To the Editor: V.A.’s Treatment of Veterans’ Trauma

To the Editor: V.A.’s Treatment of Veterans’ Trauma

The New York Times

January 24

To the Editor: V.A.’s Treatment of Veterans’ Trauma – By Charles Marmar, MD

Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry, and chair, Department of

Psychiatry, Cohen Veterans Center

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To the Editor:

I applaud the courage of David J. Morris in sharing his compelling story of struggles with treatment for post-traumatic stress disorder. Unfortunately, many veterans returning from long, emotionally challenging deployments have difficulty tolerating prolonged exposure therapy for treatment of PTSD. For some it is equivalent to retraumatization.

While prolonged exposure is widely regarded as a validated treatment for PTSD, its principal use has been for women after sexual trauma. Evidence of its effectiveness in male combat veterans — or men following any traumatic event — is weaker.

In retrospect, Mr. Morris might have been better served by a combination of medication and cognitive processing therapy. And for veterans who cannot initially tolerate jumping out of the fire of combat and into the frying pan of prolonged exposure, there are exercises in emotion regulation that can be taught first, to increase a person’s ability to tolerate reminders of combat.

In addition, research in “personalized medicine” is needed to develop biomarker predictions for those veterans who will, and will not, be able to tolerate prolonged exposure. These studies will help clinicians move away from a one-size-fits-all approach and streamline the selection of the right treatment protocol for each veteran suffering from PTSD.

New York, Jan. 21, 2015

The writer is chairman of the psychiatry department at NYU Langone Medical Center and director of the Steven and Alexandra Cohen Veterans Center there.