Paragraph 8 reads: " 'The situation is quite dire when you think about it,' Etkin said. 'There’s little evidence showing that medication can help. The only thing that works, when it does, is psychotherapy and we don’t understand it at all from a biological level'.”
Paragraph 6 reads: "According to a 2007 Institute of Medicine report, the only treatment for PTSD that has been shown to be somewhat effective is exposure-based psychotherapy a specialized type of therapy that isn’t widely available. (There is inadequate evidence for the utility of medications.)
Study of Post-Traumatic Stress Disorder Seeks Participants
By Stanford University School of Medicine
Apr 30, 2011 – 12:16:48 PM
“Understanding the brain mechanisms of psychotherapy will allow us to personalize treatment and make treatments better,” said principal investigator Amit Etkin, MD, PhD, an assistant professor of psychiatry and behavioral science at Stanford and an investigator at the VA’s Mental Illness Research, Education and Clinical Center. “Our study will also create a neural template upon which we can develop novel therapies.”
The five-year study needs 64 participants with symptoms of PTSD. Participants must be over the age of 18 and can be civilians, veterans or in active military duty; a previous diagnosis of PTSD is not necessary, as study staff will do their own diagnoses. People with bipolar disorder, a psychotic disorder such as schizophrenia or active substance abuse are not eligible for the trial, nor are those for whom MRI is not recommended (because of embedded shrapnel or electronic equipment).
Those interested in participating or obtaining more information about the trial should call (650) 725-9510 or e-mail firstname.lastname@example.org. Additional information can also be found at http://etkinlab.stanford.edu/participate.html.
PTSD is an anxiety disorder that can have devastating effects on daily life and function. The disorder affects 6.8 percent of Americans and is triggered by a traumatic event, such as military combat, physical assault, rape or the death of a child. Rates of PTSD are higher in certain populations, such as combat troops, where they exceed 30 percent. In general, women are twice as likely to develop PTSD as men.
According to a 2007 Institute of Medicine report, the only treatment for PTSD that has been shown to be somewhat effective is exposure-based psychotherapy a specialized type of therapy that isn’t widely available. (There is inadequate evidence for the utility of medications.)
All participants in Etkin’s study will receive a form of this treatment, which involves the patient’s recounting and mastering the distress associated with his or her memory of the trauma. While many patients find this helpful, a 2005 study in the American Journal of Psychiatry showed that it was ineffective for 44 percent of patients. What’s more, there are no biological markers for predicting who is likely to respond.
“The situation is quite dire when you think about it,” Etkin said. “There’s little evidence showing that medication can help. The only thing that works, when it does, is psychotherapy and we don’t understand it at all from a biological level.”
One of the goals of this research, Etkin said, is to “bridge the gap between the clinical efficacy of treatments and an understanding of their mechanisms.”
During the study, all participants will receive a PTSD-specific assessment and undergo functional magnetic resonance imaging scanning. Participants will then be randomized into two cohorts, with one group receiving nine to 12 appointments for 90-minute psychotherapy sessions over the course of five to six weeks, followed by a second fMRI scan one month after treatment is completed. The second group will initially receive no treatment before undergoing the second fMRI scan, but subsequently receive five to six weeks of the same therapy and be scanned a third time after treatment is completed. Both groups will receive PTSD assessments at key points in the trial.
This work, Etkin said, will enable the researchers to see the patterns of brain activation associated with psychotherapy.
Etkin and his colleagues also seek to pave the way for the development of a treatment for PTSD involving transcranial magnetic stimulation, a noninvasive method of brain stimulation that has been approved by the U.S. Food and Drug Administration for use on patients with treatment-resistant depression. To begin to explore the potential for using this approach to treat PTSD, all study participants will receive simultaneous fMRI and brief TMS stimulation in various places in the brain at the start of the study in addition to the initial fMRI without TMS simulation.
At the end of the study, the researchers will be able to compare the brain patterns associated with psychotherapy with those associated with TMS at different sites in the brain. This process could allow them to identify which regions of the brain a future study might target with TMS as a possible remedy for PTSD. “The findings could form the basis for a future novel, personalized, neuroimaging-guided intervention strategy,” said Etkin, explaining that a future study might involve using multiple, longer sessions of TMS as a potential therapy.
The work is funded by the National Institutes of Health, through a Biobehavioral Research Award for Innovative New Scientists Award that Etkin received last year. Collaborators on the study include James Gross, PhD, professor of psychology, and Karl Deisseroth, MD, PhD, associate professor of bioengineering and of psychiatry and behavioral sciences.
Information about the Department of Psychiatry and Behavioral Sciences and the VA’s Mental Illness Research, Education and Clinical Center, which are also supporting the research, is available at http://psychiatry.stanford.edu/ and http://www.mirecc.va.gov/visn21/.