June 6, 2012

BSSR Lecture Series: PTSD Treatment and Prevention

Speaker - Barbara O. Rothbaum, Ph.D., ABPP, Emory University School of Medicine

In the US, approximately 70% of adults will experience a traumatic event and 20% will develop posttraumatic stress disorder (PTSD). Both civilian and combat-related PTSD are major public health concerns with long term medical and mental health sequelae. Initial but transient PTSD symptoms may be considered part of the normal reaction to trauma, as they occur almost universally following severe enough traumas. In contrast, those who suffer from chronic PTSD show decreasing PTSD symptoms in the first month following trauma, which then remain fairly steady across time. They do not worsen; they just don't extinguish their original fear reactions. Therefore, PTSD can be viewed as a failure of recovery caused in part by a failure of fear extinction following trauma. Exposure therapy follows the same paradigms as extinction training and has received more evidence of its efficacy for treating PTSD than any other intervention. In this lecture, PTSD will be reviewed and treatments for PTSD will be discussed, with data on the efficacy of each, including exposure therapy (both imaginal exposure and virtual reality exposure therapy), EMDR, and pharmacotherapy. These are treatments for chronic PTSD. An important goal is secondary prevention, trying to intervene for those at risk in an attempt to prevent the development of PTSD. In the same way that there are rapid ED-based protocols for stroke or heart attack, we envision a personalized ED-based rapid intervention protocol that may prevent the development of PTSD following trauma. In translational research based on basic, preclinical, and clinical models for the consolidation of fear memories, pilot data with 137 emergency department (ED) patients seen an average of 11-12 hours after trauma exposure, randomly assigned to receive 3 sessions of exposure therapy beginning in the ED or assessment only, will be presented and discussed.