Neurobiological Predictors and Mechanisms in Exposure Therapy for PTSD


Identify changes in levels of certain hormones, steroids, and other biological substances to “track” improvements in patients’ PTSD symptoms over the course of treatment; determine the specific changes associated with three different ways of delivering Prolonged Exposure therapy.

Prolonged Exposure, or PE, is one of the most effective treatments for posttraumatic stress disorder. The therapy has helped many PTSD patients face thoughts, feelings and situations that they have avoided due to distress. Even with this effective therapy, however, many patients continue to suffer with PTSD symptoms following treatment.

In this study for the Consortium to Alleviate PTSD, a research team led by Sheila A.M. Rauch, PhD, of the Emory University School of Medicine and Atlanta VA Medical Center, will use neuroscience methods in an effort to learn how effective therapy for PTSD works on a biological level in order to learn how to make it work even better.

Neurobiological studies have found links between PTSD severity and the levels of certain compounds produced by the body. Dr. Rauch and her fellow CAP investigators want to know if changes in the levels of those substances can serve as biomarkers of response to therapy.

To help answer such questions, this study will work with active duty military personnel and veterans who enrolled in either of two studies utilizing PE that are part of the clinical trials network of the STRONG STAR Consortium and the Consortium to Alleviate PTSD.

Dr. Rauch and her colleagues will measure various neuroendocrine and neurosteroid substances before, during, and after the patients’ treatment periods to see how those substances change in response to therapy, potentially shedding light on components of PE that are most effective. They also will compare differences in biomarkers resulting from different ways of delivering PE. Substances to be measured include cortisol, allopregnanolone and related metabolites, and dehydroepiandrosterone.

Potential benefits

The ability to measure neurobiological processes in response to PTSD treatment will provide a guide for making improvements to treatment so that more patients will benefit. This study will inform our understanding of how therapy works (or does not work) and how we might improve treatments based on these biological responses.

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