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Study Finds 2-Week Long Exposure Therapy Effective In Treating Combat PTSD

Photo courtesy of UT Health San Antonio
Brooke Fina, associate professor of psychiatry with UT Health San Antonio and a therapist who works in the STRONG STAR office at Fort Hood, meets with a service member about prolonged exposure therapy.

Researchers with University of Texas Health Science Center at San Antonio co-authored a groundbreaking study on post-traumatic stress disorder published Tuesday in the Journal of the American Medical Association. The study found a common therapy proven effective for civilians also works for service members with combat PTSD.

Prolonged exposure therapy led to reduced symptoms and loss of the PTSD diagnosis in about half of the study’s participants.

Edna Foa, professor of clinical psychology with the Perelman School of Medicine at the University of Pennsylvania, led the study. It was conducted at Fort Hood in Killeen, in collaboration with Carl R. Darnall Army Medical Center. The study involved 370 active duty service members, making it the largest clinical trial for the treatment of PTSD in history.

Alan Peterson, professor of psychiatry with UT Health San Antonio and one of the lead investigators in the study, said prolonged exposure works by having patients safely recall and confront traumatic memories.

“It's really exposure to the memory. The memory that, oftentimes, is really pushed down, that people don't want to think about; don't want to talk about,” Peterson said. “But it's really what's driving the symptoms. So it's a way to kind of bring that up again, really work through those details and to somewhat put them to rest.”

Gradually, a trained therapist introduces the patient to the everyday situations that trigger traumautic memories. For example, Peterson has worked with veterans who struggle to remain in crowded parking lots or stores, or who panic when they see trash along the side of the road.

Prolonged exposure sessions are normally spread out over 10 weeks. But that longer time frame poses a challenge for service members who face demanding training and deployment schedules.

The Fort Hood study compressed that same course of therapy into just two weeks. Peterson said he initially had hesitations about moving so fast.

“We were a little bit concerned that it might be too overwhelming go into that day after day,” he said. “Basically what we found is that, because you're having a chance to meet with your therapist every single day, there's actually a lot of support that goes with that.”

The implications for military medicine could be significant. Peterson said the need is particularly great for the DOD, which has had almost 2 million service members deploy in support of combat operations since 9/11. Up to 20 percent of these service members are thought to suffer from PTSD.

“That is why now, based on these study findings, the DOD already has made policy recommendations and is acting quickly to make PE more widely available at its clinics,” he said.

Still, Peterson said, more can be done. UT Health San Antonio is currently recruiting participants for a follow-up study called Project Remission. It’s open to both veterans and active duty military personnel.

“We are now extending the treatment the treatment to three weeks instead of two. We’re also having people clear their schedules and really be available to focus full-time--all day and sometimes maybe in the evening--to really maximize the likelihood of getting positive outcomes.”

Findings were published in the Journal of the American Medical Association on Jan. 23 by researchers with the University of Pennsylvania, The University of Texas Health Science Center at San Antonio, and other institutions affiliated with the STRONG STAR consortium. STRONG STAR is a multi-institutional research network funded by the Department of Defense.

Carson Frame can be reached at carson@tpr.org or on Twitter @carson_frame

Carson Frame can be reached carson@tpr.org and on Twitter at @carson_frame