By Marques Chavez, RDECNovember 30, 2010
ORLANDO, Fla. -- Science and technology is leading the approach for treating Post-Traumatic Stress Disorder (PTSD) and those treatments were discussed by medical experts at a topical panel at the 27th Army Science Conference Nov 30. The treatments discussed ranged from cognitive therapy and pharmaceutical treatment to virtual reality.
The panel on PTSD comes a day after Gen. Peter W. Chiarelli, vice chief of staff of the Army, stressed the importance of treating soldiers with PTSD and Traumatic Brain Injuries (TBIs).
"The fact remains, these wounds are not well understood," Chiarelli said during the opening session of the conference. "Yet they affect a significant portion of the Army's Wounded Warrior population. And although the Army is taking a holistic approach to dealing with these very serious injuries, the reality is that a study of the brain is incredibly complex and rather immature."
Dr. Edna B. Foa, professor of clinical psychology in psychiatry at the University of Pennsylvania, kicked off the discussion by offering a presentation on a treatment called prolonged exposure (PE), its effectiveness in treating PTSD and whether PE can be effective in treating PTSD among active personnel.
The first component of PE is imaginable exposure, where a patient is asked to revisit and recount the traumatic event for record. The patient is then allowed to listen to the recounted event to gain perspective. In the second component of PE, in vivo exposure, the patient visits safe situations and places that are now avoided because they trigger trauma reminders.
"There are more than 40 studies on PE all showing the process is effective," said Foa.
Dr. Patricia A. Resick, from the National Center for PTSD, Veterans Affairs Boston Healthcare System and professor of Psychiatry and Psychology at Boston University, focused her remarks on Cognitive Processing Therapy (CPT).
"It is not an exposure therapy," said Resick. "It is predominantly a trauma-focused cognitive therapy with or without written accounts of worst traumas. It is a very specific, session-by-session protocol that teaches the clients to challenge their own thoughts."
During the early sessions of CPT, the patient writes detailed accounts of the incident including sensory details, thoughts and feelings. In the middle sessions, the patients start learning about patterns of faulty thinking and how those thoughts are affecting their beliefs of themselves and the world. The final sessions are targeted to help patients overcome over-generalization or when the patients think that the world is entirely too dangerous.
"Once they learn these skills, we'll have them walk through various themes," said Resick.
Dr. Murray A. Raskind, from the VA Puget Sound Health Care Center, was the only presenter who talked about a pharmaceutical treatment for PTSD symptoms.
"Contributing factors to PTSD include the brain "adrenaline rush" that saves lives in combat but appears to become persistent and maladaptive when leaving this [combat] environment," Raskind said. "What Prazosin does is reduce the brain's response to this arousal. It is non-sedating and non-addictive and has no daytime hangover."
Raskind went on to explain that Prazosin is in the same family of medications as Flowmax, but it is the only one that crosses the bloodbrain barrier. It has a short duration of action-about six to ten hours-and it is relatively inexpensive. He also explained that the drug provides significant advantages for sleeping at night.
"When you get a good night's sleep, your clinical global sense of well being will improve as well," Raskind explained. "With Prazosin, sleeping was greatly improved. When nightmares are reduced or eliminated and sleep is normalized, alcohol self medication is reduced or eliminated and suicidal ideation is also reduced or eliminated."
The final presenter on the panel discussed the role Virtual Reality (VR) technology is now being applied in clinical care issues.
"VR is a way for humans to interact with computers and extremely complex data in a more naturalistic fashion," said Dr. Albert "Skip" Rizzo, research scientist for the Institute for Creative Technologies, University of Southern California. "Over the last 15 years, we've seen VR go from the realm of expensive toy into that of functional technology.
"We can design virtual environments to assess and rehabilitate," continued Rizzo. "Since 1994, we've seen pretty dramatic growth in VR technology."
Rizzo explained that exposure therapy still has the most positive results for its use, but there may be challenges for some patients. Some are unwilling to imagine their trauma situations and VR can be used in place of exposure therapy.
"This is an ideal merger of therapy and technology," Rizzo said.
Col. Carl Castro, director for the U.S. Army Military Operational Medicine Research Program at Fort Detrick, Md. was the chair for the panel and wrapped-up the proceedings following the panelists' remarks.
"I hope that one of the things that everyone takes away is that none of these procedures is mutually exclusive," said Castro. "You can do prolonged exposure therapy, CPT, pharmaceutical treatment and virtual reality. I just hope folks don't leave here thinking you have to pick just one," Castor concluded.