Understanding and treating PTSD

Top row: Joyce Bittinger, Helen Miller, Lori Zoellner. Bottom row: Afsoon Eftekhari, Sally Moore. Not pictured: Michele Bedard

When UW Psychology Associate Professor Lori Zoellner was an undergraduate at Rice University, two things that captured her interest had a lasting effect: volunteering in a psychophysiology lab doing research on anxiety disorders and learning about cognitive psychology. Her present work on understanding and treating posttraumatic stress disorder (PTSD) directly combines these two influences in seeking to understand the role of memory functioning in PTSD and improving treatment for this disorder. While reactions following traumatic events such as natural disasters, car accidents, or sexual assaults vary across individuals, some individuals develop some form of chronic psychopathology. PTSD describes the cluster of re-experiencing, avoidance, and hyper-arousal symptoms that is often observed following trauma exposure, with prevalence rates estimated between 8%-14% of the US population. “Key questions remain about PTSD,” notes Prof. Zoellner. “Who is most likely to develop chronic psychopathology? How do we most effectively intervene for those immediately following trauma exposure, and, for those who are still suffering, months and years later?”

“Based on the events of recent years, I found myself in the position of being one of a small number researchers/clinicians to have an intimate knowledge of recovery mechanisms and brief interventions following acute trauma, having helped conduct one of the largest studies to date on this topic. Material from this study was used for training of the mental health service providers in New York City and the Pentagon. I have been giving both research presentations and clinical training workshops on PTSD and its treatment around the country and in the state of Washington. In the Spring of 2002, I was asked to be one of approximately 50 international experts to serve on the Expert Consensus Conference on Acute Posttraumatic Reactions in Washington, DC., whose findings were published in Biological Psychiatry.

“From a basic-science perspective, we have focused on memory mechanisms underlying the development of PTSD. One of the cardinal features of PTSD is uncontrollable and intrusive memories of the traumatic event. We want to understand how threat-relevant information and how traumatic memories themselves are organized in individuals with chronic PTSD. A second related interest of ours is how emotion regulation strategies that characterize PTSD such as dissociation or emotional numbing impact how threat-relevant information and how traumatic memories themselves are encoded and retrieved. By better understanding changes in memory processing, we hope to better understand mechanisms associated with resilience and risk following trauma exposure.

“From an applied-science perspective, we have focused on how better to successfully treat individuals with chronic PTSD. Based on years of clinical trials, there are now a number of effective treatment options for chronic PTSD. However, one of the important remaining questions in our field is for whom and under what circumstances these treatments work. Our current research directly explores these questions comparing two empirically-supported therapies for PTSD: prolonged exposure (a cognitive behavioral therapy) and sertraline (Zoloft, a FDA approved medication for the treatment of PTSD). We are now conducting a large 5-year, multi-site treatment study funded by a $1.67 million grant from the National Institute of Mental Health to better address these questions.

Besides helping to understand memory mechanisms and therapies that are important to help prevent and treat PTSD, Prof. Zoellner’s studies have provided a key research training ground for undergraduate and graduate students at UW. Several outstanding undergraduate students – including Katie Klein, Larry Pruitt, Chandra Wajdik, and Allison Clarke - have conducted Psychology Honor’s theses in this area. Furthermore, psychology graduate student Sally Moore recently received a Kirschstein−NRSA Individual Fellowship through the National Institute of Mental Health to conduct a series of studies exploring the role of emotion regulation of personal memories in PTSD.

“This large [NIMH-funded] study impacts not only our students but also the community in general. Our adult clinical graduate students and postdoctoral fellows receive training in how to conduct diagnostic interviews and provide empirically supported treatment for PTSD. For our community, this study provides free state-of-the-art treatment for chronic PTSD and long-term follow-up care for almost two hundred men and women who suffer from this disorder,” says Prof. Zoellner. For more information about this study or to participate, please call Helen Miller, study coordinator, at (206) 685-3617.

“By better understanding changes in memory processing, we hope to better understand mechanisms associated with resilience and risk following trauma exposure.”

Learn more about PTSD:

Anxiety Disorders Association of America http://www.adaa.org/

International Society for Traumatic Stress Studies

http://www.istss.org/

Prof. Zoellner’s PTSD study:

http://faculty.washington.edu/zoellner/