New Research Could Improve Treatments for PTSD
Sweeping new studies shed light on the underlying mechanisms of posttraumatic stress disorder
June is PTSD awareness month. Thanks to the arduous work of researchers, advocates, survivors, and psychological and medical professionals over the years, the acronym for posttraumatic stress disorder is now common parlance.
The effects of PTSD are also more widely known:
- About 8 million adults in the U.S. have PTSD during a given year.
- 3.5 percent of U.S. adults are diagnosed every year with PTSD.
- An estimated one in 11 people will be diagnosed with PTSD in their lifetime.
- 20 percent of people in the U.S. who experience a traumatic event will develop PTSD.
- Women are twice as likely as men to have PTSD.
- An estimated 354 million adult war survivors globally have PTSD and/or major depression.
- 13.5% of deployed and non-deployed Iraq and Afghanistan veterans have PTSD, while other studies show the rate to be as high as 20% to 30%.
- Three ethnic groups — U.S. Latinos, African Americans, and American Indians — are disproportionately affected and have higher rates of PTSD than non-Latino whites.
What hasn’t been clear among researchers and clinicians is the optimal treatment approach for PTSD. Some are in favor of medication, such as antidepressants, while others prefer psychotherapy. Even among professionals who use a combination of the two approaches, there is still disagreement about which form of psychotherapy is best. Cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) are currently the first-line choices. But there is also disagreement of the order in which to try them.
What hasn’t been clear among researchers and clinicians is the optimal treatment approach for PTSD.
For anxiety — one of the prime symptoms of PTSD — research generally shows that psychotherapy is more effective than medication, and that adding medication doesn’t significantly improve outcomes. But, until now, researchers weren’t sure what specifically it was about psychotherapy that made that so. A new study recently published in Biological Psychiatry sought to find this out.
The study, out of The University of Texas at Austin, used neuroimaging to look at how the areas of the brain responsible for generating emotional responses to threats are changed by psychotherapy — specifically trauma-focused therapy. Trauma-focused psychotherapy uses “imaginal exposure” techniques to help a person directly face a trauma memory. Specifically, researchers wanted to know how brain networks communicate with each other before and after psychotherapy.
Using functional magnetic resonance imaging (fMRI) scans, researchers measured three areas of the brain: the amygdala, which is involved with experiencing emotions (and can become hyperactive after traumatic events); the insula, which controls autonomic functions related to basic survival needs; and the prefrontal cortex, the “rational” command center, which modulates cognitive control. What they found was compelling.
The participants who had undergone trauma-focused psychotherapy saw a reduction of “traffic,” or communication, in these areas of the brain and a reduction of symptoms. In fact, the greater the connectivity change, the bigger the symptom reduction. The study’s lead author, Greg Fonzo, Ph.D., and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Dell Medical School at The University of Texas at Austin, says the findings show that psychotherapy is having a measurable biological effect on the brain, and they provide a potential “biosignature” that could be leveraged to develop new and better PTSD treatment.
Speaking of (possibly better) treatment, Written Exposure Therapy (WET) is a newer evidenced-based psychotherapy that was recently added as a first-line, trauma-focused treatment for PTSD by the VA/DoD Clinical Practice Guidelines. And studies show that it may be as effective as lengthier first-line interventions.
WET is a brief therapy that consists of five sessions during which individuals write continuously for 30 minutes about a specific traumatic event. Clinicians provide scripted instructions directing a person to focus on the thoughts and feelings that came up during the event and tell them not to worry about grammar or spelling. Afterwards, clients are asked to rate their distress on a scale from 0 to 100.
WET was adapted by Denise M. Sloan, PhD and Brian P. Marx, PhD from research by James Pennebaker on the health benefits of Expressive Writing.
While WET has yet to be broadly tested against other first-line PTSD treatments, the findings of an initial study comparing WET to CPT were promising. Not only was WET as effective as CPT, but also WET offered a more streamlined intervention. Unlike other first-line psychotherapies, WET involves fewer sessions, less specialized clinician training, and no homework assignments, which reduces the burden on individuals receiving the treatment. Although more research is needed to identify the populations that WET may work best for, proponents suggest that WET should be considered a viable treatment option for PTSD.
As a society, we have come a long way from the days of dismissing a veteran’s very real and intrusive distress as “shell shock” or “battle fatigue” that will simply go away if we all turn our heads and ignore it. But we still have far to go in terms of getting folks from all walks of life who are suffering in silence with PTSD the care they need.
As with any treatment, there is no one-size-fits-all approach to trauma. But with continued support from individuals, organizations, and communities, we can continue to make breakthroughs, like those above, in both understanding and treatment.
Resources
If you or someone you know might be experiencing PTSD, these resources are for you.