Posts Tagged ‘prolonged exposure therapy’

Bridging Access to PTSD Care in Primary Care

soldier hugs fatherEmory Healthcare Veterans Program (EHVP) is known for its innovative research when it comes to treating posttraumatic stress disorder (PTSD). Now the team behind the research is working to make treatment more accessible nationwide. In her role as Director of Mental Health Research and Program Evaluation at the Atlanta Veterans Affairs Medical Center, Dr. Sheila Rauch, EHVP’s Clinical Director, works to make PTSD care more accessible within the VA by utilizing a version of prolonged exposure for embedded mental health workers in primary care.

After demonstrating the effectiveness of the protocol to reduce PTSD symptoms in primary care, Dr. Rauch designed a program to train primary care mental health providers so they are better prepared to help patients struggling with PTSD.

“PTSD is a disorder of avoidance; any hurdle to receiving care could be a reason someone seeking help will go back to avoiding, so we are working to reduce barriers to care. There is no wrong door, we want to assist everyone who comes in looking to treat their PTSD and we want to do it as soon and as quickly as possible,” said Dr. Rauch.

“There is still a large population of those with PTSD who do not seek care, so we are working to find ways to provide treatment that is not only effective but also can be accessed quickly because this population will most likely not follow through with treatment the first time they reach out.”

What is Prolonged Exposure Therapy?

Prolonged exposure therapy involves working with patients to help them approach the memories and reminders of trauma so that they are the ones in control of their lives—not the trauma. PTSD is a disorder of avoidance and prolonged exposure therapy gives the patient the tools needed to approach the memory and the people, places and situations they had been avoiding.

“At its bones, the treatment is simple relearning, doing what you are afraid of over and over again and it gets easier,” said Dr. Rauch.

Three common components of prolonged exposure therapy are:

  • Psychoeducation
  • Imaginal Exposure
  • In Vivo

Psychoeducation provides a foundation of information on how PTSD develops and how treatment works. This foundation helps the patient and provider speak the same language and lets the patient begin to learn how to approach instead of avoid.

During imaginal exposure, the patient is asked to narrate the feared situation to the clinician multiple times. This narration is an important step because it allows the patient to finally process the trauma that occurred and understand why it was so disarming in the first place.

In Vivo (a Latin phrase translated as “in the living”) is a method used to take the tools learned during therapy sessions into a real-world setting. If the patient is working to overcome a fear of driving, for example, an in vivo session may include the clinician and patient driving through Atlanta traffic.

All three components of prolonged exposure therapy work together to help patients overcome the fear of the traumatic experience and begin processing what they had been avoiding for so long.

What Does a Prolonged Exposure Primary Care Session Look Like?

Prolonged exposure primary care (PE-PC) includes four to eight 30-minute sessions provided in primary care as opposed to specialty mental health. Since most people suffering with PTSD prefer to receive their care in a primary care setting with the providers they know, this option really increases access to effective PTSD care. The treatment can also be conducted through telehealth (a web-based platform) to increase reach.

“We are setting up a process to reach patients where they are instead of waiting for them to come to us because any hurdle could become a reason to go back to avoiding care,” said Dr. Rauch.

Emory Healthcare Veterans Program

EHVP provides expert, collaborative care for post-9/11 veterans and service members in the United States, regardless of discharge status. Conditions treated include PTSD, traumatic brain injury, military sexual trauma, depression and anxiety. Learn more about the program by calling 888-514-5345 or visiting the website at emoryhealthcare.org/veterans.

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Using Virtual Reality as Therapy for PTSD

virtual reality exposure therapy for ptsdJune is Post-Traumatic Stress Disorder (PTSD) Awareness Month and Emory Healthcare Veterans Program would like to share how it uses Prolonged Exposure therapy and Virtual Reality Exposure therapy to heal invisible wounds. Our highly skilled team of professionals is led by world-renowned Emory clinical psychologist Barbara Rothbaum, Ph.D., who has been working in the PTSD field since 1986 and pioneered Virtual Reality Exposure therapy as a treatment for PTSD in veterans and service members. In exposure therapy, we help people confront reminders of the traumatic event, but in a therapeutic manner so that their distress decreases.

Prolonged Exposure Therapy

There are many approaches to treating PTSD, and after several decades of research, our program has determined Prolonged Exposure therapy to be the most successful in healing invisible wounds. This process treats PTSD by asking the patient to recall the memory repeatedly, and in a therapeutic manner, so that he/she will feel more comfortable with the memory and gain a sense of mastery over the experience, rather than experiencing anxiety and avoidance. Avoidance is a common behavior for those suffering from PTSD, and although facing the memory head-on appears intimidating, revisiting the wound is the only way to heal it.

“This form of treatment is successful because the trauma needs to be emotionally processed so it can become less painful. The process is similar to the grief process. When a loved one dies, it is extremely distressing, but by expressing that hurt (say, through crying), it gradually becomes less upsetting. Eventually, we can think about that person without crying, although the loss will always be sad. Those with PTSD devote much effort to avoiding thinking about the trauma because they mistakenly view the process of remembering as too agonizing to tolerate,” said Dr. Rothbaum.

Virtual Reality Exposure Therapy

Sometimes recalling the memory is difficult because it has been locked away for so long. Virtual Reality Exposure therapy is an extension of Prolonged Exposure therapy, which immerses the patient in a virtual world that is reminiscent of his or her traumatic memory. As the patient describes the memory to the therapist, the therapist is able to recreate scenes of the memory, complete with smells, vibrations, and landscapes.

“VR is a tool that helps to extend what we already do effectively, which is exposure therapy for PTSD and anxiety disorders. It helps to resolve some of the barriers we can sometimes encounter, like if a person is unable to connect fully with their traumatic memory, we can use VR to help strengthen that connection,” said Dr. Liza Zwiebach, a clinical psychologist with Emory Healthcare Veterans Program.

Dr. Rothbaum first used Virtual Reality Exposure therapy to help people overcome their fear of heights, then in helping her patients gain control over their fear of flying in airplanes. This innovative process proved just as effective as the standard practice of using an actual airport and airplane in treatment. In follow-ups months after therapy ended, 93 percent of treated patients reported flying in real airplanes. She then used Virtual Reality Exposure therapy to treat Vietnam veterans suffering from PTSD and developed the program Braveheart, which later became the Emory Healthcare Veterans Program.

“We wanted to see if the Virtual Reality Exposure therapy would have anything to offer them—as another treatment alternative. And it did. They got better,” said Dr. Rothbaum. “They’ve reported that it didn’t bother them anymore, these experiences that have been haunting them for decades.”

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