Why do some people who experience a severe traumatic event develop PTSD while others do not? Yuval Neria, PhD, professor of medical psychology (in psychiatry) at Columbia’s College of Physicians and Surgeons, hopes to find neural markers for PTSD to enable clinicians to more accurately diagnose and assess PTSD and tailor patients’ treatment. Dr. Neria is also a professor of epidemiology at Columbia’s Mailman School of Public Health and director of the Trauma and PTSD Program at Columbia Psychiatry and the New York State Psychiatric Institute,
“The capacity to handle fearful ordeals, to keep them at an emotionally manageable level,” says Dr. Neria, “depends on a successful ‘dialogue’ between the temporal lobe brain structure known as the amygdala—the seat of emotions like fear and anger—and the prefrontal cortex and hippocampus. In individuals with PTSD, there doesn’t seem to be as much input from the prefrontal cortex and hippocampus to dampen down the amygdala as in more emotionally resilient individuals.”
When the amygdala becomes overactivated, it triggers a cascade of physiological and emotional events. A military veteran with PTSD, for example, may experience extreme anxiety when hearing a helicopter approach, a reminder of a crash in which he suffered terrible injuries. Such fears can lead to social withdrawal and detachment from others, as well as to self-medication with substances like alcohol and marijuana. Though some people with PTSD recover slowly on their own, PTSD for many is a chronic, debilitating condition.
Using fMRI scans before and after treatment with a cognitive behavioral therapy called prolonged exposure (PE) therapy, Dr. Neria and his lab have been able to determine whether neural functioning of fear circuitry (amygdala-–prefrontal cortex-–hippocampus) is improved. With PE therapy, which was developed specifically to treat individuals with PTSD, the patient recalls the main trauma over and over until it no longer provokes anxiety. Dr. Neria wants to know whether PE therapy, both with and without serotonin selective reuptake inhibitors (SSRIs)—the only FDA-approved medications for PTSD—works and, if so, whether the improvement can be measured via brain imaging and sustained.
“Once patients are able to elaborate and discuss their trauma fully,” says Dr. Neria, “they not only begin to feel relief, but often to exhibit better neural functioning, especially in brain regions known to process fearful experiences.”
Below is the story of one program participant’s experience with PE therapy.
Chris, a 26-year-old veteran, came from a family with a military history dating back to World War I. He considers himself a patriot, but he also saw military service as a way out of his small town. “I didn’t have the smarts or the money to get into college,” he says. “I already tried community college but it just wasn’t working for me.”
His enlistment was short-lived when, during basic training, he was sexually assaulted. “It was the worst experience of my life, but I did what I could to block it out,” he says. Throwing himself into his duties, however, was not enough to stanch the emotional hemorrhaging he was experiencing. His drinking grew out of control, he experienced headaches, his marriage fell apart, and he came dangerously close to killing himself.
After discharge from the military, Chris moved back to the New York area. While job searching on craigslist, he came across an ad for Dr. Neria’s research study on PTSD. Though Chris knew he needed help, making the decision to enroll wasn’t easy. “This took a lot of thinking,” he says, “but I was at a point in my life where—what choice did I have?” He also rationalized, “Even if the treatment doesn’t work, at least I get some extra cash out of it.”
As part of the brain imaging study in which he participated, Chris completed a 10-week course of PE therapy. While his anxieties haven’t completely gone away, he says, “The main thing is that I am able to deal with them in such a way that they’re not going to hold me back in my life significantly.”
Foundation Lends Support
The Hopeful Dawn Foundation has announced a collaboration with Columbia University and Tel Aviv University in Israel to develop programs that will research, prevent, and treat war veterans and other young adults who suffer from trauma, severe post-traumatic stress disorder, and related psychiatric disorders.
Columbia’s Yuval Neria and Tel Aviv’s Yair Bar Haim will collaborate to expand PTSD programs offered by the Trauma and PTSD Program at Columbia’s Department of Psychiatry and the PTSD Center at the School of Psychological Sciences at Tel Aviv University.
The Hopeful Dawn Foundation will provide philanthropic support of activities to advance trauma-related research, clinical care, and training. The collaboration will seek to develop innovative clinical interventions and prevention programs to address the paucity of research on primary prevention of PTSD and the limited efficacy of existing treatments.
“The effects of emotional trauma on mental function, particularly in the context of military combat, has been understudied for too long and is a critical public health priority,” says Jeffrey A. Lieberman, MD, chair of psychiatry at Columbia. “We are grateful for this generous support to Columbia and Tel Aviv Universities to expand our research and services in PTSD.”