Posttraumatic Stress Disorder Research
PTSD Related to September 11, 2001
Long Term Impact of 9/11 Attacks in Primary Care
Principal Investigator: Yuval Neria, PhD
*Not recruiting participants
Overview of the Study:
The aim of this study is to identify risk and protective factors for the development and persistence of post-disaster psychopathology in a low-income, urban, primary care population; to determine the role of ethnicity and acculturation in the expression of physical and mental symptoms and in seeking post-disaster mental health treatment; and to explore the role of post disaster factors such as social support in mediating the disaster effects over time.
In collaboration with Drs. Myrna Weissman and Mark Olfson from the Department of Epidemiology/NYSPI, Rafael Lantigua and Stevan Shea from the Department of Medicine, and the AIM primary care clinic/CUMC, we have conducted a longitudinal study in a cohort of primary care, mostly Hispanic patients, who are residents of NYC and who have reported significant exposure to the 9/11 attacks, when they have been interviewed by our research team approximately one and four years after the 9/11attacks.
Initial findings from this study suggest that 9/11 PTSD in this urban population of primary care patients is common and clinically significant (Neria et al., 2006). PTSD found to be highly comorbid with major depression, generalized anxiety disorder, suicidal ideation, impairment and disability.
PTSD Related to Trauma Exposure
Psychotherapies for Chronic Posttraumatic Stress Disorder (IRB#5660)
Principal Investigator: John Markowitz, MD
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Overview of the Study:
Posttraumatic stress disorder (PTSD) is a prevalent, debilitating psychiatric disorder. Only two types of treatment have shown efficacy for chronic PTSD in replicated research: exposure-based cognitive behavioral therapies (CBTs) and serotonin reuptake inhibitors. Prolonged Exposure (PE) studies have shown that repeated exposure to memories and reminders of trauma is an effective way to treat PTSD. Yet multiple studies also document a central role for social and interpersonal processes in recovery after trauma, and exposure to reminders of trauma may not be the only way to treat PTSD.
Interpersonal Psychotherapy (IPT), a well established treatment for mood disorders, differs in theory and technique from CBT. It focuses on the relationship between symptoms and social environment: how feelings affect interactions with other people, and how encounters with other people affect feelings. Our pilot study found IPT had great promise for PTSD. Unlike CBT treatments for PTSD, IPT targets interpersonal functioning, encouraging neither reexperiencing of traumatic memories nor out-of-session exposure to reminders of the trauma. IPT is thus a plausible alternative treatment approach. Relaxation Therapy, a treatment that helps patients learn to relax their bodies and minds, has shown benefits in treating PTSD in multiple studies.
We propose to test the efficacy of IPT for PTSD under controlled conditions. A 14-week randomized controlled trial will compare IPT adapted for PTSD (IPT-PTSD), Prolonged Exposure (PE) therapy, and Relaxation therapy (R) for 165 patients with chronic PTSD. Therapists are highly trained and expertly supervised. Independent evaluators will assess outcomes. Responders will enter a three-month observational follow-up phase to assess persistence of treatment benefits. This state-of-the-art design will allow clinicians to interpret results with practicality. It presents a rare and nearly ideal opportunity to study psychotherapy mechanisms by contrasting two very different treatments. The study explores hypotheses about treatment mechanism by studying the timing of exposure-related change and interpersonal change in the two active treatments. We have been funded by the National Institute of Mental Health to begin a five year study in the spring of 2008.
Neurocircuitry of Treatment Response among Patients with PTSD (IRB#5997)
Principal Investigator: Yuval Neria, PhD
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Overview of the Study:
One of the more salient and replicable biological findings in PTSD has been impaired fear extinction recall. One of the few efficacious psychotherapies for PTSD is one in which fear extinction is central to the method, namely cognitive-behavioral therapy/prolonged exposure (CBT/PE). Among the research findings in PTSD, impaired extinction in the disorder has been associated with hypoactivity in hippocampus (HIP) and ventromedial prefrontal cortex (vmPFC) and hyperactivity of dorsal anterior cingulate cortex (dACC) during extinction recall, as measured by functional magnetic resonance imaging (fMRI).
The aim of this study is to employ fMRI and an established fear conditioning/extinction protocol to investigate whether CBT/PE-associated remission from PTSD is associated with changes in activity of particular brain regions during extinction learning and recall, as compared to pre-treatment baseline activity.