Real-life exposure to settings that remind the patient of the trauma occurs on a sliding scale of subjective discomfort. The situation has to be safe, Foa said, and the goal is to gradually expose the patient to settings that provoke more anxiety for them. For example, a rape victim may avoid crowds or wearing dresses. On a scale of 0 to 100, going to the mall might rank a 50. Wearing a dress could be a 60 and going to a party where men are present could be a 70.
The goal for patients is to reclaim their lives, Foa said. As they gradually recover, their views about themselves and the world become more positive.
"The problem with prolonged exposure is dissemination," Foa said. But that is not for a lack of cooperation among psychologists and psychiatrists, and the therapy is now beginning to gain widespread recognition for its effectiveness.
In June, Foa's treatment program in Philadelphia received an exemplary substance abuse prevention award from the Substance Abuse and Mental Health Services Administration, and it is one of 25 model programs listed this year in its National Registry of Effective Prevention Programs.
She is also working on disseminating the treatment to rape crisis centers. Counselors trained in PET in the Philadelphia area are seeing the same results as are clinicians in her program, in terms of a drop in symptom severity. The U.S. Department of Veterans Affairs also is looking into the treatment strategy, comparing PET with present-centered therapy services at 12 sites.
Some studies have looked at improving on PET, Foa said, but have found that adding procedures such as cognitive and family therapy have not achieved better results than has PET alone (Foa and Street, 2001).Combined Treatment Study
Preliminary findings from the first study adding PET to medication treatment suggest the strategy is highly effective in reducing symptoms and preventing relapse in patients with PTSD. Foa, Davidson and Barbara Rothbaum, Ph.D., of Emory University conducted the three-center study.
Subjects began the study with 10 weeks of sertraline(Drug information on sertraline) treatment. They were then randomized into two groups for an additional five weeks of treatment: one that continued receiving only sertraline and one that received a combination of sertraline and twice-weekly PET.