Post-Traumatic Stress Disorder

Common Questions About PTSD

common ptsd questionsThere are many misconceptions about post-traumatic stress disorder (PTSD) and how it can be treated. By exploring a few fallacies about the disorder, the team at Emory Healthcare Veterans Program wants to emphasize that it is possible to heal invisible wounds through evidence-based treatment.

Misconception: There is no cure for PTSD

Believing that PTSD is incurable may be the most harmful misconception because it prevents warriors from seeking help. Life after PTSD is possible because evidence-based treatment works.

Seventy-five percent of warriors who complete treatment through Emory Healthcare Veterans Program experience a dramatic decrease in PTSD symptoms and many have shared their experience, proving that treatment works. See video testimonials.

Misconception: You can only get PTSD if you saw combat

PTSD is a disorder that can occur as a result of a traumatic event. Combat may be a source of PTSD, but it is certainly not the only one. Other life events, such as actual or threatened death, serious injury, or sexual violence, can also lead to PTSD. However, exposure to trauma does not mean that an individual will suffer from PTSD. People can react in many ways to trauma exposure, including natural recovery or resilience.

Question: My friend and I experienced the same event. Why did I get PTSD but he/she didn’t?

Most people will be exposed to some type of trauma in their lifetime; however, most will not develop PTSD. Various protective and risk factors play a role in whether individuals will develop PTSD (or another mental health diagnosis) following trauma, including environmental, genetic, and cultural factors.

Question: Why would I want to relive the memory?

PTSD is a disorder marked by avoidance, so it makes sense that facing the memory would be frightening. However, it is that very avoidance (of the memory, of traumatic reminders, of painful emotions) that helps maintain the symptoms of PTSD, such as intrusive thoughts, anxiety, and anger.

Through prolonged exposure (PE) therapy, individuals learn that the memory itself is not harmful or dangerous and that they can tolerate the distress that they’re avoiding. Through repeated exposure, individuals learn to place the memory into the appropriate context and emotionally process the event. While reliving the memory is difficult, the result of PE is a decline in the distress associated with the event and a decline in PTSD symptoms.

 

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Bridging Access to PTSD Care in Primary Care

father hugs soldier sonEmory 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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Emory Healthcare Veterans Program Director Dr. Rothbaum on How PTSD Affects Veterans

man with backpackPost-traumatic Stress Disorder (PTSD) is an anxiety disorder that can result from a traumatic or life-threatening event such as military combat. Thousands of servicemembers and Veterans struggle with PTSD. Often, they resist seeking help because of negative ideas about PTSD or the fear of what others might think. PTSD can affect personal relationships and even destroy families.

Question: Can you have PTSD even though you didn’t see combat?

Dr. Rothbaum: Absolutely. PTSD can result from any event in which someone felt that they or someone they care about could be seriously injured or killed. Sexual assault survivors, motor vehicle crash survivors, natural disaster survivors, and many others develop PTSD. Approximately 10% of the US population at any given time has PTSD, and most of this is not from combat.

Question: What treatment options do you offer besides talking to a counselor? Talking has got me nowhere.

Dr. Rothbaum: Good question. We offer what are known as evidence-based treatments for PTSD, meaning that controlled studies have shown that these treatments work. “Talking therapy” alone is not one of the treatments that has been shown to work for PTSD. At Emory Healthcare Veterans Program, we are offering Prolonged Exposure (PE) therapy, Cognitive Processing Therapy (CPT), Virtual Reality Exposure Therapy (VRE), and others, as well as pharmacotherapy and the combination of pharmacotherapy and psychotherapy. We are offering two tiers of treatment: Tier I are the evidenced-based treatments, and Tier II are more innovative treatments for folks who don’t receive an adequate response from Tier I treatments. You can learn more about the treatment options available at http://emoryhealthcare.org/veterans-program/treatments-services/index.html

 

Learn more about the Integrated Memory Care ClinicTo make an appointment, call 888-514-5345