VA Tries 'Exposure' Therapy on Older Female Vets

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A study contains surprises on the causes of post-traumatic stress disorder in female military veterans. Meanwhile, Veterans Affairs counselors try a new technique — prolonged-exposure therapy — on nearly 300 women suffering from long-term PTSD.

RENÉE MONTAGNE, host:

Most of you, when you hear the term post-traumatic stress disorder, you think of combat. In fact, PTSD is a long-term anxiety disorder that can result from any trauma and it affects twice as many women as men. This week's Journal of the American Medical Association published the largest study yet on treatment for women vets with PTSD. And there are some surprises, as NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: Here's the typical treatment for anyone with PTSD. You go to a therapist and talk about the current problems in your life - with relationships or keeping a job. Maybe there's some talk about how those problems are caused by your PTSD, but there's no intense focus on the trauma itself. That can work. But researchers who deal with veterans knew about another therapy that seemed to work faster and for more people. Something called prolonged exposure therapy. Paula Schnurr is with the Department of Veterans Affairs' National Center for PTSD.

Ms. PAULA SCHNURR (Deputy Executive Director, National Center for Post-Traumatic Stress Disorder): The person focuses repeatedly and vividly on a traumatic experience they've had. Retelling it in a safe context in a therapist's office.

SHAPIRO: Exposure therapy is a bit counterintuitive because it forces the patient to focus on the traumatic event that caused the PTSD in hopes of taking away some of its power.

Ms. SCHNURR: Eventually, learning that the feared memory, the feared experience is no longer as frightening, and gaining a sense of safety and mastery over the thoughts and feelings.

SHAPIRO: Schnurr and her colleagues led a team of 50 therapists who treated nearly 300 women. After 10 weeks of exposure therapy, the results were striking. Forty-one percent had their symptoms go away, compared to only 28 percent who got the usual therapy. And a lot of those women had had PTSD for 20 years or more. Right now, therapists at the VA mostly offered the traditional therapy. Doctor Matthew Friedman says that needs to change. He runs the VA's National Center for PTSD and is co-author of the research.

Dr. MATTHEW FRIEDMAN (Executive Director, National Center for Post-Traumatic Stress Disorder): This works for PTSD of long standing. The obvious implication is that we ought to make this available then we ought to train our practitioners to be able to provide it for those that come asking for it.

SHAPIRO: There's something else striking about the research on women vets. Paula Schnurr says, for the most part, their PTSD wasn't caused by combat. It was from sexual assault.

Dr. SCHNURR: About 90 percent of the women had had sexual trauma at some point in their lives.

SHAPIRO: Women in the military are more likely than other women to have dealt with sexual assault and rape. One theory is because many come from lower economic classes where sexual assault is thought to be more common. And sexual assault is a problem in the military itself. Schnurr saw that in her study.

Dr. SCHNURR: I can't comment specifically on how many had childhood trauma, adult, post-military, and so on. We do know that almost 70 percent reported military sexual trauma as well.

SHAPIRO: Almost all those women were from an earlier generation of soldiers. Very few were veterans of Afghanistan or Iraq. For women in the military now, combat stress is becoming more common. Linda Schwartz is Connecticut's state commissioner for Veterans' Affairs. She says women veterans today are likely to change our thinking on PTSD, like the two who changed hers.

Ms. LINDA SCHWARTZ (State Commissioner for Veterans' Affairs, Connecticut): A very, kind of, humbling experience for me. I met with a group of women who had just come back from Iraq, and they were asking about the availability of counseling here.

SHAPIRO: Schwartz expected them to say they were dealing with trauma from sexual assault.

Ms. SCHWARTZ: But in reality, what they said was, well, we were riding in a Humvee and there was an explosion and our buddy's arm landed in my lap. And every time I go to sleep at night, I'd see his arm on my lap.

SHAPIRO: The VA researcher say their study suggests that exposure therapy is effective. Whether a trauma was caused by rape or by combat. And it's likely to be the therapy that works best for women and for men too.

Joseph Shapiro, NPR News.

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