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'Prolonged exposure' therapy may help vets with PTSD

By Genevra Pittman

NEW YORK (Reuters Health) - Therapy that involves repeatedly processing painful memories and approaching anxiety-provoking situations in a safe way may ease symptoms of posttraumatic stress disorder (PTSD) among veterans, a new study suggests.

Although there is good evidence so-called prolonged exposure therapy can help people with PTSD, researchers said most of the data come from civilians, including women who have been sexually assaulted.

"One of the important factors in chronic PTSD is avoidance - avoiding thinking about the trauma and avoiding going to places that remind you of the trauma or are similar," said Edna Foa, head of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia and a developer of prolonged exposure therapy.

The idea behind prolonged exposure is "helping the patient confront the memories and confront the situations they avoid," added Foa, who wasn't involved in the new study.

"They realize they can talk about this event, and they don't fall apart. It gives them a sense of control over the memory, rather than the memory controlling them."

One Veterans Affairs report showed that of about 830,000 veterans who were treated at VA medical centers over the last decade, 29 percent had a diagnosis of PTSD and 22 percent were depressed.

In 2007, the VA launched a national initiative to train psychologists and social workers in prolonged exposure therapy. Every VA facility is now required to provide evidence-based treatments for PTSD, including prolonged exposure.

The new study, led by Afsoon Eftekhari from the National Center for PTSD, VA Palo Alto Health Care System in California, included 804 clinicians who had recently completed a four-day course in the technique and 1,931 of their patients.

Patients included veterans of wars in Iraq and Afghanistan, the Vietnam War and the Persian Gulf War.

The researchers scored the veterans' self-reported PTSD symptoms on a scale of 17 to 85, where a score of 50 or above suggests a diagnosis of PTSD. Depression was scored on a scale of 0 to 63.

Before starting exposure therapy, veterans had an average PTSD score of 63, and 88 percent of them met the cutoff for the condition.

After about nine sessions, that fell to an average symptom score of 48, and only 46 percent still scored high enough for a PTSD diagnosis.

Likewise, veterans' average depression scores dropped from 30 - meaning moderate to severe depression - pre-therapy to 21 afterwards, the researchers reported Wednesday in JAMA Psychiatry.

Just over a quarter of veterans dropped out before completing at least eight sessions of therapy.

Sheila Rauch, who studies veterans' mental health at the University of Michigan Medical School and the VA Ann Arbor Healthcare System, said the study "adds a lot more evidence" to what is already known about the effectiveness of prolonged exposure.

"The unique piece of information it provides is really a very large sample of veterans," Rauch, who didn't participate in the new research, told Reuters Health.

One limitation of the trial is that there was no comparison group of veterans who didn't receive prolonged exposure therapy, the researchers noted. That makes it difficult to know if the improvement can be attributed solely to the treatment itself.

Still, Foa told Reuters Health, "I think it's pretty encouraging that we get such good results with novice therapists."

"The more that we can get the word out to people with posttraumatic stress disorder that there are treatments that work … the happier I am," Rauch said.

"We have lots of people who are serving us overseas in military conflicts and some percentage of them are coming back with PTSD, and we need to know how to take care of them."

SOURCE: http://bit.ly/K3aQdr JAMA Psychiatry, online July 17, 2013.

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