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.