Abnormal Psychology

Anxiety Disorders 323

Targeting Neurological Factors: Medication

The SSRIs sertraline (Zoloft) and paroxetine (Paxil) are the fi rst-line medications

for treating the symptoms of PTSD (Brady et al., 2000; Davidson et al., 1997; Stein

et al., 2000). In general, an SSRI should be taken continuously for at least 9 months

for fullest symptom relief (Rosenbaum et al., 2005). An added advantage of SSRIs

is that these medications can also help reduce comorbid symptoms of depression

(Hidalgo & Davidson, 2000)—which is important because many people with PTSD

also have depression. As with other anxiety disorders, when people discontinue the

medication, the symptoms may return. This is why medication is not usually the sole

treatment for PTSD, but rather is combined with treatment that directly addresses

psychological and social factors (Rosenbaum et al., 2005).

Two experimental treatments that directly target neurological factors hold

promise for helping people with PTSD. One is the use of propranolol (Inderal), a

beta-blocker (also used to treat performance anxiety, as noted earlier in this chapter);

preliminary studies suggest that when taken soon after a traumatic event, it

may decrease the risk of subsequent PTSD by diminishing neural aspects of fear

conditioning (Pitman & Delahanty, 2005; Vaiva et al., 2003), although not all stud-

ies fi nd such preventative medication treatment to be more effective than placebo

(Stein et al., 2007). The other experimental treatment for PTSD is transcranial mag-

netic stimulation (TMS; see Chapter 4). Preliminary results suggest that TMS can

reduce PTSD symptoms, but these fi ndings need to be replicated and further

understood before TMS becomes part of the repertoire of standard treatments

(Cohen et al., 2004; Osuch et al., 2008).

Targeting Psychological Factors

Treatments that target psychological factors generally employ a combination of be-

havioral methods and cognitive methods, which, separately or in combination, are

about equally effective (Keane & Barlow, 2002; Marks et al., 1998; Schnurr et al.,

2007; Tarrier et al., 1999). However, most studies of CBT for acute stress disorder

or PTSD do not include lengthy follow-up (Bradley et al., 2005).

CBT conducted online helped people

who developed PTSD as a result of the

September 11, 2001, terrorist attack on

U.S. Navy/Getty Images the Pentagon (Litz et al., 2007).

Behavioral Methods: Exposure, Relaxation, and Breathing Retraining

A traumatic experience can leave someone who has PTSD with a diminished sense of

control over the environment, and perhaps over himself or herself; this person may

then go to unreasonable lengths to avoid stimuli associated with the trauma. This is

why treatment aims to increase a sense of control over PTSD symptoms and to decrease

avoidance. Just as exposure is used to decrease avoidance associated with other anxiety

disorders, it is used for PTSD: Imaginal exposure or in vivo exposure (see Chapter 4)

aims to induce habituation and to reduce the avoidance of internal and external cues

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