For Release: February 27, 2007 4 P.M. (Et)
Contact: DMS Communications 603-650-1492
Effective Therapy for War Trauma in Military Women Demonstrated
HANOVER, NH—A form of cognitive behavioral therapy benefits female veterans with posttraumatic stress disorder (PTSD), according to a five-year nationwide Veterans Affairs study led by Dartmouth Medical School psychiatry researchers.
The findings, reported in the February 28 issue of JAMA (Journal of the American Medical Association), could have far-reaching effects on treatment options for those suffering from PTSD, an anxiety disorder that can result from exposure to traumatic events such as combat, rape, assault or disaster.
Events this decade -- 9/11, the Iraq war, Hurricane Katrina -- have underscored PTSD. Symptoms include re-experiencing the traumatic event or avoiding its reminders, emotional numbness or increased psychological and physiological tension.
"The disorder is associated with psychiatric and physical illnesses, reduced quality of life and substantial, economic costs to society, " according to the research team, led by Dr. Paula P. Schnurr deputy director of the VA National Center for PTSD based at the Veterans Affairs Medical Center in White River Junction, VT and research professor of psychiatry at Dartmouth Medical School. "Lifetime prevalence in US adults is higher in women (9.7 percent) than in men (3.6 percent) and is especially high among women who have served in the military," the researchers wrote.
A therapy called "prolonged exposure" was more effective than the supportive intervention typically used to treat female military veterans and active duty women with PTSD, the researchers found. The clinical trial they conducted is considered the first to evaluate treatment for PTSD in military women. Coauthors included Matthew Friedman, DMS professor of psychiatry and of pharmacology and toxicology, who is executive director of the National Center for PTSD.
The study compared the effectiveness of two types of PTSD treatments: prolonged exposure and present-centered therapy. Prolonged exposure is a cognitive behavioral therapy (CBT) where a patient is asked to vividly recount a traumatic event repeatedly until her emotional response decreases and she can gradually learn to confront trauma reminders with diminishing distress. Present-centered therapy, a supportive intervention VA clinicians commonly use to address the problems of female veterans with PTSD, includes discussing and reviewing general daily difficulties that may be manifestations of PTSD.
The randomized controlled trial included 277 female veterans and seven active-duty personnel with PTSD recruited from nine VA medical centers, two VA readjustment counseling centers, and one military hospital, from August 2002 through October 2005. Participants were randomly assigned to receive prolonged exposure or present-centered therapy, delivered in 10 weekly 90-minute sessions. PTSD symptom severity data were collected before and after treatment and at three- and six-month follow-up.
The researchers found that women who received the prolonged exposure therapy were more likely than those who received the present-centered therapy to no longer meet criteria for the diagnosis of PTSD (41 percent vs. 27.8 percent) and were more than twice as likely to achieve total remission (15.2 percent vs. 6.9 percent). Self-reported PTSD, depression and overall mental health improved from pretreatment to post-treatment in both groups. Anxiety decreased and quality of life improved with prolonged exposure.
The results, however, have some limitations, the researchers caution, including that few active-duty women enrolled, most likely because of the reluctance to acknowledge PTSD while serving.
"Practice guidelines for PTSD recommend prolonged exposure and other CBT, but the treatments are not widely used. Along with recent findings, our study demonstrates the feasibility of implementing CBT across a range of clinical settings," the authors concluded. "With the high prevalence of PTSD among military personnel returning from service in Iraq and Afghanistan, the challenge for large health care systems like those of the VA and the Department of Defense is to find efficient ways to train personnel to promote dissemination of these effective treatments."
The study was conducted with support from the VA Cooperative Studies Program and the Department of Defense. For more information, call Peggy Willoughby at 802-296-5132.