'Prolonged Exposure' Therapy Best for Female Vets With PTSD

Study found it was more effective than commonly used treatment

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HealthDay Reporter

TUESDAY, Feb 27, 2007 (HealthDay News) -- A type of post-traumatic stress disorder (PTSD) therapy that involves recounting a traumatic event until emotions diminish is more effective for female military veterans than a more commonly used treatment is, new research shows.

"The study authors have shown that [prolonged] exposure therapy, which has been shown to be efficacious for other patients with PTSD, seems to be effective for this population -- women veterans returning mainly from Iraq and Afghanistan," said Jane Leserman, a medical sociologist and professor in the department of psychiatry at the University of North Carolina School of Medicine. "Because it seems to be efficacious for this group, it would make sense that this kind of treatment be available to them."

PTSD is an anxiety disorder involving nightmares, flashbacks and panic attacks linked to event "triggers" that develop after exposure to combat or other disturbing events, including 9/11 and Hurricane Katrina.

Women who have served in the military have a higher level of PTSD than women in the general population do. No studies, however, have evaluated treatments among these women.

Some 9.7 percent of U.S. women in general experience PTSD, compared with 3.6 percent of men.

According to the study, guidelines for treating PTSD recommend cognitive behavioral therapy such as the type tested in this study, along with antidepressants.

Most physicians, however, do not regularly use cognitive behavioral therapy, the authors stated. The "present-centered" approach, by contrast, is widely used by the Department of Veterans Affairs (VA). That type of therapy involves discussing the difficulties in daily life that often follow a traumatic experience.

"The majority of therapists nationally and internationally don't have training in prolonged exposure therapy, so they don't use it widely, but it is the type of therapy recommended in practice guidelines," said study lead researcher Paula Schnurr, deputy executive director of the VA National Center for PTSD in White River Junction, Vt.

"I hope that our findings encourage people to seek this kind of training," Schnurr said. "The VA has been very supportive of this study and its findings and is looking into the question of how to disseminate the treatment."

"We're certainly aware of the research, and the department is looking at ways we can implement it across the system," added Matt Burns, a spokesman for the Department of Veterans Affairs in Washington, D.C.

This study, which is in the Feb. 28 issue of the Journal of the American Medical Association, randomly assigned 277 female veterans and seven active-duty personnel with PTSD to receive either prolonged exposure therapy or present-centered therapy.

Both were applied in 10 weekly 90-minute sessions.

Participants were recruited from nine VA medical centers, two VA readjustment counseling centers and one military hospital.

Women in the prolonged exposure group were more likely to no longer meet the criteria for having PTSD (41 percent vs. 27.8 percent, respectively) and were more than twice as likely to achieve total remission (15.2 percent vs. 6.9 percent).

Almost 69 percent of all participants identified sexual trauma as the worst type of trauma they had experienced in their lifetime. On average, the first sexual trauma had occurred 23 years before.

However, more than 70 percent of participants had also experienced sexual trauma in the military.

"That is horrifying," Leserman said. "We clearly need to address this issue within the military. Military policy makers and the military itself have to really look into what is going on with sexual violence, and what we can do to address this."

But Schnurr said of the sexual trauma numbers that the study was not a random sample. "Our study enrolled women who have PTSD and who are seeking care for PTSD, and that, by definition, would be a select sample," she said.

Schnurr added: "We also know from other studies that sexual trauma is especially likely to lead to PTSD, so it wasn't surprising."

More information

To learn more about PTSD, head to the U.S. National Institute of Mental Health.

SOURCES: Jane Leserman, Ph.D., medical sociologist and professor, department of psychiatry, University of North Carolina School of Medicine at Chapel Hill; Paula Schnurr, Ph.D., deputy executive director, VA National Center for PTSD, White River Junction, Vt.; Matt Burns, spokesman, Department of Veterans Affairs, Washington, D.C.; Feb. 28, 2007, Journal of the American Medical Association

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