Posttraumatic Stress Disorder (PTSD) is a debilitating, often chronic disorder with serious psychiatric morbidity among civilians. The incidence in the U.S. is estimated at 1 % to 3%, although rates can be considerable higher in vulnerable populations. In traumatized groups such as rape and severe assault victims, the rate of PTSD can approach 50%. Little is known regarding effective pharmacologic and psychosocial treatment in civilians with PTSD, as the majority of research to date has been conducted in war veterans. This grant proposes a five year training and research program, which encompasses 3 major research domains of PTSD: pharmacologic treatment, psychosocial treatment, and biological correlates of clinical symptoms. Training would be accomplished in intensive supervision with the mentor (Michael Liebowitz, M.D.) and scientific advisors; course work; tutorials in major research centers; collaboration with established investigators; and original research projects. Five interrelated projects are proposed: 1) a double-blind, placebo-controlled, 12-week trial of paroxetine in PTSD; 2) development of a time-limited individual psychotherapy which integrates cognitive-behavioral and psychodynamic principles; 3) a systematic open trial of the integrated psychotherapy; 4) measurement of cortisol levels pre- and post-treatment in both clinical treatments; 5) assuming positive findings in #1 and #3, development of a clinical trial to assess the efficacy of paroxetine, pill- placebo, psychotherapy, and combined paroxetine and psychotherapy. It is hypothesized that both paroxetine and psychotherapy will be effective for PTSD, and that the combination might be superior to either treatment alone.
| Marshall, Randall D; Bryant, Richard A; Amsel, Lawrence et al. (2007) The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears. Am Psychol 62:304-16 |
| Dohrenwend, Bruce P; Neria, Yuval; Turner, J Blake et al. (2004) Positive tertiary appraisals and posttraumatic stress disorder in U.S. male veterans of the war in Vietnam: the roles of positive affirmation, positive reformulation, and defensive denial. J Consult Clin Psychol 72:417-33 |
| Marshall, Randall D; Carcamo, Jaime H; Blanco, Carlos et al. (2003) Trauma-focused psychotherapy after a trial of medication for chronic PTSD: pilot observations. Am J Psychother 57:374-83 |
