Bridging Access to PTSD Care in Primary Care

By: Emory Healthcare Veterans Program
Date: Aug 5, 2019
PTSDVeterans HealthPrimary Care
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Emory Healthcare Veterans Program (EHVP) is known for its innovative research when it comes to treating posttraumatic stress disorder (PTSD). Now the team behind the research is working to make treatment more accessible nationwide. In her role as Director of Mental Health Research and Program Evaluation at the Atlanta Veterans Affairs Medical Center, Dr. Sheila Rauch, EHVP’s Clinical Director, works to make PTSD care more accessible within the VA by utilizing a version of prolonged exposure for embedded mental health workers in primary care.

After demonstrating the effectiveness of the protocol to reduce PTSD symptoms in primary care, Dr. Rauch designed a program to train primary care mental health providers so they are better prepared to help patients struggling with PTSD.

“PTSD is a disorder of avoidance; any hurdle to receiving care could be a reason someone seeking help will go back to avoiding, so we are working to reduce barriers to care. There is no wrong door, we want to assist everyone who comes in looking to treat their PTSD and we want to do it as soon and as quickly as possible,” said Dr. Rauch.

“There is still a large population of those with PTSD who do not seek care, so we are working to find ways to provide treatment that is not only effective but also can be accessed quickly because this population will most likely not follow through with treatment the first time they reach out.”
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What is Prolonged Exposure Therapy?

Prolonged exposure therapy involves working with patients to help them approach the memories and reminders of trauma so that they are the ones in control of their lives—not the trauma. PTSD is a disorder of avoidance and prolonged exposure therapy gives the patient the tools needed to approach the memory and the people, places and situations they had been avoiding.

“At its bones, the treatment is simple relearning, doing what you are afraid of over and over again and it gets easier,” said Dr. Rauch.

Three common components of prolonged exposure therapy are:

  • Psychoeducation
  • Imaginal Exposure
  • In Vivo

Psychoeducation provides a foundation of information on how PTSD develops and how treatment works. This foundation helps the patient and provider speak the same language and lets the patient begin to learn how to approach instead of avoid.

During imaginal exposure, the patient is asked to narrate the feared situation to the clinician multiple times. This narration is an important step because it allows the patient to finally process the trauma that occurred and understand why it was so disarming in the first place.

In Vivo (a Latin phrase translated as “in the living”) is a method used to take the tools learned during therapy sessions into a real-world setting. If the patient is working to overcome a fear of driving, for example, an in vivo session may include the clinician and patient driving through Atlanta traffic.

All three components of prolonged exposure therapy work together to help patients overcome the fear of the traumatic experience and begin processing what they had been avoiding for so long.

What Does a Prolonged Exposure Primary Care Session Look Like?

Prolonged exposure primary care (PE-PC) includes four to eight 30-minute sessions provided in primary care as opposed to specialty mental health. Since most people suffering with PTSD prefer to receive their care in a primary care setting with the providers they know, this option really increases access to effective PTSD care. The treatment can also be conducted through telehealth (a web-based platform) to increase reach.

“We are setting up a process to reach patients where they are instead of waiting for them to come to us because any hurdle could become a reason to go back to avoiding care,” said Dr. Rauch.

Emory Healthcare Veterans Program

EHVP provides expert, collaborative care for post-9/11 veterans and service members in the United States, regardless of discharge status. Conditions treated include PTSD, traumatic brain injury, military sexual trauma, depression and anxiety. Learn more about the program by calling 888-514-5345 or visiting the website at emoryhealthcare.org/veterans.
 

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