co-investigator Christine Marx, MD, MA, will
run sophisticated blood tests before and after treatment to check the
levels of brain hormones related to stress,
such as allopregnanolone and pregnenolone.
Marx says preliminary data have linked
several neurosteroids to PTSD symptoms.
Besides evaluating the effects of guided
imagery, she thinks her analysis may help
identify promising new targets for drug
interventions for PTSD.
This phase of the work is supported
by the Samueli Institute, a Virginia-based
nonprofit that aims to "transform healthcare
through the scientific exploration of
healing," and that partners with researchers
from academia, health systems and
government agencies—including VA and
the Department of Defense—on studies of
alternative treatments.
Besides the brain scans and blood tests,
outcomes of the study will be measured
through standardized assessments for
PTSD.
Later this summer, Strauss will begin
piloting the guided-imagery audios with
20 combat veterans, mostly men. She cites
prior work by Leslie Root, PhD, formerly
with the VA in Biloxi, Miss., who had
begun exploring guided imagery for PTSD
in combat veterans and found it effective.
Strauss admits that even she still tends to
instinctively associate this gentle therapy
more with women than with men, but she is
quick to point out that Root’s data and her
own don’t support this notion. Her preliminary
surveys among patients at the Durham
VA—a mostly male population—showed
that about 85 percent had used some form
of complementary and alternative medicine,
and that most were open to the idea of using
guided imagery.
"When we described what the therapy
involves and asked them if they would use
the audio, most said yes. They seemed very
receptive."
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