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Prolonged exposure therapy to treat PTSD

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Based on research findings, VA has trained around 7,000 mental health staff throughout the VA system in prolonged exposure therapy to treat PTSD, as well as cognitive processing therapy. These two psychotherapies are recommended by VA and American Psychiatric Association clinical practice guidelines as the best treatment for PTSD, often combined with medication. VA research was essential in showing the effectiveness of the treatments. Both therapies are offered to Veterans with PTSD nationwide in VA.

In prolonged exposure therapy, patients are asked to vividly recount a traumatic event repeatedly until their emotional response decreases. The idea is to get to a point where the traumatic memory is no longer overwhelming. A 2007 VA Cooperative Studies Program study showed that prolonged exposure therapy was an effective treatment for PTSD symptoms in female Veterans. This study was important to VA's adoption of this therapy system-wide. The Institute of Medicine (now the National Academy of Medicine) cited this paper as some of the best evidence for prolonged exposure, in their recommendations on PTSD treatment. A 2017 study by researchers at the Ralph H. Johnson VA Medical Center found that prolonged exposure could be delivered as effectively by video conferencing as in person.

Cognitive processing therapy involves exposing patients to memories, dialogue, and introspection about their trauma in a safe, clinical setting. Patients learn more about their symptoms, become aware of their thoughts and feelings by confronting them, and are taught coping skills that allow them to challenge negative or distressing thoughts. Cognitive processing therapy was developed in the 1980s by a researcher who would later join VA.

VA is currently conducting a large clinical trial comparing prolonged exposure and cognitive processing therapy.

To learn more about VA research on PTSD, visit www.research.va.gov/topics/ptsd.cfm.

Principal investigator: Paula P. Schnurr, Ph.D.; National Center for PTSD

Selected publications:

Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resnick PA, Thurston V, Orsillo SM, Turner C, Bernardy N. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007 Feb 28;297(8):820-30.

Acierno R, Knapp R, Tuerk P, Gilmore AK, Lejuez C, Ruggiero K, Muzzy W, Egede L, Hernandez-Tejada MA, Foa EB. A non-inferiority trial of prolonged exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behav Res Ther. 2017 Feb;89:57-65.

Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry. 2013 Jun;74(6):e541-50.


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