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In order for prolonged exposure therapy, an evidence-based psychotherapy for PTSD, to reach its full potential, any misperceptions or ruptures in trust and communication between therapist and client need fixing, according to a new Case Western Reserve University study.
The study, reported in the Journal of Consulting and Clinical Psychology online article, “Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for PTSD,” is among the first to examine how ruptures in the relationship between the therapist and client can damage a patient’s treatment outcome.
An alliance rupture may occur when there is a break in the therapist-client bond. For example, ruptures in the therapeutic relationship may occur when therapeutic progress stalls, negative feelings arise between the therapist and client, or when the work in therapy becomes challenging.
“We want therapists to know that a rupture in the therapeutic relationship isn’t a bad thing, as long as the therapist tends to it,” said Stephanie Keller, one of the study’s researchers and a Case Western Reserve doctoral student in clinical psychology. “However, if the rupture is not repaired, then your patient may not do as well in treatment.”
The research study included 116 people who experienced a traumatic event such as childhood sexual or physical abuse, physical assault, or combat exposure, and had a primary diagnosis of PTSD. Participants engaged in a 10-session treatment program called prolonged exposure (PE) therapy.
To help therapists chart progress and examine the therapeutic relationship, each client assessed his or her own PTSD symptoms and perception of their relationship with the therapist during treatment. This helped researchers to identify those clients who experience no ruptures in the therapeutic relationship (a stable relationship), clients who experienced a rupture that was subsequently repaired, and those with ruptures that went unrepaired.
Researchers have just identified a drug capable of preventing memory problems and increased anxiety in traumatized mice suffering from PTSD-like symptoms.
The finding has huge medical implications for future human PTSD (post traumatic stress disorder) treatment and/or prevention.
According to Howard Hughes Medical Institute investigators, a receptor called Oprl1 is altered when mice experience PTSD symptoms. The scientists then developed a drug that targets that specific gene, thus preventing the development of the disorder.
Mice were put through a traumatic event – being restrained to wooden boards – and were at a heightened state of fear.
The researchers then gave the mice the Oprl1-targeted drug and found that it had a preventive effect on PTSD and a significant impact on fear memory modulation.
The study, which was published in the journal Science Translational Medicine, indicated that humans with genetic variants of the Oprl1 gene are at a higher risk of developing PTSD after a traumatic event, suggesting that the new drug could have a similar effect in humans.
Study leader, HHMI investigator Kerry J. Ressler of the Emory University School of Medicine, said:
“PTSD is a tractable problem that can be prevented and treated if we put our mind to it. Bringing neuroscience and genetic approaches together provides a powerful way to understand this debilitating illness.”
PTSD is a severe anxiety disorder brought on by direct experience of traumatic events – the NHS (National Health Service) in the U.K estimated that about 40% of sufferers developed PTSD after a loved one died suddenly. A sufferer’s life may be completely disrupted, by reliving the horrific event through nightmares as well as flashbacks. Approximately 5% of men and 10% of women suffer from PTSD at some point in their lives.