Retraining the Brain : Applied Neuroscience in Exposure Therapy for PTSD

"Rauch and McLean bridge the gap between neuroscience research and the treatment of PTSD patients. Individuals with PTSD have developed automatic associations between specific stimuli and traumatic events. As a result, these individuals experience intense fear when exposed to the stimuli, even though the original threat is no longer present. This book presents prolonged exposure therapy (PE), a specific manualized exposure therapy program for PTSD. A variant of exposure therapy, PE is a cognitive behavioral approach designed to reduce pathological anxiety and related emotions by helping patients approach relatively safe but distress-provoking thoughts, memories, situations, and stimuli, with the goal of reducing unhelpful emotional reactions to those stimuli. Informed by extensive research but written for clinicians, the book explains how neuroscience can guide our application of the three key components of PE: (1) psychoeducation about the nature of trauma, (2) in vivo exposure to trauma reminders, and (3) imaginal exposure to the memory of the traumatic event followed by processing of the imaginal and other exposures"-- Provided by publisher post-traumatic stress disorder treatment, cognitive therapy, neurosciences Retraining the Brain -1 Title Page 5 Copyright 6 Dedication 7 Contents 9 Preface 13 Part I: Theory and Overview of Prolonged Exposure 15 Chapter 1: Theory and Prolonged Exposure 17 Early Learning Theories 17 Schema Theories 20 Cognitive Theories 21 Emotional Processing Theory 22 Inhibitory Learning Theory 31 Chapter 2: What is Prolonged Exposure Therapy? 33 Development of Prolonged Exposure Therapy 34 Overview of Treatment 36 Efficacy of Prolonged Exposure 45 Part II: Neuroscience Methods for Clinicians 53 Chapter 3: Neurosteroids, Cortisol, and Other Neurochemicals 55 Methods of Scientific Discovery 56 Hypothalamic–Pituitary–Adrenal (HPA) Axis 58 Catecholamines 62 Sex Hormones 64 Oxytocin 66 Brain-Derived Neurotrophic Factor 66 Conclusion 67 Chapter 4: Imaging 69 Methods for Scientific Discovery 70 Conclusion 79 Chapter 5: Electroencephalography 81 Methods for Scientific Discovery 81 What Does This Mean for PTSD? 85 What Does This Mean for PE? 87 Conclusion 88 Chapter 6: Psychophysiology 91 Methods for Scientific Discovery 91 What Does This Mean for PTSD? 92 What Does This Mean for PE? 95 Within-Session Extinction 98 Between-Session Extinction 99 Conclusion 102 Chapter 7: Genetics and Genomics 105 Methods for Scientific Discovery 106 What Does This Mean for Trauma Exposure and PTSD? 108 What Does This Mean for PE? 110 Part III: Applied Neuroscience: Prolonged Exposure for PTSD 113 Chapter 8: Psychoeducation and Neuroscience 115 Establishing the Foundation 116 Learning Under Stress 119 Avoiding Relapse 120 Chapter 9: In Vivo Exposure and Neuroscience 123 Neuroscience Applied to Hierarchy Planning 123 Activation During In Vivo Exposure Practice 126 Discriminating Safety From Threat 127 Chapter 10: Imaginal Exposure and Neuroscience 129 Activation 129 Extinction and Inhibitory Learning in Imaginal Exposure 131 Chapter 11: Processing and Neuroscience 135 Making Implicit Learning Explicit 136 Facilitating Contextualization of Previous Fear Learning 137 Reflection 139 Part IV: Future Directions 141 Chapter 12: Augmentation of Prolonged Exposure 143 Psychotherapy Augmentation 144 Pharmacotherapy Augmentation 146 Pharmacological Augmentation of Extinction 146 Transcranial Magnetic Stimulation 152 Behavioral Augmentation 153 Alternative Medicine Approaches 154 Idiographic Approaches 155 Chapter 13: New Models of Care Delivery 159 Massed Treatment 160 Shorter Sessions 162 Abbreviated Treatment 163 Primary Care 164 Virtual Reality 165 Telehealth 166 eHealth 166 mHealth 169 Conclusion 170 Glossary 173 References 177 Index 221 About the Authors 233 "Rauch and McLean bridge the gap between neuroscience research and the treatment of PTSD patients. Individuals with PTSD have developed automatic associations between specific stimuli and traumatic events. As a result, these individuals experience intense fear when exposed to the stimuli, even though the original threat is no longer present. This book presents prolonged exposure therapy (PE), a specific manualized exposure therapy program for PTSD. A variant of exposure therapy, PE is a cognitive behavioral approach designed to reduce pathological anxiety and related emotions by helping patients approach relatively safe but distress-provoking thoughts, memories, situations, and stimuli, with the goal of reducing unhelpful emotional reactions to those stimuli. Informed by extensive research but written for clinicians, the book explains how neuroscience can guide our application of the three key components of PE: (1) psychoeducation about the nature of trauma, (2) in vivo exposure to trauma reminders, and (3) imaginal exposure to the memory of the traumatic event followed by processing of the imaginal and other exposures"-- Site de l'éditeur A clinician-driven, research-based review of the theory and applicable neuroscience informing prolonged exposure therapy, a cognitive behavioral approach designed specifically for PTSD patients to reduce pathological anxiety and related emotions