Ladies' Home Journal's 3rd Annual Health Breakthrough Awards

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Paula P. Schnurr, PhD: Helping Vets with Post-Traumatic Stress

Post-traumatic stress disorder (PTSD) can be life altering. Triggered by a traumatic event -- living through a natural disaster like Hurricane Katrina, experiencing military combat, or enduring sexual assault -- PTSD plagues half its sufferers for life, leaving them emotionally numb, subject to insomnia, nightmares, and flashbacks, and unable to face reminders of their trauma.

Though both men and women are at risk for PTSD, women are twice as likely to develop it, a fact that long predates the current conflicts in the Middle East but has become more urgent because of them. There are now more than 1.7 million women veterans, 177,000 of whom have served in Iraq or Afghanistan since September 2001. But while PTSD treatments had been evaluated in studies on male veterans, no one had done large-scale definitive research on the most effective PTSD treatment for female veterans and active-duty personnel.

Then, in February 2007, Paula P. Schnurr, PhD, deputy executive director of the National Center for PTSD for the Department of Veterans Affairs (VA), in White River Junction, Vermont, published groundbreaking research in the Journal of the American Medical Association. She and her team studied 284 veteran and active-duty women and found that PTSD symptoms were twice as likely to decrease dramatically in those treated with prolonged exposure therapy than in those women who received the other main treatment, present-centered therapy (PCT), which focuses on a patient's current problems. In prolonged exposure therapy, the patient repeatedly recounts the traumatic event until her emotional response eases. By contrast, PCT focuses on coping with issues that may be caused by PTSD.

Even more remarkable: Some women who benefited from the exposure therapy had been experiencing PTSD for more than 20 years. "With just 10 weekly 90-minute sessions, we improved their symptoms," says Dr. Schnurr, 52, who has two grown daughters. "It was a joy and a relief to have really good evidence that this treatment could make a difference."

Dr. Schnurr's findings drove the VA to support a national training program in prolonged-exposure therapy, which had not previously been widely used in its giant healthcare system or in civilian healthcare settings. "This is the most important clinical trial to date examining the psychological treatment of combat- related PTSD," says Terence M. Keane, PhD, director of the behavioral science division at the National Center for PTSD, in Boston. "It really is what drove the decision to implement the VA education efforts."

Experts don't know why women are more vulnerable to PTSD. Some research shows that, overall, women are likelier to experience the kind of traumatic events that would cause anyone -- male or female -- to develop PTSD, explains Dr. Schnurr. Next on her agenda? Finding a way to help primary-care providers manage PTSD in people who want to come to their family doctor for treatment and giving PTSD patients tools to make informed choices about care, such as details about the side effects from medication and benefits of different therapies. "I am very interested in doing the kind of research policy makers can use to help the men and women who sacrificed so much for their country," Dr. Schnurr says.

Paula P. Schnurr won the Marianne J. Legato Award for Gender-Specific Medicine (named in honor of Ladies' Home Journal's medical adviser, a pioneer in researching the different health needs of men and women).

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