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Experts explore wide range of therapies: McGuire psychologist and former UR composer explore musical approach
September 16, 2007

Richmond Times-Dispatch, Va. -- In a search to improve patients' receptiveness to psychological treatment, psychiatrists are trying newer antidepressants.

Experts also are investigating the use of other drugs, such as anti-epileptics, beta-blockers typically used by heart patients and even a tuberculosis drug. Other researchers are exploring new forms of behavioral therapy mixed with 21st-century technology.

This fall, the federal Institute of Medicine will issue a report examining new treatments for post-traumatic stress disorder. The institute reported last year on PTSD diagnosis and assessment at the request of the Department of Veterans Affairs.

Despite decades of research, no one knows immediately which combination of treatment is right for a particular patient. Genetic screening to know who is more at risk for PTSD, or which drugs will work best for certain patients, is decades away.

"The reality is that [patients] come in and sit in your office and talk with you and you have to use your best judgment. It would be fabulous if we got to the point where we could screen people and determine what kind of treatment would help them best," said psychologist John R. Lynch, who treats PTSD patients at McGuire Veterans Affairs Medical Center in Richmond.

Lynch studies ways to reduce the problem of hypervigilance, which helps keep soldiers alive in wartime but can create problems in civilian life.

Sleep becomes difficult when veterans feel they cannot physically relax and be safe, increasing the PTSD sufferer's "profound sense of isolation," he said. Lynch and his colleagues describe some issues for PTSD-affected vets and their families in a new booklet at McGuire.

Some of Lynch's patients listen to a 33-minute compact disc when they go to sleep. The patient hears Lynch describing relaxation exercises while anxiety-reducing music plays in the background. The use of this music has been studied in pain management and as an aid in the healing process.

Fred Cohen, formerly of the University of Richmond, composed the music specifically to accompany Lynch's script.

"It's not often a concert composer can boast of writing a piece with the express purpose of putting the audience to sleep, over and over again," said Cohen, now at Columbus State University in Georgia.

Cohen said his composition had to avoid familiar sounds that would bring the listener out of the trancelike state the music intends. The music's tempo, which serves as a kind of pulse, gradually and intentionally slows to calm the listener. "I had never done anything like this before," he said.

Another approach soon to be tested at McGuire is a form of acceptance and commitment therapy now used to help rape victims. In this treatment, patients write about their experience numerous times as a way to get through their trauma, said John Benesek, acting director of McGuire's PTSD program. "This is a way of . . . getting it so you can deal with it, integrate it into yourself and get beyond it."

Another experimental PTSD treatment combines a high-tech form of exposure therapy with an old TB drug. Backed by federal funding, including about $4 million from the Office of Naval Research, several teams of university-based scientists are studying exposure therapy, which uses virtual reality. Some of the teams conducting the research are in San Diego, Atlanta, Seattle and Hawaii.

Some of the virtual-reality studies combine the treatment with the drug d-cycloserine. The drug activates a protein that appears to help the brain form new, less-emotional associations with the original trauma, allowing patients to tolerate unpleasant memories better and reduce the number of therapy sessions.

The virtual-reality therapy exposes patients to scenes, sounds, vibrations and odors related to combat in Iraq. Participants repeatedly undergo treatment for about a month to help disengage their fearful response from their war experiences.

"It seems to allow people to get through the process more quickly," said psychiatrist John Hettema of Virginia Commonwealth University, who specializes in fear and anxiety disorders.

Although early studies suggest the therapy can help some patients, the virtual-reality systems are expensive and labor-intensive. In some cases, its use may instead reinforce some patients' fearful responses, critics said.
 

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