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VA EMBRACES NEW IOM REPORT ON PTSD, OPENS DOOR

TO COGNITIVE THERAPY "CURE" -- VA will push exposure

therapy and cognitive therapy which has been declared

a PTSD "cure" by former VA Secretary Jim Nicholson.

We have another report on PTSD from the Institute of Medicine (IOM).

The report is titled Treatment of Post-Traumatic Stress Disorder: An Assessment of the Evidence.

The full report is available here... http://www.nap
.edu/catalog.php?record_id=11955

In short form, the study says that there is not enough evidence to prove efficacy of drug therapies and group therapy.

There is, however, evidence to suggest that exposure therapy and cognitive behavioral therapy do have value.

It should be noted that a certain type of cognitive therapy has been touted by former VA Secretary Jim Nicholson as a "cure" for PTSD.  That audio here... http://www.you
tube.com/watch?v=WkPXT9FOIgc

In the above clip, Nicholson refers to a program in Cincinnati with a 70% "cure" rate.  That story here... http://www.va
watchdog.org/07/nf07/nfAUG07/nf081907-2.htm

The VA's rapid embrace of this report raises many questions.

But, the biggest question is:  Will they use this report to push a "cure" for PTSD on veterans?

Again, a report, presented in a positive light, could be the tool the VA uses to radically change the way it treats PTSD and compensates veterans.

For more about PTSD, use the VA Watchdog search engine...click here...
http://www.yourvabenefits.org/ses
search.php?q=ptsd&op=and

We have three reports.  First from the AP.  Second is the IOM press release.  And, third is the VA press release.

News story here... http://ap.google.com
/article/ALeqM5gNJVFOFf5t43iZy41D
an-NDnbGDQD8SBTHSG0

Story below:

-------------------------

More Evidence Needed on PTSD Treatments

By LAURAN NEERGAARD

WASHINGTON (AP) — There isn't enough evidence to tell if most treatments for post-traumatic stress disorder work, says a scientific review that highlights the urgency of finding answers as thousands of suffering veterans return from Iraq.

The one proven treatment is exposure therapy in which PTSD patients are gradually exposed to sights and sounds that essentially simulate their trauma, to help them learn to cope, advisers to the government reported Thursday.

The lack of evidence for other therapies doesn't mean patients should give them up — they still should get whatever care their personal doctors deem most promising, stressed Thursday's report from the Institute of Medicine.

"The take-home message for patients should be that they seek care," said Dr. David Matchar of Duke University, who co-authored the report, which was requested by the Department of Veterans Affairs as it struggles with an influx of patients.

"That is the way medicine is practiced — we do the best we can with what we've got," Matchar added. But, "we need better."

While PTSD was first recognized in Vietnam veterans, war is far from its only trigger. Crime, accidents and other trauma can cause it in civilians, too. Sufferers experience nightmares, flashbacks and physical symptoms that make them feel as if they are reliving the trauma, even many years later.

"Not only veterans, but millions who have been exposed to trauma suffer from PTSD," noted Dr. Alfred Berg of the University of Washington, who chaired the Institute of Medicine panel. "Research on this disorder should be a high priority, and VA should take the lead to ensure that the specific needs of veterans are addressed adequately."

Today, PTSD is the most commonly diagnosed mental disorder among veterans returning from Iraq and Afghanistan, affecting an estimated 13 percent and 6 percent of them, respectively, the report found.

Delays in care for both mental and physical health problems plague many injured veterans, as the Pentagon and VA struggle with backlogs in processing disability benefits and in coordinating services. Ensuring prompt PTSD care was a key recommendation of a presidential panel appointed last summer to investigate those problems.

Thursday's report addresses a somewhat different issue: Once a patient arrives for treatment, what to offer? The VA asked the prestigious Institute of Medicine to review the scientific evidence for medications and psychological treatments — before the department updates its own treatment guidelines.

Exposure therapies already are offered in the VA system, and "we will redouble our efforts to ensure our mental health staff are trained to provide these effective psychotherapies," said Antonette Zeiss, a clinical psychologist who is deputy chief of VA's mental health services.

Other existing treatments will remain, too, she said, but VA officials planned to meet Thursday to begin planning new research to better prove their value.

"The other treatments have not definitely been shown to be effective. That's different from being shown to be ineffective," Zeiss cautioned. "They are some of the best clinical tools we have. But we should continue to try to understand them better, understand for whom they work."

Aside from exposure therapies, most of the research so far done on other treatments has been of poor quality, Berg said. Some studies had huge numbers of participants drop out, for example, meaning there's no way to know if they left in frustration or because they felt better. Many lumped together patients with varying degrees of PTSD, spurred by very different traumas, making it hard to tease out effects.

Few studies even have tracked patients for longer than six or 12 months to see if any treatment effects last, even though PTSD in many people lasts far longer.

"It's the poster child for difficult research," Matchar said.

Aside from which treatments truly work, the report raised a list of additional concerns:

_It's not clear if veterans and civilians need different types of therapy.

_Depression and other co-existing problems may complicate treatment.

_It's not clear if treatment works best soon after symptoms begin, or is equally effective later.

-------------------------

IOM press release here... http://www8.
nationalacademies.org/onpinews/n
ewsitem.aspx?RecordID=11955

Press release below:

-------------------------

EFFECTIVENESS OF MOST PTSD THERAPIES IS UNCERTAIN; RESEARCH URGENTLY NEEDED TO DETERMINE WHICH THERAPIES WORK
 

WASHINGTON -- Many people, including significant proportions of active duty military personnel and veterans, suffer from post-traumatic stress disorder (PTSD), often in conjunction with other injuries or illnesses. While several drugs and psychotherapies are used to treat PTSD, many of the studies concerning their effectiveness have problems; as a result, they do not provide a clear picture of what works and what doesn't, says a new report from the Institute of Medicine.

Given the growing number of veterans with PTSD, the U.S. Department of Veterans Affairs (VA), Congress, and the research community urgently need to take steps to overcome the problems that often plague studies of psychiatric therapies for PTSD, and to ensure the right studies are undertaken to yield data that would help clinicians treat PTSD sufferers, said the committee that wrote the report.

The committee reviewed 53 studies of pharmaceuticals and 37 studies of psychotherapies used in PTSD treatment and concluded that because of shortcomings in many of the studies, there is not enough reliable evidence to draw conclusions about the effectiveness of most treatments. There are sufficient data to conclude that exposure therapies -- such as exposing individuals to a real or surrogate threat in a safe environment to help them overcome their fears -- are effective in treating people with PTSD. But the committee emphasized that its findings should not be misread to suggest that any PTSD treatment ought to be discontinued or that only exposure therapies should be used to treat PTSD.

"At this time, we can make no judgment about the effectiveness of most psychotherapies or about any medications in helping patients with PTSD," said committee chair Alfred O. Berg, professor of family medicine, School of Medicine, University of Washington, Seattle. "These therapies may or may not be effective -- we just don't know in the absence of good data. Our findings underscore the urgent need for high-quality studies that can assist clinicians in providing the best possible care to veterans and others who suffer from this serious disorder."

PTSD is the most commonly diagnosed service-related mental disorder among military personnel returning from Iraq and Afghanistan. Surveys of these individuals indicate that around 12.6 percent of personnel who fought in Iraq and 6.2 percent who were in Afghanistan have experienced PTSD. Moreover, significant proportions of Vietnam veterans and veterans of earlier conflicts also report suffering from PTSD. The vast majority of people who experience the disorder also have other concurrent conditions, such as alcoholism, depression, drug use, or anxiety disorders. Sexual assault during military service is another factor that can lead to PTSD among service members.

Clinicians turn to both drugs and psychotherapeutic interventions to treat PTSD. Anticonvulsants, antidepressants -- including selective serotonin reuptake inhibitors (SSRIs) -- monoamine oxidase inhibitors (MAOIs), and novel antipsychotics such as olanzapine and risperidone are among the drugs used to treat these patients. Psychotherapies used in PTSD treatment include exposure to trauma-related memories or stimuli, cognitive therapy, coping skills training, and hypnosis.

The committee identified 90 studies that met its criteria for trials from which it could anticipate reliable and informative data on of PTSD therapies. However, several problems and limitations characterize much of the research on PTSD treatments, making the data less informative than expected. Many of the studies have problems in their design or how they were conducted, and high dropout rates -- ranging from 20 percent to 50 percent of participants -- reduced the certainty of several studies' results. Moreover, the majority of drug studies were funded by pharmaceutical firms and many of the psychotherapy studies were conducted by individuals who developed the techniques or their close collaborators. Further investigation is needed to know whether these treatments would produce the same results if tested by other researchers and in other settings.

In addition, the research has not taken into account potential differences in the effectiveness of treatments for subgroups such as those with traumatic brain injury, depression, or substance abuse; nor have studies examined the effects in ethnic minorities, women, and older individuals. Many studies excluded individuals with concurrent health problems such as depression and substance abuse, raising questions about whether the results apply to the many PTSD sufferers who have multiple conditions.

VA and other government agencies that fund clinical research should make sure that studies of PTSD therapies take necessary steps and employ methods that would handle effectively problems that affect the quality of the results. Although the nature of PTSD presents special challenges to researchers, the committee did find some high-quality studies that show it is possible to overcome the problems.

Congress should ensure that resources are available for VA and other federal agencies to fund quality research on treatment of PTSD and that all stakeholders -- including veterans -- are represented in the research planning, the report said.

The committee emphasized that its role was solely to review what is known about the effectiveness of various PTSD treatments, and not to offer or suggest guidelines on what health care professionals or patients should do. Efficacy is one of many factors that contribute to making decisions about treatment. Other factors include safety, clinician and patient preferences, access and availability of different treatment options, and ethical issues.

The study was sponsored by the U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

Pre-publication copies of Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu . Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). INSTITUTE OF MEDICINE

-------------------------

VA press release here...
http://www.vawatchdog.org/07/
vap07/vap101807-1.htm

Press release below:

-------------------------

VA Agrees with Key Points about PTSD Treatment

October 18, 2007

In New Institute of Medicine Report

WASHINGTON – The Department of Veterans Affairs (VA) today agreed with a new Institute of Medicine (IOM) report finding exposure-based therapies for the treatment of post-traumatic stress disorder (PTSD) to be effective.

The report released today by the IOM Committee on Treatment of PTSD concluded among its key findings that exposure-based therapies such as prolonged exposure therapy and cognitive processing therapy have proven to be effective treatments for PTSD, while more research is needed on pharmacotherapy to determine its effectiveness.

“VA is pleased to see IOM agrees with us that exposure-based therapies are effective treatments for PTSD,” said Dr. Antonette Zeiss, VA’s Deputy Chief of Mental Health Services. “VA has been making the therapies readily available, even before the IOM report was released.”

Prolonged exposure therapy utilizes techniques to promote confrontation with feared objects, situations, memories and images. It involves use of psychoeducation, breathing retraining, prolonged exposure to the memory of the trauma through imaginary reliving, and repeated exposure to safe situations being avoided because of traumatic fear.

Cognitive process therapy involves psychoeducation; written exposure in which patients write about the impact of trauma on themselves and others and interpret traumatic events; challenging patient’s interpretations of traumatic events and cognitive restructuring of their beliefs that have been disrupted by traumatic events.

Dr. Zeiss said VA began developing training about a year ago for its mental health professionals in the use of exposure-based therapies, starting with cognitive processing therapy and now including prolonged exposure therapy.

In fact, VA’s Dr. Patricia Resick, head of the Women’s Division of the National Center for PTSD in Boston, is a leading researcher in cognitive processing therapy. And the leading researcher in prolonged exposure therapy is Dr. Edna Foa, who helps train VA mental health professionals.

Dr. Zeiss said VA also concurs with other key conclusions of the report that more research is needed about pharmacotherapy as an effective treatment. It is important to note, Dr. Zeiss said, the IOM conclusion states only more research is needed, not that medications have been found to be ineffective.

VA provides treatment for PTSD through cognitive and exposure-based therapies, with the use of drugs approved by the Food and Drug Administration.

VA is a recognized international leader in treatment and research for PTSD. In 1989, the Department created the National Center for PTSD, which promotes research, trains health care professionals and serves as an information resource for researchers and clinicians around the world.

-------------------------

Larry Scott  --

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