Sheila A M Rauch

Sheila A M Rauch
Emory University | EU · Department of Psychiatry and Behavioral Sciences

Ph.D.

About

272
Publications
99,316
Reads
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6,843
Citations
Additional affiliations
June 2015 - present
U.S. Department of Veterans Affairs
Position
  • Director of Research and Program Evaluation
June 2015 - present
Emory University
Position
  • Professor (Associate)
October 2005 - present
University of Michigan
Position
  • Professor (Associate)

Publications

Publications (272)
Article
Full-text available
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that affects 6% of U.S. adults, yet is treated in only 30% of affected individuals and even fewer low-income individuals. One third of the nation’s low-income individuals are treated in Federally Qualified Health Centers (FQHCs). Most of these facilities lack capacity to pr...
Article
Objective: To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high impact chronic pain, offered in a large metro-area Veterans Health Administration (VHA) system. Data sources: VHA Corporate Data Warehouse...
Article
Objective Post-9/11 U.S. veterans and servicemembers are at increased risk for suicide, indicating an important need to identify and mitigate suicidal ideation and behaviors in this population. Method Using data modeling techniques, we examined correlates of suicidal ideation and behavior at intake in 261 post-9/11 veterans and servicemembers seek...
Article
Despite the availability of effective psychological interventions for PTSD, access to and retention in these interventions remains problematic. Of note, the Veterans Health Administration (VHA) developed and implemented post-deployment health surveys that screen for PTSD in primary care (PC), but effective PC-based, psychological intervention treat...
Article
Introduction Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacologica...
Article
Despite strong evidence of their effectiveness in reducing symptoms of posttraumatic stress disorder (PTSD), prolonged exposure therapy (PE) and cognitive processing therapy (CPT) remain challenging for some service members and veterans to access and complete. Delivering PE and CPT in time-condensed or “massed” formats may reduce barriers to receiv...
Article
Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout...
Article
Empirically-supported psychotherapies for posttraumatic stress disorder (PTSD) are highly effective and recommended as first-line treatments, yet dropout rates from standard outpatient therapy are high. Intensive outpatient programs (IOPs) that provide these therapies in condensed format with complementary interventions show promise, as they have d...
Article
Full-text available
Prolonged exposure (PE) therapy is a first-line treatment for posttraumatic stress disorder (PTSD) and involves repeated presentation of trauma-related cues without aversive outcomes. A primary learning mechanism of PE is fear extinction (new learning that a dangerous cue is now safe) and its retention (maintaining this new learning over time). Ext...
Article
Full-text available
Background Intensive outpatient programs (IOPs) for trauma‐focused therapy, such as prolonged exposure (PE), have the potential to deliver highly effective treatment, quickly and with minimal dropout. Identifying factors that predict maintenance of gains after treatment can help triage individuals who may need additional services. Methods Growth m...
Article
Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern ab...
Article
Reports an error in "The effects of web-prolonged exposure among military personnel and veterans with posttraumatic stress disorder" by Carmen P. McLean, Edna B. Foa, Katherine A. Dondanville, Christopher K. Haddock, Madeleine L. Miller, Sheila A. M. Rauch, Jeffery S. Yarvis, Edward C. Wright, Brittany N. Hall-Clark, Brooke A. Fina, Brett T. Litz,...
Article
Full-text available
Background: Fear conditioning and extinction are well-characterized cross-species models of fear-related posttraumatic stress disorder (PTSD) symptoms, and recent animal data suggest that 3,4-methylenedioxymethamphetamine (MDMA) enhances fear extinction retention. Aims: This study investigated the effect of MDMA on fear learning, extinction trai...
Article
Prolonged Exposure therapy (PE) is a first-line treatment for posttraumatic stress disorder (PTSD); however, few VA patients receive this treatment. One of the barriers to PE receipt is that it is only available in an individual (one-on-one) format, whereas many VA mental health clinics provide the majority of their psychotherapy services in group...
Article
Objective: Web-based prolonged exposure therapy (Web-PE) has potential to increase the reach of effective posttraumatic stress disorder (PTSD) treatment. While there is initial support for the efficacy of Web-PE, no studies have examined the perceptions and experiences of participants receiving PE in this novel, Web based format. Method: We used...
Article
While inflammatory markers have been implicated in the link between PTSD and poor health outcomes, there is a paucity of research investigating C-reactive protein (CRP) and psychotherapy treatment response for posttraumatic stress disorder (PTSD). The present study utilized a large, well-characterized sample of veterans and service members (N=493)...
Article
Posttraumatic negative thoughts about one's self and the world are related to posttraumatic stress disorder (PTSD) symptom severity and change in cognitive behavioral treatment (CBT), but little is known about this association when CBT is delivered with medication. The current study presents a planned comparison of changes in negative posttraumatic...
Article
Many patients evince significant post-traumatic stress disorder (PTSD) symptoms after a dose of an evidence-based treatment (EBT) for PTSD. Little research systematically addresses if individual PTSD symptoms are more or less resistant to change through an EBT for PTSD or have greater or lesser post-treatment severity levels. Two studies within VA...
Article
Objective: The impact of disrupted sleep on the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) is not well understood. Researchers have suggested that comorbid sleep disorders contribute to nonresponse by impairing therapeutic mechanisms such as emotional processing of trauma memories and extinction in cu...
Article
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI...
Article
Introduction: The Emory University Prolonged Exposure (PE) Consultant Training Program seeks to develop a national network of competent PE consultants. Comprehensive training in empirically supported treatment (EST), such as PE, includes a didactic training followed by a period of experiential learning through consultation during real-world clinic...
Article
Objective Veterans suffer disproportionately from the combined adverse health impacts of chronic pain and hazardous opioid use. This evaluation involved a substance use treatment program that included medication for opioid use disorder (SATP-MOUD) in a large metro-area Veterans Health Administration (VHA). This form of treatment has become increasi...
Article
The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid con...
Article
Full-text available
Objective Emergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for...
Article
The onset of the COVID‐19 pandemic disrupted many aspects of daily life and required a rapid and unprecedented shift in psychotherapy delivery from in‐person to telemental health. In the present study, we explored the impact of the pandemic on individuals’ ability to participate in posttraumatic stress disorder (PTSD) psychotherapy and the associat...
Article
Objective: The current study is an analysis of predictors of posttraumatic stress disorder (PTSD) treatment response in a clinical trial comparing (1) prolonged exposure plus placebo (PE + PLB), (2) PE + sertraline (PE + SERT), and (3) sertraline + enhanced medication management (SERT + EMM) with predictors including time since trauma (TST), self-r...
Article
Objective: Dissemination of prolonged exposure (PE) for the treatment of posttraumatic stress disorder (PTSD) requires the availability of consultants who can help mental health clinicians learn to deliver the protocol faithfully and effectively. However, there is a dearth of PE consultants. We created a training program that aims to develop a nat...
Article
Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and r...
Article
Background and Objectives Reduction of trauma related negative cognitions, such as guilt, is thought to be a mechanism of change within PTSD treatments like prolonged exposure (PE). Research suggests PE can directly address guilt cognitions. However, whether pharmacotherapies for PTSD can remains unclear. Methods Data from a randomized controlled...
Article
Full-text available
Background: Food addiction (FA) is a dysregulated eating pattern characterized by difficulties in controlling the intake of certain foods. There is an overlap in physical and mental health correlates of FA and post-traumatic stress disorder (PTSD). The purpose of this study was to examine sex differences in the rates of positive FA status in indiv...
Article
Repetitive transcranial magnetic stimulation (rTMS) as a treatment for posttraumatic stress disorder (PTSD) has gained interest over the past two decades. However, it has yet to be recommended in major treatment guidelines. We conducted a systematic review of randomized controlled trials to examine the efficacy of rTMS for PTSD. Thirteen studies wi...
Article
Intensive treatment programs (ITPs) are treating veterans with posttraumatic stress disorder (PTSD) and suicidal ideation (SI). The reduction of SI is a target to the abatement of suicide risk. This study examined whether ITPs utilizing PTSD treatments reduce SI and whether SI reduction is associated with PTSD symptom improvement. Veterans (N = 684...
Article
Full-text available
Background: Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks af...
Article
Many war veterans struggle with depression and suicidality, and separation from the military is a time of particularly high risk. Based on research in non-human animals, we hypothesized that reduced oxytocin signaling would mediate symptoms of depression and suicidality in war veterans recently separated from their close comrades. We also hypothesi...
Article
Objective: Web-based treatments address many of the logistical and stigma-related barriers to in-person behavioral health care. Prior studies of web-based treatments for posttraumatic stress disorder (PTSD) did not employ gold-standard treatments and have not compared to in-person therapy. Method: We compared a web version of Prolonged Exposure...
Article
Anxiety sensitivity is a potential risk factor for posttraumatic stress symptoms (PTSS) and has been hypothesized to contribute to PTSS development. However, few prospective studies have evaluated whether anxiety sensitivity predicts PTSS. In a subsample of 48 women sexual assault survivors enrolled as part of a larger prospective observational stu...
Article
The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population's level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (...
Article
Full-text available
Background Alterations in resting‐state functional connectivity (rsFC) have been reported in posttraumatic stress disorder (PTSD). Here, we examined pre‐ and post‐treatment rsFC during a randomized clinical trial to characterize alterations and examine predictors of treatment response. Methods Sixty‐four combat veterans with PTSD were randomly ass...
Article
First-line treatments for patients with PTSD require referral to specialty mental health services to receive trauma-focused therapies such as Prolonged Exposure (PE), a psychotherapy that involves 8–15, 90-min sessions. Many patients referred to specialty mental health care services do not follow up with the recommended care, making efforts to incr...
Article
Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are pervasive consequences of the post-9/11 conflicts. Treatment of PTSD and mTBI has historically occurred separately and sequentially, which does not reflect the overlapping etiology of symptoms and may attenuate or delay recovery. This paper describes an integrated 2-wee...
Chapter
Cynthia awoke in the middle of the night to a hand over her mouth, feeling something sharp against her neck, and a voice in the dark saying, “Don’t scream or I’ll cut you.” As we ask in the introduction to this book, where is...
Chapter
A message of hope As we have discussed throughout this book, we live in a dangerous world, and, unfortunately, about 70 percent of us may encounter a potentially traumatic event in our lifetime, with many of us experiencing more than one trauma. But the good news...
Chapter
A psychological concept known as Maslow’s hierarchy of needs helps us understand how to help trauma survivors. Basic human needs include food, water, warmth, and rest. These basic needs are closely followed by our safety needs to make sure we...
Chapter
In Chapter 3 of this book, we described what it’s like to live with PTSD. The bad news is it stinks to have PTSD, as it disrupts people’s lives, health, and relationships. And as hard as it is to live with PTSD, it...
Chapter
As we discussed in Chapter 2 of this book, experiencing a traumatic event is like going through the grief process. We need to emotionally process the painful emotions. There is no way to the other side of the pain except through it. But...
Chapter
As we are going to press with PTSD: What Everyone Needs to Know , we are in the midst of the global COVID-19 pandemic. Today there are 1,237,420 confirmed cases globally, 321,762 in the United States, with over 67,000 deaths to date. We...
Chapter
Children are not just little adults. Children understand the world differently and have “rules” for the way their world is supposed to work. It can be very difficult for an adult to make sense of a traumatic event; it can be nearly impossible for...
Book
What is posttraumatic stress disorder (PTSD), and who experiences it? Why do some people develop PTSD after a traumatic event, while others do not? What are the unique impacts of trauma on children? Are there effective treatments for traumatic stress disorders? PTSD: What Everyone Needs to Know is a scientifically-supported yet accessible resource...
Article
Leveraging technology to provide evidence‐based therapy for posttraumatic stress disorder (PTSD), such as prolonged exposure (PE), during the COVID‐19 pandemic helps ensure continued access to first‐line PTSD treatment. Clinical video teleconferencing (CVT) technology can be used to effectively deliver PE while reducing the risk of COVID‐19 exposur...
Article
High rates of drop-out from treatment of PTSD have challenged implementation. Care models that integrate PTSD focused psychotherapy and complementary interventions may provide benefit in retention and outcome. The first 80 veterans with chronic PTSD enrolled in a 2-week intensive outpatient program combining Prolonged Exposure (PE) and complementar...
Article
Full-text available
Background Posttraumatic stress disorder (PTSD) has been associated with exaggerated threat processing and deficits in emotion modulation circuitry. It remains unknown how neural circuits are associated with response to evidence‐based treatments for PTSD. Method We examined associations between PTSD symptoms and indicators of neural response in ke...
Chapter
Case management plays a critical role in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP) model. This chapter presents the logistics and rationale for case management as used in PE-IOP. The goal of case management is to provide necessary logistics to help the patient maximize therapeutic benefit from the PE-IOP program. Case management...
Chapter
This chapter presents key assessment issues and recommendations to assist in patient selection and examination of response across the prolonged exposure-intensive outpatient (PE-IOP) treatment program. The authors discuss key issues including dissociation, suicide and self-harm risk, anger, moral injury, complex trauma, personality disorder, guilt,...
Book
Trauma can leave a lasting impact on survivors. Some survivors are haunted by intrusive memories; avoid people, places, and situations related to the trauma; and feel constantly on edge due to posttraumatic stress disorder (PTSD) and related posttrauma reactions. Effective treatment can help survivors suffering with PTSD to process the trauma and n...
Chapter
This chapter presents the foundations for prolonged exposure (PE) therapy as they have been developed in emotional processing theory to immerse the provider in theory that will guide all decisions during PE, whether they are using the intensive outpatient program (PE-IOP) in this manual or another model (e.g., PE-Primary Care, or standard PE). The...
Chapter
This chapter presents in-depth details of how to implement the exposure component of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), including places where variation is acceptable and why. The authors present the logistics and rationale for individual sessions that include imaginal exposure and individualized trauma emotional processi...
Chapter
In addition to the core of prolonged exposure in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), the program also includes integrative interventions designed to encourage positive coping, wellness, and maintenance of gains from PE-IOP. These integrative interventions can vary based on availability, cost, patient population, etc. While...
Chapter
This therapist guide presents the scaffold and structure for the Prolonged Exposure-Intensive Outpatient Program (PE-IOP). The program is focused on exposure as provided through individual imaginal exposure and group in vivo exposure. The format presented is based primarily on the model used in the Emory Healthcare Veterans Program (EHVP), but this...
Chapter
This chapter presents how all the pieces of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP) fit together to form a program. The authors discuss areas for variations and ways to improve efficiency. Each day of the PE-IOP program is described, with each component noted and the detailed specifics outlined. Suggested time markers for sessi...
Chapter
This chapter presents the rationale for why Prolonged Exposure for Intensive Outpatient Programs (PE-IOP) was created through an examination of some of the barriers to care that may appear in traditional outpatient psychotherapy for posttraumatic stress disorder (PTSD). Evidence for efficacy and effectiveness of PE-IOP for PTSD and related issues a...
Article
Although prolonged exposure (PE) and SSRI antidepressants are effective in treating posttraumatic stress disorder (PTSD), previous studies have shown that some symptoms tend to persist. The current study compared sertraline hydrochloride plus enhanced medication management (EMM), PE plus placebo, or PE plus sertraline hydrochloride in the likelihoo...
Article
Full-text available
Now freely downloadable on the Anxiety and Depression Association of America website (https://adaa.org/sites/default/files/PhasedApproachtoCovid‐19.ver1.1%20(002).pdf) is a framework for COVID‐19 mental health response (see Table 1). This framework of phased interventions and resources is intended to assist health systems and programs impacted by t...