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Boston Tragedy Highlights Need to Implement Effective PTSD Therapies

The recent events in Boston remind us how important it is to help people, children and families affected by such tragedies get the most effective mental health treatments out there.

The good news is, over the years, evidence-based therapies (EBT), like prolonged exposure therapy, where patients with posttraumatic stress disorder (PTSD) face the situations, places, and people they have been avoiding, have been shown to successfully ameliorate PTSD severity.  The bad news is, though, the majority of these patients haven’t been getting them. But researchers are trying to change that.

“The recent tragic events will leave a host of lingering health and mental health problems, like PTSD, in its wake,” said Edna B. Foa, PhD, a professor of Clinical Psychology in the department of Psychiatry. “And it highlights how important it is to identify and overcome the barriers to dissemination and implementation of effective treatment, such as prolonged exposure, among mental health providers, so that people affected by such tragedies can benefit from those short-term treatments.”

Foa 2010 diCarlo

Reporting in the May issue of the journal Psychological Science in the Public Interest, Dr. Foa and her colleagues at Haverford College and University of New South Wales in Australia discuss why many mental health professionals are not utilizing them, despite a proven track record.  Instead, most are choosing other techniques, like counseling, which was found to be less effective. 

Years of testing have proven that EBT are effective at addressing the distress and dysfunctional problems that trauma victims experience. An example frequently referenced in the report is the prolonged exposure therapy developed by Dr. Foa.

Here, patients confront safe trauma reminders in two procedures:  revisit the traumatic memory in imagination, recounting it aloud, and discussing new perspectives and thoughts that emerge from the experience; and second, they approach safe trauma-related situations and objects they avoid because they illicit fear and distress.

The repeated exposure to the perceived threat disconfirms individuals’ expectations of experiencing harm and, over time, leads to a reduction in their fear.

Many clinicians, however, believe that psychotherapy and counseling should be focused on the underlying causes of one’s problems and symptoms, and they steer away from EBT.

Several reasons point to the hesitation.

“Arguably the major obstacle to resistance at each stage is allegiance to current practice,” the authors write. “This allegiance can result in resistance to EBTs…” The authors say there’s also lack of training in EBTs and significant costs associated with dissemination models holding things back.

Dr. Foa’s next step is studying how to best train therapists and get health systems to adopt EBTs.

A full news release on the study from the Association for Psychological Science can be found here.

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