Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that increases suicide risk and affects up to 20% of military veterans and 8% of the general population. Prolonged Exposure (PE) is a highly efficacious, evidence-based, cognitive-behavioral therapy for PTSD. However, dropout rates are high (25-30%) and an estimated one-third of patients who complete PE remain symptomatic. This study directly addresses these limitations by obtaining patient perspectives on an innovative technology system that will help to personalize optimization of a critical component of PE: In Vivo Exposure (IVE).
PTSD is a prevalent condition for which veterans frequently seek treatment in the VA healthcare system. There are a number of first-line PTSD treatment approaches available, such as Prolonged Exposure and Cognitive Processing Therapy. However, the efficacy rates of these treatments is not as high as what has been observed with civilian populations and approximately 36% of individuals drop out of these treatments prematurely. A proposed alternative to these treatments is Written Exposure Therapy (WET), a brief, 5 session intervention that has been shown to reduce symptoms of PTSD and contribute to lower dropout rates. The goal of this study is to investigate whether WET is as effective compared to Prolonged Exposure (PE) in the treatment of PTSD in a sample of veterans diagnosed with PTSD. It will involve approximately 150 Veterans. This research is funded by the Department of Veterans Affairs.
The purpose of this study is to gain a better understanding of how stressful life experiences and learning styles impact threat reactivity in childhood. Children that experience highly stressful situations are at risk for diverse mental health concerns, including anxiety and depressive disorders and PTSD.There may be certain periods of time in development that this risk is heightened. By studying the mechanisms underlying threat response, we hope to better predict short-term and long-term effects of stress and trauma in youth, as well as inform and improve clinical care.
The study will collect information from patients who have received treatment for posttraumatic stress disorder (PTSD) about their thoughts, preferences, and suggestions for ways to incorporate mobile technologies into PTSD treatment.
The purpose of this study is to better understand the different ways that female Veterans are affected by their experience with military sexual trauma (MST) and to look at the role of several factors that cause some people, but not others, to develop posttraumatic stress disorder (PTSD) or PTSD symptoms. This study is being conducted at the Charleston VA Medical Center, Tuscaloosa VA Medical Center and Atlanta VA Healthcare System. It will involve approximately 150 female Veterans who have experienced MST.
This research is taking place at the Ralph H. Johnson VAMC and surrounding Community-Based Outpatient Clinics (CBOCs). This study is examining the effectiveness of PE-PC in VHA primary care mental health integration (PCMHI) clinics. We will randomize Veterans presenting in VA PC with chronic PTSD who meet minimal inclusion/exclusion criteria to receive PE-PC (four, 30-minute weekly sessions) or PCMHI treatment as usual.
Veterans who have prematurely dropped out of exposure therapy for PTSD will be contacted and offered the opportunity to return to treatment, this time with the assistance of a Veteran who has successfully completed this treatment in the past. Participants may receive a PE "Workout Buddy." This peer will meet them at the in vivo exposure therapy location and offer support and encouragement while the patient remains in that location. Participants may receive a PE general support peer. This peer will contact them once per week to check in about treatment progress and encourage session attendance, as well as discuss any life stresses. As the PTSD treatment standards in Charleston and other VA sites across the country increasingly include telemedicine delivered care, both in person and telemedicine based exposure therapy recipients will be included.
Behavioral health problems among Veterans have raised awareness of the critical need for more reliable, effective, and accessible ways to recognize those in need, direct them to help, and ensure that they receive the best evidence-based care available. AboutFace is a novel peer education program that features the personal stories of Veterans and is designed to improve Veterans' likelihood of engaging in PTSD specialty care. Using a randomized controlled study design we propose to compare the efficacy of AboutFace relative to standard care for improving treatment engagement and outcomes. Additional data from VA providers will provide valuable information on wide scale implementation and dissemination of AboutFace. If AboutFace increases access of services, data will have broad implications for overcoming barriers to care for Veterans with PTSD and other stigmatized conditions.
The purpose of the study is to examine whether 60-minute sessions of Prolonged Exposure (PE) is as effective as the standard 90-minute sessions in reducing the symptoms of posttraumatic stress disorder (PTSD). PE is a well-researched, very effective individual (one-to-one) therapy that is designed to help people to deal with traumatic events they have suffered in the past, including combat. This study is being conducted at the Charleston VA Medical Center, surrounding Community-Based Outpatient Clinics (CBOCs), and in the community. It will involve approximately 200 active duty participants. This research is funded by the Department of Defense.
We recently published results from a NIDA-funded study of a brief behavioral treatment that was designed to reduce the troublesome cravings that smokers encounter when they attempt to quit smoking. This intervention was based on a growing body of neuroscience studies showing that memories for prior learning can be retrieved by the presentation of cues involved in that learning. Once retrieved, the memories enter into a brief period of vulnerability, during which they can be modified, but after which they are reconsolidated (restabilized) back into long-term storage. The treatment potential of this phenomenon was initially demonstrated in a Science report in which inpatient heroin addicts were briefly exposed to cues associated with heroin use in order to prompt the heroin use memories into a vulnerable state. Once the memories were in this state, the heroin addicts received extinction training consisting of protracted exposure to heroin associated cues. It was argued that extinction would change the memories such that the cues would no longer be associated with heroin administration and reward. Remarkably, after just two sessions of retrieval-extinction training (RET), the investigators found that craving in response to heroin cues was substantially reduced for up to 6-months post-treatment. This effect was observed relative to a control group that received retrieval involving non-heroin cues, followed by extinction. These impressive initial findings led us to replicate and extend the study in cigarette smokers. In our study, one group of smokers received two sessions of RET with smoking cues whereas a control group received the same training except that retrieval consisted of brief exposure to neutral, smoking-unrelated cues. Craving and other reactions to familiar and novel smoking cues were assessed in test sessions performed 24-hrs, 2-weeks and 1-month after intervention; smoking behavior was also assessed over 1-month follow-up. Remarkably, at 1-month follow-up, craving to both familiar and novel smoking cues was significantly lower in the group receiving R-E training vs. control. Even more striking was the 25% reduction in the number of cigarettes smoked per day in the RET group vs. control. [Also of significance was suggestive evidence that, relative to control participants, more participants in the RET group achieved a 60% reduction in smoking (from pretreatment levels)]. The proposed project will replicate and extend these findings by 1) increasing the dose of intervention so as to bolster the observed treatment effects, 2) employing brain imaging methods to identify patterns of brain activity uniquely associated with the intervention and potentially predictive of treatment outcome, 3) adding a control group that will enhance understanding of the effects of RET, and 4) extending follow-up period to more completely document the long-term effects of RET. Positive findings from this study could lead to the development of a brief, effective behavioral intervention to reduce the burden levied against society by smoking. Importantly, this intervention could be easily adapted to treat other forms of addiction and co-occurring anxiety disorders, such as PTSD.