Exposure Therapy for Posttraumatic Stress Disorder

Rothbaum, Barbara O.; Schwartz, Ann C.

doi:10.1176/appi.psychotherapy.2002.56.1.59

Cited by 225 publications

(147 citation statements)

References 25 publications

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“…Extinction has been used for more than 70 years in the treatment of phobias and more recently as a basis of "exposure," "desensitization," or "flooding" techniques for the treatment of panic and post-traumatic stress disorders (Beckett, 2002;Rothbaum and Schwartz, 2002), either alone or coupled with anxiolytic treatments (Van Minnen et al, 2002). Clearly, any method that strengthens the unconditioned aspect of the CS-no US association is preferable to those that merely repeat the original experience or the CS alone.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of mRNA and Protein Synthesis in the CA1 Region of the Dorsal Hippocampus Blocks Reinstallment of an Extinguished Conditioned Fear Response

et al. 2003

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Memories are extinguished by the repeated presentation of a conditioned stimulus in the absence of an unconditioned stimulus to which it has been associated. It is believed that extinction establishes a new hierarchy of responses rather than an actual forgetting of the original response, which can usually reappear spontaneously after interruption of the extinction process. In this study, our aim was to analyze how profound extinction can be. Rats were trained in a one-trial, step-down inhibitory avoidance paradigm and then were exposed to several extinction sessions in which they were allowed to freely explore the apparatus for 30 sec after having stepped down. Extinction was complete enough so that there was no spontaneous recovery, and test session performance could not be enhanced by pharmacological agents with well known facilitative actions on retrieval. After being submitted to a new training session, control animals reacquired the avoidance response; however, animals failed to do so after receiving bilateral intra-CA1 infusions of either the protein synthesis inhibitor anisomycin or the mRNA synthesis blocker 5,6-dichloro-1-␤-d-ribofuranosyl benzimidazole 15 min before the retraining session. Our results indicate that extinction can be carried to a point at which reinstallment of the conditioned response requires, like the original learning, de novo gene expression and protein synthesis in the CA1 region of the dorsal hippocampus.

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Section: Discussionmentioning

confidence: 99%

Inhibition of mRNA and Protein Synthesis in the CA1 Region of the Dorsal Hippocampus Blocks Reinstallment of an Extinguished Conditioned Fear Response

et al. 2003

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“…Consistent with this theory, PTSD patients exhibit deficits in extinction retention (Orr et al, 2000), along with reduced vmPFC and hippocampal volume and activity and increased amygdala activity (Gilbertson et al, 2002;Bremner, 2006;Liberzon and Martis, 2006;Shin et al, 2006). In addition, PTSD symptoms may improve after exposure therapy (Rothbaum and Schwartz, 2002;Foa, 2006). Research showing the facilitation of extinction learning through pharmacological means (Walker et al, 2002;Ressler et al, 2004; see Anderson and Insel, 2006;Quirk and Mueller, 2008 for reviews) suggests that drug administration may enhance the efficacy of such extinctionbased therapies.…”

Section: Extinctionmentioning

confidence: 98%

Changing Fear: The Neurocircuitry of Emotion Regulation

Hartley

Phelps

2009

Neuropsychopharmacol

413

346

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The ability to alter emotional responses as circumstances change is a critical component of normal adaptive behavior and is often impaired in psychological disorders. In this review, we discuss four emotional regulation techniques that have been investigated as means to control fear: extinction, cognitive regulation, active coping, and reconsolidation. For each technique, we review what is known about the underlying neural systems, combining findings from animal models and human neuroscience. The current evidence suggests that these different means of regulating fear depend on both overlapping and distinct components of a fear circuitry.

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“…This approach is believed to provide a low-threat context where the client can begin to confront and therapeutically process the emotions that are relevant to a traumatic event as well as de-condition the learning cycle of the disorder via an extinction learning process. While the efficacy of imaginal PE has been established in multiple studies with diverse trauma populations (Bryant, 2005; Rothbaum & Schwartz, 2002; Van Etten & Taylor, 1998), many patients are unwilling or unable to effectively visualize the traumatic event, and this may result in treatment failure (Difede & Hoffman, 2002). In fact, avoidance of reminders of the trauma is inherent in PTSD and is one of the cardinal symptoms of the disorder.…”

Section: Virtual Reality Prolonged Exposure For Ptsdmentioning

confidence: 99%

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Rizzo

Shilling

2017

European Journal of Psychotraumatology

131

107

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Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.

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Exposure Therapy for Posttraumatic Stress Disorder

Cited by 225 publications

References 25 publications

Inhibition of mRNA and Protein Synthesis in the CA1 Region of the Dorsal Hippocampus Blocks Reinstallment of an Extinguished Conditioned Fear Response

Inhibition of mRNA and Protein Synthesis in the CA1 Region of the Dorsal Hippocampus Blocks Reinstallment of an Extinguished Conditioned Fear Response

Changing Fear: The Neurocircuitry of Emotion Regulation

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

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