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New PTSD study examines treatment methods

In an effort to help doctors treat Posttraumatic Stress Disorder (PTSD) more effectively, two Dartmouth Medical School professors are leading a nationwide psychotherapy research study they believe is the largest study of its kind. The research takes a multi-site approach to gathering data, and the results will be widely applicable to the general population. Primarily small, community-based studies have been done in the past.

PTSD results when a person cannot cope psychologically with a painful, frightful or alarming experience. This new study will focus on the treatment method known as prolonged exposure where the therapist leads the patient through a vivid memory of a traumatic event until the patient no longer experiences a strong emotional response. This method currently is not widely used for treating PTSD but has shown promise in clinical trials. The established mainstream therapy, called present centered therapy, focuses on current problems while avoiding discussion of the traumatic event.

The five-year study, titled "Cognitive-Behavioral Therapy for Treatment of PTSD in Women," begins July 1, 2001, and it will focus on military women. The principal investigators are Dartmouth Medical School Professors of Psychiatry Paula Schnurr and Matthew Friedman and their colleague Lt. Col. Charles Engel, Chief, Deployment Health Clinical Center at the Walter Reed Army Medical Center in Washington, D.C.

Approximately 8 to10 percent of military women, both active duty and veteran, currently suffer from PTSD, and are more than twice as likely as the average American man to develop the disorder. Although these women suffer an unusually high rate of PTSD, they tend to be overlooked in the research.

"Even at facilities that have special programs for women, it would not be possible to obtain enough women at a single site to attain acceptable statistical power during a reasonable time frame," said Schnurr. The study will incorporate data from 12 sites across the United States and will include 48 therapists and 384 patients. The broad sample will come much closer to approximating clinical practice conditions nationwide than the existing single-site trials.

PTSD is an affliction most people associate with veterans and their frightening flashbacks of war, and, while it’s true that war veterans do suffer the highest rates of the disorder, civilians are afflicted as well. More than 10 million Americans will face PTSD at some point in their lives. The disorder manifests itself differently in individuals, but symptoms often include depression, substance abuse, psychosocial impairment, poor physical health and general functional difficulties, including other anxiety disorders. For women, the trauma most often involves sexual assault or rape, but other distressing events including, but not limited to, physical assault, accidents, natural disasters and war-zone events can also contribute to mental distress.

Once a patient is accepted into the study, she will be randomly assigned to one of two treatments, either prolonged exposure or present centered therapy. The patient will then receive the assigned treatment weekly for 10 weeks. Patient evaluations take place before treatment, directly after treatment and again at three and six months following treatment. The data gathered will reveal which of the two treatments is most effective, not only to treat PTSD, but also to treat the anxiety disorders and functional difficulties often associated with the illness.

The causes of PTSD may vary to some degree between military and civilian people, but the debilitating effects are often the same, so both populations can benefit from similar treatments, according to Schnurr, Friedman and Engel.

The study is headquartered at the National Center for PTSD at the Veterans Affairs Medical Center in White River Junction, Vt., where Friedman is the Executive Director and Schnurr is the Deputy Director. The study is part of the Veterans Affairs Cooperative Studies Program and will be funded as a joint venture of the Department of Veterans Affairs and the Department of Defense. The budget is $5 million for the 5-year duration of the study.

Ultimately, Schnurr, Friedman and Engel hope clinicians, researchers and policymakers across the United States and internationally will be able to use the findings to best treat patients and develop future research to help those suffering from PTSD.

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