Posttraumatic Stress Disorder (PTSD) is a debilitating stress-related psychiatric condition associated with significant psychiatric comorbidity, functional impairment, compromised health status, early mortality, and substantial economic costs to society.
Despite the efficacy of cognitive-behavioral therapies for treating PTSD, there is relatively little evidence of adoption of these treatments into the community. Clinicians note that interventions do not typically ameliorate the significant interpersonal and emotional management disturbances found in individuals with PTSD and cite concerns related to the potential risk of increased dropout from exposure-based treatments.
At the NYU Child Study Center Institute for Trauma and Resilience, we seek to bridge this gap between clinical services and research findings. We are working toward this goal in three ways: by conducting research studies evaluating the efficacy of various treatments for PTSD, by training clinicians in the effective implementation of empirically sound interventions, and by providing direct clinical services to individuals and families affected by trauma.
Dr. Marylene Cloitre, Director of the Institute, recently concluded an NIMH funded R01 randomized controlled trial testing a two-phase, sequential therapy called Skills Training in Affective and Interpersonal Regulation with Modified Prolonged Exposure (STAIR-MPE). The first phase, skills training, focuses on improvement in day-to-day functioning while the second, a modified version of prolonged exposure, focuses on the processing of traumatic memories. The results of the clinical trial indicate that the sequential combination of skills training followed by emotional processing work addresses many of the aforementioned concerns of clinicians and suggest that STAIR-MPE may be effective in community settings.
In our current research, we are comparing the efficacy of STAIR versus the SSRI medication sertraline (Zoloft) for individuals with PTSD related to sexual trauma. In addition to the scientific value of the research, this treatment study meets a community need by offering free therapy to individuals who meet criteria for the study, and appropriate treatment referrals to those who do not. Our participants are adults (ages 18-56) living in and around New York City with either child and/or adult sexual trauma histories. Participants are administered a full clinical evaluation and participate in an fMRI scan of the brain before and after receiving their treatment of choice. Each participant has the option of receiving 16 sessions of cognitive behavioral therapy (STAIR-MPE) or medication treatment. Dr. Christie Jackson is the Project Director for this study and supervises the administration of STAIR. The SSRI arm is administered by Dr. Anthony Charuvastra, a psychiatrist mentored by Dr. Cloitre toward a research career in trauma-related psychiatric disorders. Study participants receive sertraline (Zoloft) in an open, flexibly dosed schedule designed to mimic typical clinical practice. Participants have weekly visits to assess their response to medication and address any side effects or other obstacles to treatment.
The neurobiological directive of the study is to examine the emotion regulation systems in the brain during Emotional Memory and Anticipatory Threat paradigms. Although the study is ongoing, a preliminary analysis of pre- and post-treatment data indicates reduced amygdala reactivity and increased right ventromedial prefrontal cortex activity during both paradigms after treatment. These neurochemical changes reflect reductions in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS) and improved emotion regulation skills as measured by the Negative Mood Regulation (NMR) Scale. Individuals interested in seeking treatment through our research study may call (212) 263-2483.
Dr. Cloitre and Dr. Jackson also work to disseminate effective treatments for PTSD. They recently conducted a two-day workshop at Columbia University’s New York Presbyterian Hospital for clinicians who treat individuals with histories of trauma. Dr. Cloitre has traveled throughout the world presenting findings from her research studies evaluating the efficacy of STAIR-MPE and teaching clinicians how to implement STAIR in their own practices. Both Dr. Cloitre and Dr. Jackson are actively supervising clinicians-in-training in the effective treatment of trauma-related disorders. Dr. Cloitre and colleagues recently published Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life, a treatment manual for clinicians who work with individuals with histories of chronic interpersonal trauma.
The final goal of the staff of the Institute for Trauma and Resilience is to offer high-quality direct clinical services. We work with children, adolescents, and adults who have experienced traumatic events such as the loss of a loved one, a motor vehicle accident, acts of terrorism, physical assault, sexual assault and other forms of interpersonal violence. The Institute provides evaluation, consultation, and treatment for individuals who are concerned about the possible effects of such events on their children, themselves or family functioning. The services provided are specifically tailored to the individual’s or family’s needs and include academic and psychological evaluation, cognitive-behavioral therapy, medication, skills building and resilience enhancement. State-of-the-art treatment approaches that are grounded in empirical support and have demonstrated efficacy in treating survivors of stressful events are offered. If you are interested in learning more about the clinical services offered, as well as our ongoing research projects, please visit our website: www.AboutOurKids.org.
Christie Jackson, PhD, is Clinical Assistant Professor, Kate R. Kuhlman, BA, is Project Associate, and Marylene Cloitre, PhD, is the Cathy and Stephen Graham Professor of Child and Adolescent Psychiatry at the Institute for Trauma and Resilience, NYU Child Study Center.