OPENup: Optimizing exposure therapy for Posttraumatic Stress disorder
Although exposure therapy is the gold-standard treatment of posttraumatic stress-disorder (PTSD), only half of the patients adequately benefit from it. Based on recent insights into the mechanisms of extinction, this project examines strategies and techniques to improve exposure treatment outcome in PTSD.
- Rianne de Kleine
One in every 12.5 people will experience post-traumatic stress disorder (PTSD) at some point in their life. People with PTSD suffer from intrusive memories of the traumatic event, attempt to avoid all trauma-related thoughts, feelings and situations, have negative cognitions and are hypervigilant. PTSD is a disruptive disorder, with large psychological, social and economic impact. Although proven effective treatments for PTSD are available, 50 percent of people remain symptomatic after treatment. Improved treatment outcome for this patient population is urgently needed.
Exposure therapy is the treatment of choice for PTSD and is based on the principles of fear extinction. Extinction is based on the learning of non-threat inhibitory associations. Translated to exposure therapy for PTSD, a patient needs to learn (experience) that confrontation with trauma-related stimuli may elicit unpleasant symptoms but will not lead to their feared negative outcome (e.g. “going crazy”; “losing one’s mind”). Pre-clinical studies have established several strategies to enhance inhibitory learning.
Empirical studies testing the efficacy of translating Inhibitory Learning Theory (ILT) to exposure therapy are scarce, especially in complex disorders such as PTSD. To date, the best-investigated strategies to enhance inhibitory learning in non-clinical samples are 1) maximizing expectancy violation; 2) increasing variability. In this project, it is investigated whether maximizing inhibitory learning, by adding these ILT-based enhancement strategies to exposure therapy for PTSD, improves treatment outcome.