Psychological Approaches and
Related Therapeutic Tools
Current evidence-based psychological treatments for PTSD include prolonged exposure therapy and cognitive processing therapy. Further research on psychotherapeutic methods is needed, however, to identify other effective approaches and advance the care of Veterans with PTSD.
Psychological Approaches and
Related Therapeutic Tools
Examples of research in this area
include the following:
- Prolonged exposure therapy
In the largest study to date in women
Veterans with PTSD, VA researchers found
prolonged exposure therapy, in which
patients are helped to recall their traumas in
a safe, controlled environment, to be more
effective than supportive counseling that
does not involve trauma recall. VA is
systematically adopting this treatment
approach, with a nationwide dissemination
effort being spearheaded by VA's National
Center for PTSD.
- Virtual reality simulations
Computer-generated environments are
continually evolving that simulate the
sights, sounds, sensations, and smells of
feared situations. Therapists can use the
technology as an aid to prolonged exposure
therapy as they work with patients to
change the negative thoughts, feelings, and
behaviors linked to traumatic events.
- Guided imagery
VA researchers are examining whether
guided imagery—a technique involving
relaxation and mental visualization—is effective for PTSD. As part of this study,
women who developed PTSD as a result
of sexual trauma while in the military and
did not improve with other therapies are
being taught to use specially created audio
programs specific to PTSD that enable
them to practice guided imagery at home.
Medication for PTSD
Research has found that certain medications,including the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs),
may be effective for PTSD, either by themselves or in combination with psychotherapy.
Highlights of VA Research in this area include:
- Hypertension drug found to help nightmares
The inexpensive, well-tested generic drug
prazosin, already used by millions of
Americans for high blood pressure and
prostate problems, has been found in pilot
studies to improve sleep and lessen trauma
nightmares in Veterans with PTSD. A large
multisite trial has been launched to follow
up on these results.
- Beta-blocker may weaken traumatic
memories
A clinical trial is underway to test the
theory that traumatic memories may
be weakened or extinguished by giving the
drug propranolol, a beta blocker commonly
used to treat high blood pressure, as the
troubling memories are reactivated under
controlled conditions.
- Drug risperidone for persistent PTSD
VA investigators are conducting the firstever
multisite clinical trial of a medication
to treat military-related chronic PTSD.
This study, which will include 400 Veterans,
will help determine whether risperidone—a drug shown to be safe and previously
tested in the treatment of PTSD in general
populations—is effective in Veterans with
chronic PTSD who have not been helped
by antidepressants.
- Medication may boost psychotherapy
outcomes
VA investigators are studying whether the
drug D-cycloserine, originally used to treat
tuberculosis and more recently shown to
lessen anxiety, can improve the results of
psychotherapy treatment for PTSD.National Center for PTSD
Biological Factors in PTSD
VA investigators have established much of
the evidence relating to the biological basis
of PTSD, and they continue to learn about
changes in the body that are linked to the
condition.
Important examples of VA research
in this area include:
- Role of stress-related hormones
VA researchers studied patients with
war-related PTSD to see how their levels
of certain stress-related hormones changed
as they watched a film containing combat
footage, compared with changes as they
watched a neutral film about oil painting.
Understanding the link between PTSD
and hormone levels may help researchers
develop new therapies or evaluate the
effects of existing treatments.
- Imaging brain activity
A new VA research program will focus
on the study of brain and mental health
conditions, including PTSD, common
among troops returning from Afghanistan
and Iraq. The program features a mobile
MRI machine that will be used with
Veterans and active-duty troops at two
VA sites and a nearby military base.
Functional brain images taken with the
machine will help researchers correlate
PTSD symptoms with activity in particular
areas of the brain.
Risk Factors for PTSD
VA researchers also study clinical and lifestyle
factors that may increase a person's risk of
developing PTSD.
Highlights of VA research in this area include:
- Assessment before and after deployment
In a major study, VA researchers and
colleagues from the Department of Defense
are collecting health information from
military personnel prior to their deployments
to Afghanistan and Iraq. These
service members will be reassessed upon
their return and several times thereafter
to identify possible changes that occurred
in emotions or thinking as a result of their
tours of duty and to identify possible
risk factors for PTSD and other health
conditions.
- Long-term PTSD in Veterans of the
Vietnam War
VA Research has launched a 20-year study
of PTSD in Veterans of the Vietnam War
to look at the long-term course of the
disorder, its long-term medical consequences,
and patterns of health care usage
among these Veterans. Findings from the
study will help VA better understand the
current and future health care needs of
those who served in the Vietnam era.
Ongoing PTSD Initiatives
As research continues to shed more light
on PTSD and its prevention, diagnosis,
and treatment, VA is working to translate
research findings into advances in care. As
part of this effort, Best Practices Guidelines
for the diagnosis and treatment of PTSD,
based on past study findings, have been
distributed to clinicians throughout the
VA health care system. Another current effort involves the creation of a PTSD registry, in collaboration with the
Department of Defense, that will help
researchers learn more about the risk factors and health outcomes associated with PTSD. VA researchers are also working to develop telehealth models of PTSD care that take advantage of communication technologies such as the telephone, Internet, videoconferencing, email, and text messaging. These initiatives are especially important for Veterans with PTSD who live in rural areas.
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