Psychosocial therapy for posttraumatic stress disorder [Supplement 2]

Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA 19104, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2006; 67 Suppl 2:40-5.
Source: PubMed


Immediately after experiencing a traumatic event, many people have symptoms of posttraumatic stress disorder (PTSD). If trauma victims restrict their routine and systematically avoid reminders of the incident, symptoms of PTSD are more likely to become chronic. Several clinical studies have shown that programs of cognitive-behavioral therapy (CBT) can be effective in the management of patients with PTSD. Prolonged exposure (PE) therapy-a specific form of exposure therapy-can provide benefits, as can stress inoculation training (SIT) and cognitive therapy (CT). PE is not enhanced by the addition of SIT or CT. PE therapy is a safe treatment that is accepted by patients, and benefits remain apparent after treatment programs have finished. Nonspecialists can be taught to practice effective CBT. For the treatment of large numbers of patients, or for use in centers where CBT has not been routinely employed previously, appropriate training of mental health professionals should be performed. Methods used for the dissemination of CBT to nonspecialists need to be modified to meet the requirements of countries affected by the Asian tsunami. This will entail the use of culturally sensitive materials and the adaptation of training methods to enable large numbers of mental health professionals to be trained together.

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    • "This appears to be caused by a failure of consolidating and recalling extinction memory that most likely originates from a mPFC dysfunction (Rauch et al., 2006; Etkin, 2012). Since exposure therapy as an effective treatment for anxiety disorders (Foa, 2006) represents the implementation of extinction , it is of clinical relevance to improve extinction learning and extinction memory consolidation. In this regard, manipulations of memory consolidation processes have been established in cross-species translational research. "
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    ABSTRACT: The extinction of conditioned fear depends on an efficient interplay between the amygdala and the medial prefrontal cortex (mPFC). In rats, high-frequency electrical mPFC stimulation has been shown to improve extinction by means of a reduction of amygdala activity. However, so far it is unclear whether stimulation of homologues regions in humans might have similar beneficial effects. Healthy volunteers received one session of either active or sham repetitive transcranial magnetic stimulation (rTMS) covering the mPFC while undergoing a 2-day fear conditioning and extinction paradigm. Repetitive TMS was applied offline after fear acquisition in which one of two faces (CS+ but not CS-) was associated with an aversive scream (UCS). Immediate extinction learning (day 1) and extinction recall (day 2) were conducted without UCS delivery. Conditioned responses (CR) were assessed in a multimodal approach using fear-potentiated startle (FPS), skin conductance responses (SCR), functional near-infrared spectroscopy (fNIRS), and self-report scales. Consistent with the hypothesis of a modulated processing of conditioned fear after high-frequency rTMS, the active group showed a reduced CS+/CS- discrimination during extinction learning as evident in FPS as well as in SCR and arousal ratings. FPS responses to CS+ further showed a linear decrement throughout both extinction sessions. This study describes the first experimental approach of influencing conditioned fear by using rTMS and can thus be a basis for future studies investigating a complementation of mPFC stimulation to cognitive behavioral therapy (CBT).
    Frontiers in Behavioral Neuroscience 02/2014; 8:44. DOI:10.3389/fnbeh.2014.00044 · 3.27 Impact Factor
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    • "Exposure therapy is the most common behavioral treatment for patients with post-traumatic stress disorder (PTSD) (Foa, 2006). Procedurally, it is similar to the fear extinction paradigm in rodents, involving exposure to a series of conditional stimulus (CS). "
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    ABSTRACT: Extinction is a well-known and important behavioral phenomenon that allows an organism to adapt its behavior to its environment. Previous studies have shown that the expression of extinction is highly context dependent, meanwhile, conditioning context, as part of fear memory, might have influence on extinction formation. To this end, we have conducted four different extinction paradigms in this study: extinction conducted in the conditioning context but tested in another, novel context (AAB); conditioning in one context and extinction and testing in the second (ABB); conditioning in context A, extinction training in context B, but test back to context A (ABA); and extinction training in a third context, context C (ACB). Additionally, a low dose of the GABAA agonist muscimol was used to temporarily inactivate CA1 to observe its effect in extinction. Our results showed that rats under the AAB, but not the ACB or ABA condition, showed a similar level of freezing compared with the typical ABB extinction paradigm. Moreover, muscimol infused into CA1 before extinction training resulted in impaired extinction and down-regulation of NR2B activity and phosphorylated GluR1 (at Ser845) in CA1, and the expression levels of NR2B and GluR1 were decreased significantly in the BLA. Thus, CA1 may play an important role in the context-specific expression of fear extinction, and Ser845 may be a phosphorylation site in GluR1 in CA1, triggering the context-specific response of extinction memory.
    Neuroscience 12/2013; 260. DOI:10.1016/j.neuroscience.2013.12.014 · 3.36 Impact Factor
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    • "In PTSD, however, adaptive coping does not occur, and symptoms persist and disrupt normal functioning. [3] Currently, both psychotherapy, especially prolonged exposure therapy which is a cognitive behavioral therapeutic (CBT) approach, and pharmacotherapy, are used for the treatment of PTSD [3] As the present review is focused on drug treatment, the reader is referred elsewhere for comprehensive reviews regarding psychotherapy [4]. The largest body of pharmacological treatment literature in PTSD exists for the Selective Serotonine Reuptake Inhibitors (SSRIs) [5] [6] The most recent review of the effectiveness of medications in reducing PTSD symptoms [6] confirmed the evidence based efficacy of SSRIs and consider them a first-line treatment approach in PTSD, especially paroxetine and sertraline, which have received a Food and Drugs Administration (FDA) approval for this indication. "
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    ABSTRACT: Introduction: Post-traumatic stress disorder (PTSD) is a frequent and disabling condition that occurs after exposure to a traumatic event, and Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line treatment approach for this disorder. However, a large proportion of patients remain symptomatic and other pharmacological agents have been investigated, based on the understanding of the underlying biological dysfunctions of PTSD. Methods: We conducted a review of the literature on the pharmacological options for PTSD other than the antidepressants, using MedLine and Web of Science databases, with search terms including the pharmacologic class of each agent plus PTSD, or pharmacotherapy, or fear conditioning. The literature review covered articles published until august 2012, including reviews and original articles. Results: Agents like antipsychotics, anticonvulsants, benzodiazepines, anti-adrenergic agents, have been studied in randomized clinical trials (RCTs), with general positive results for antipsychotics, especially as adjunct therapy, and for prazosin for sleep-related disturbances. However, one important target for novel medications is the modulation of the fear conditioning process, through the alteration of retrieval/reconsolidation or enhancement of fear extinction. This is traditionally targeted in prolonged exposure therapy, but pre-clinical findings from studies investigating agents like propanolol, clonidine, N-Methyl-D-aspartic Acid Receptor (NMDAR) compounds, 3,4-methylenedioxy-N-methylamphetamine (MDMA) and cannabinoids, indicate promising results in affecting the fear conditioning process and thus improving PTSD core symptoms. Discussion: Antipsychotics can be considered a reasonable alternative option to PTSD, with the largest body of evidence for risperidone, even though larger RCTs are warranted. Prazosin is also a promising agent, especially for sleep-related disturbances, while anticonvulsants and benzodiazepines lack empirical support. However, the most promising area for pharmacotherapy in PTSD is the modulation of the fear conditioning process, through agents used in adjunct to exposure therapy.
    02/2013; 10(2). DOI:10.2174/157488471002150723122127
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