ptsd Col. Dan's Assessment Of The

[Berta]

He makes very good points- this IOM study is very troubling:

"The Institute of Medicine (IOM) released “Treatment of PTSD: An Assessment of The Evidence,” on Oct. 17, 2007. The IOM conducted a systematic review of PTSD literature including 90 randomized clinical trials, 37 pharmacotherapy studies, and 53 psychotherapy studies. In the report, the IOM concluded that the scientific evidence on treatment modalities for PTSD does not reach the level of certainty that would be desired for such a common and serious condition among veterans. Most studies included in the committee’s review were characterized by methodological limitations, some serious enough to affect confidence in the studies’ results. The committee reached a strong consensus that additional high quality research is essential for every treatment modality. http://www.iom.edu/CMS/3793/39330/47389.aspx

The Department of Veterans Affairs (VA) agreed with a new Institute of Medicine (IOM) report finding exposure-based therapies for the treatment of post-traumatic stress disorder (PTSD) to be effective.

Among the findings, the IOM concluded that exposure-based therapies such as prolonged exposure and cognitive processing therapy have proven to be effective treatments for PTSD, while more research is needed on pharmacotherapy to determine its effectiveness."

Prolonged exposure therapy utilizes techniques to promote confrontation with feared objects, situations, memories and images. It involves use of psycho-education, breathing retraining, prolonged exposure to the memory of the trauma through imaginary reliving, and repeated exposure to safe situations being avoided because of traumatic fear.

Cognitive process therapy involves psycho-education; written exposure in which patients write about the impact of trauma on themselves and others and interpret traumatic events; challenging patient’s interpretations of traumatic events, and cognitive restructuring of their beliefs that have been disrupted by traumatic events.

VA provides treatment for PTSD through cognitive and exposure-based therapies, with the use of drugs approved by the Food and Drug Administration.

http://www1.va.gov/opa/pressrel/pressrelea...m?id=1397"

[Wings]

Berta, Where are Col Dan's comments?

He makes very good points- this IOM study is very troubling:

[Berta]

Adora THANK you for pointing that out- I thought the first 2 paragraphs were HIS comments-

got to contact him to clarify- this is another email I just got from Alamostation (ALLVETS)and this makes sense:

(I dont see how the VA can come up with some CURE for PTSD-but looks to me like they are trying to- where are all these therapy doctors going to come from anyhow- the VA does not have enough good PTSD shrinks now--not the time to make the appointments that some of this stuff would entail)

Here is Alamostations email:

"Most PTSD Treatments Not Proven Effective

Scientists Find That One Therapy Is Shown to Help Disorder; Evidence of Drugs' Benefits Inconclusive

By Shankar Vedantam

Washington Post Staff Writer

Friday, October 19, 2007; A03

The majority of treatments for post-traumatic stress disorder that are used to treat hundreds of thousands of veterans lack rigorous scientific evidence that they are effective, according to a report issued yesterday by a panel of the federal government's top scientists.

The report by the National Academies emphasized that the therapies might not be useless. Rather, it said, the evidence is weak when it comes to drawing any kind of conclusion about most of them. The findings of the panel, widely considered the nation's most influential scientific arbiter, will have far-reaching consequences. The report comes when awareness of PTSD has risen as a result of its incidence among veterans returning from the wars in Iraq and Afghanistan.

"If a treatment that is not shown to be efficacious is nevertheless delivered to veterans, and if the treatment is relatively inert, even if it does not harm the veterans, it may demoralize the veteran," said Richard McNally, a Harvard University psychologist and PTSD expert. "Providing treatments that do not have a good basis in evidence can result in people not improving, therefore getting demoralized and therefore not seeking treatment that can actually help them."

The report did find strong evidence that one particular treatment known as exposure therapy was effective; the technique asks patients to repeatedly reimagine traumatic events as a way to make the events lose their potency. In a statement, the Department of Veterans Affairs said it was ramping up its ability to provide this therapy to patients.

But the panel failed to find evidence that any medication was effective in treating PTSD -- this included the drugs Paxil and Zoloft, which have been approved by the Food and Drug Administration to treat the disorder.

"A very high percentage of people who have been diagnosed with PTSD are on medications," said Larry Scott, the founder of the advocacy group VA Watchdog dot Org, which serves as an information clearinghouse for veterans.

Most of the evidence supporting the use of medications and psychological therapies for PTSD has been assembled by pharmaceutical companies that make the drugs or by researchers with conflicts of interest in the outcome of the studies, and lack independent and rigorous proof, the report said.

The researchers also found there was insufficient evidence to support the use of a range of psychotherapies known as cognitive restructuring, coping skills training, eye-movement desensitization and reprocessing therapy, and group therapy. Cognitive restructuring is a technique that trains patients to reinterpret a traumatic event from a different perspective. In the eye-movement therapy, patients are asked to think about traumatic memories while tracking quick movements of a therapist's finger.

A host of complicated political, economic and medical issues swirl around the issue of PTSD in a time of war. Many veterans advocacy groups are convinced that the government is trying to limit the spiraling costs of treating the flashbacks, anxieties and co-occurring psychiatric disorders that mark PTSD.

"I see the IOM report and the VA's acceptance as an indication that the agency will continue to move away from pharmaceutical-based therapies and group therapy for veterans with PTSD and continue to push their agenda of cognitive processing therapy as a 'cure,' as stated by former VA Secretary Jim Nicholson," Scott added. "If VA declares a veteran 'cured' of PTSD, this will mean the reduction or loss of disability compensation."

In the new report, scientists said evidence for many issues besides treatment efficacy was also limited. It is not clear, for example, how early treatment for PTSD should be started or how long such therapy should be offered.

"We found much of the research on PTSD to have major limitations when judged against contemporary standards for conducting trials," said Alfred O. Berg, professor of family medicine at the University of Washington, who chaired the panel that conducted a comprehensive review of the evidence for PTSD treatments.

Part of the problem, Berg said, is that studies for PTSD have been conducted over a long period of time. The modern standards the panel sought to apply simply happened to be much higher.

"Our report certainly must raise questions about treatments and whether they are effective or not, but our assessment of inadequate evidence does not mean the treatments are ineffective," Berg said. "It could mean some of the therapies are more effective than the exposure therapy, where we did find proof of effectiveness" but only that the other therapies lack evidence to show that this is the case.

Berg and another author, David Matchar, a professor of medicine at Duke University Medical Center, said a sustained national effort for high-quality research on PTSD, with a special focus on veterans and minority groups, was needed.

Edna B. Foa, a professor of clinical psychology in the department of psychiatry at the University of Pennsylvania, and one of the pioneers in developing exposure therapy as a PTSD treatment said the technique was based on the insight that many victims of trauma do all they can to avoid being reminded of traumatic events.

A rape victim might avoid going out in the evenings, while someone injured in an auto accident might avoid getting into any kind of vehicle. Soldiers might avoid movies or TV shows about war.

Two things happen in this process, Foa said. Patients come to replace actual recollections of trauma with other perceptions -- taking on blame and guilt, for example, for being afraid. Second, by avoiding situations, patients can fail to see that much of life is not dangerous -- the movie is only fiction.

Foa said she has patients recount traumatic events aloud with their eyes closed. She records the patient, and then has the patient listen to the tape repeatedly.

"People don't recover because they avoid thinking about the trauma," Foa said. "Every time the trauma comes to the mind, they push it away. They don't allow themselves to process and digest the memory, so it keeps on haunting them with nightmares, flashbacks."

Foa also has patients make lists of situations that trigger anxiety and encourages them to deliberately expose themselves to the least-frightening situation. As people realize that many situations are harmless, Foa said they replace images of self-doubt and helplessness with a more healthy outlook."

________________________________________________

[Pete53]

Wonder what would happen if the over 200,000 Vets with PTSD wanted to see a shrink in less than 30 days?

[Wings]

Walk a mile in our shoes.

[jessejames]

"Foa said she has patients recount traumatic events aloud with their eyes closed. She records the patient, and then has the patient listen to the tape repeatedly."I personally tried this therapy with a VA assigned Psychiatrist, it made me so much worse that I told them I would never participate again even if they took my disability check. I could not sleep AT all after doing this, it made the nightmares and panic attacks come over and over at night, and I fully believe a panic attack can kill you. I was taken to the ER several times at night with Blood Pressure so high it's a marvel that I did not have a stroke. I have woke up at night with my gun in my hand not knowing why, my wife has removed all guns from our house because it scared her so much. I see the VA psychiatrist every 3 months, she tells me there is NO cure, she has tried EVERY anti-depressant available either they did nothing or made me a zombie. I take 2 Clonazapam at bedtime and it cuts the panic attacks down, but doesn't take them all away especially if I have been under stress that day. If they have NO difinite cure, leave me alone...I could see myself easily being pushed back into the mode of having to actually force myself to pull my car off the road to keep my mind from making me turn in front of an 18 wheeler and ending it all. I got sick of being a guinea pig long ago, as long as I can stay non-suicidal and be able to control my environment...being left alone...that's all I ask.