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PTSD treatment confronts the trauma behind the disorder

FALLS CHURCH, Va. (AFNS) -- Post-traumatic stress disorder is considered one of the “signature wounds” of the current conflicts in the Middle East. But many people may not know that there are highly effective treatments for this invisible wound being deployed at Air Force hospitals and clinics today.

It’s normal to feel stressed and anxious after a traumatic event. For patients with PTSD, those feelings don’t go away with time. PTSD can leave its sufferers feeling anxious, exhausted and depressed. They often relive the traumatic event over and over in their mind, and respond by avoiding situations that remind them of the traumatic event, shutting off emotional responses, and by feeling constantly “on edge” or tense, with exaggerated angry outbursts.

Scientifically researched and proven methods for treating PTSD work by getting the patient to confront and learn to process the trauma causing their symptoms. The process can start by talking with anyone, like a health care provider, chaplain or even just a friend.

“Ultimately, people with PTSD need to speak with a mental health provider,” said Maj. Joel Foster, the Air Force Medical Service chief of Deployment Mental Health, and a licensed psychologist. “We use very specific treatments that have been subjected to scientific scrutiny and research investigation, and we want people with PTSD to get those treatments.”

All Air Force mental health providers are trained in evidence-based techniques to treat PTSD. One such technique is called Prolonged Exposure therapy. PE therapy is a protocol based treatment, meaning the provider works through a structured and scripted process with the patient. There are usually eight to twelve sessions, lasting 60 to 90 minutes each. During the therapy sessions, the provider guides the patient through two techniques that help them learn to process their trauma – imaginal exposure and in-vivo exposure.

“In imaginal exposure, we expose the patient to thoughts, memories and associations that are linked to the trauma,” said Foster. “They talk in detail about the traumatic event, and we record the discussion. They go from the start to the finish of their traumatic event, and between sessions, they listen to the recording. As the title “prolonged exposure” suggests, we do this over and over for several weeks.”

This is intended to habituate the patient to talking and hearing about the traumatic event. Whereas the event was once a source of anxiety and distress, the brain learns to remember it without those severe feelings. The memory is never pleasant, but it is no longer disabling.

“Imaginal exposure works the same way we get used to other things in life,” said Foster. “If you live near the subway or an airport, you may not sleep much the first couple of nights. Eventually though, you do get used to it, and you’ll be able to sleep right through it.”

In-vivo exposure does the same thing, but in real life. The patient and the provider make a list of situations, locations and other stimuli that remind the patient of the traumatic event, and rank them based on the level of distress. Working together, they come up with a plan for the patient to go to those places and gradually get used the situations.

“These ‘homework assignments’ ramp up,” said Foster. “It might start out as going to the grocery store during low hours for 30 minutes, and you do it over and over, until you are gradually spending an hour during busy times.”

This treatment floods the patient with sensations and experiences that are distressing to them, and builds up their tolerance. While it may initially be an unpleasant experience for some patients, Foster says the results speak for themselves.

“It’s a really hard thing to do, since PTSD patients really don’t want to think about things that remind them of their trauma,” said Foster. “But it works. More than 20 years of research and testing have gone into this treatment. We see about an 80 percent reduction in symptoms using this technique, and many service members are able to return to active duty after treatment.”
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