Three innovations and trends in PTSD treatment deserve specific attention: Internet-based assessment and treatment, virtual-reality therapy, and transcranial magnetic stimulation. Each of these is making use of exciting new technologies or social trends and forces that are unarguably the wave of the future in mental health research and practice.
European researchers Lange, Rietdijk, Hudcovicova, van de Ven, Schrieken, and Emmelkamp (2003) developed and tested an Internet-based treatment for PTSD. Internet-based therapy, although new and with many ethical and practical issues yet to be worked out, is a promising line of inquiry and practice. In contrast to simple computer-based therapy or even workbook-based therapy, Internet-based therapy provides direct feedback to the patient or participant via computer and the Internet. Internet-based therapy is promising for many reasons. Patients who live in remote areas, those with mobility or transportation problems, and those who have difficulty leaving their home because of psychological or symptomatic reasons might benefit from the access provided via the Internet.
Lange and colleagues (2003) developed a form of Internet-based therapy they call Interapy, which consists of structured writing assignments with three phases, "self-confrontation, cognitive reappraisal, and social sharing" (pp. 1-2). Treatment consists of a ten 45-minute writing sessions over a 5-week period. Patients must log in to the treatment system on the Internet. In the middle of each of the three phases, the therapist provides feedback about what has been written about thus far and how to continue. The self-confrontation phase is essentially an exposure phase of treatment with instructions to describe the traumatic event and to write about emotions and thoughts the patient has. Patients must write in the first person and use substantial detail, and no emphasis is placed on the mechanics of writing, such as punctuation or spelling. The second phase of the treatment consists of cognitive reappraisal in which the patient receives some psychoeducation about cognitive reappraisal and instructions to formulate advice for a hypothetical friend who suffered the same trauma. The third phase consists of psychoeducation about sharing with others and instructions for patients to write about developing a new focus in life, with less focus on the trauma. Ultimately, Lange and colleagues found that more than 50 percent of participants "showed reliable change and clinically significant improvement, with the highest percentages being found for depression and avoidance" (p. 1).
Researchers have developed and tested an immersive virtual-reality (VR) therapy treatment for PTSD with various populations, including combat veterans and 9/11 victims (Difede & Hoffman, 2002; Hodges et al., 1999; Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001). The necessary technology is much cheaper and more sophisticated than in years past. The power of VR therapy is explained by Glantz, Durlach, Barnett, and Aviles (1996):
The power to "immerse" the user in a simulated, multimodal world—derives not so much from the realism of the displays, as from the fact that perception and action are integrated, just as they are in the real world The user of VR is a doer, and since, as is well known, doing has a more powerful effect than passive participation, the probability that learning will be transferred from the therapy setting to the real world is increased. (p. 464)
Glantz, Rizzo, and Graap (2003) identify four strengths of VR therapy: (1) the potential to precisely control what is presented to the patient, (2) the ability to tailor treatment environments to the needs of each individual, (3) the ability to expose the client to a range of conditions that would be impractical or unsafe in the real world, and (4) the ability to improve confidentiality by substituting for group treatment or in vivo desensitization.
Virtual-reality treatments for PTSD utilize cognitive-behavioral principles, primarily brief or prolonged exposure. Virtual exposure environments are constructed based on the specific traumatic event, such as combat or war. Although VR is promising for many reasons, technological issues, cost, and people's attitudes and resistances to technology can be complicating factors. Nonetheless, VR therapy for PTSD as well as other disorders holds much promise for the future.
Several studies have been conducted that investigate the use of magnetic brain stimulation on PTSD with some promise (Cohen et al., 2004; Grisaru, Amir, Cohen, & Kaplan, 1998; McCann et al., 1998; Rosenberg et al., 2002). The technology and technique is called transcranial magnetic stimulation (TMS) and has been used with other disorders as well, including depression and Schizophrenia. Transcranial magnetic stimulation is primarily an investigation tool for neuroscience research. An electromagnetic coil is placed on the head, and a series of high-intensity currents is turned on and off within the coil, thus producing an altered magnetic field around and amongst the brain. This results in the flow of electrical current throughout the brain and the depolarization of neural membranes. This can be done in a single episode or in repeated trials. Mantovani and Lisanby (2004) explain:
The ability to focally alter cortical excitability opens up the potential to modulate cortical circuitry for potential therapeutic benefit. The focality of the effects also presents a challenge to clinical application, because it is necessary to know the circuitry of the underlying disorder to guide where and how to stimulate to ameliorate symptoms.
With respect to PTSD, as interpreted by McCann et al. (1998), TMS is considered to have an effect on the altered-baseline levels of cerebral metabolism. Grisaru et al. (1998) proposed that the possible active-change mechanism is a reduction in overall cerebral excitability and hyperarousal. This treatment is still in its infancy and is not approved by the U.S. Food and Drug Administration (FDA). Nonetheless, it holds promise in its short-duration, not requiring months and months of treatment, and in its ability to further research while also serving as a treatment.
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