Over the years, she has advanced the theory that people who are most at risk for developing PTSD have exaggerated negative thoughts about themselves and about the world, which they tend to view as an extremely dangerous place. They also tend to engage in self-blame.
Left untreated, a person with PTSD can experience symptoms for 20 years or more. Rates of attempted suicide for PTSD sufferers are as high as 19% (Davidson et al., 1991). Comorbidity is also a problem. In addition to depression, anxiety and substance abuse, PTSD is associated with hypertension, bronchial asthma, peptic ulcers and other diseases (Davidson et al., 1991). Previous research has estimated the average work loss for people with PTSD to be 3.6 days a month, resulting in an annual loss in productivity of $3 billion in the United States (Kessler, 2000).
The disorder requires long-term treatment with medication, Davidson said. "We have to--in our own minds--have that expectation and communicate that to patients so they don't get discouraged that it's been 12 weeks and they're only 30% better."
A study led by Davidson that appeared in the December 2001 issue of the American Journal of Psychiatry was the first to examine the long-term effects of sertraline(Drug information on sertraline) for PTSD in a double-blind, placebo-controlled trial. The study found that the largest proportion of worsening symptoms occurred during the first two months after the patient stopped taking the drug.
Prolonged-exposure therapy may mitigate the relapse that occurs after drug discontinuation, Foa reported. The therapy works to change a person's concept about what happened during a traumatic event, even decades later. For example, one woman treated by Foa had been gang-raped by four men at the age of 16. Twenty years later, she still blamed herself for what happened. It was only through the process of PET that she grew to realize that she could not have done anything to prevent what had happened to her.
It has been Foa's experience that people with PTSD who receive five weeks of such therapy, even after 20 years with the disorder, usually do not relapse. Instead, the person may experience a temporary increase in symptoms around the event's anniversary.
Prolonged-exposure therapy involves four elements: education about common reactions to trauma, breathing retraining, prolonged repeated exposure to the trauma memory, and repeated in vivo exposure to situations that the client is avoiding because of assault-related fear.
The two main procedures involved in PET are the patient's recounting of traumatic memories and in vivo confrontation with situations that remind the patient of the trauma. Recounting the memory allows the patient to reorganize it as an episodic memory, one that occurred at a specific point in time and space and is separate from other memories of similar events, Foa said.