The research builds on past animal studies that indicated retrieval or reactivation of an emotion­al memory opens a window of opportunity in which a training procedure can alter it. Learning not to fear, a process called fear extinc­tion, appears to depend on a specific type of cell in the amygdala, a brain structure known for its role in emotion, learning, and memory. Dis­abling these “intercalated” (ITC) amygdala cells impairs extinction suggesting that therapies which can boost ITC function may improve treatment effectiveness.

Early stage research suggests that virtual reali­ty exposure therapy (VRE) may serve as an effective and efficient alternative to traditional exposure therapy. Immersive technology that can recreate a multisensory experience — sight, sound, smell, and touch — in the relative comfort of a doctor’s office may be more accept­able to clinicians and their patients. Early studies have shown that certain medica­tions may help reduce fear, manage sleep problems, and reduce stress.

These medications may be used in conjunction with psychotherapy. Further stud­ies are testing whether such treatments are also effective for people with PTSD and de­termining the optimal timing and dosage for treatment. Researchers are studying the use of medications that may speed-up and enhance the positive effects of talk thera­py. There is promising evi­dence that so called “cogni­tive enhancers,” when taken prior to talk therapy, make the process of diminishing fear memories (extinction) more efficient.

Research on corticosterone, a hormone in rats involved in responding to stress, and en­ergy-producing cell structures called mitochondria revealed how individual cells adapt to cope with sudden or ex­treme stress. In humans, the hormone cortisol is believed to work in the same way as corticocosterone does in rats. This finding may be relevant to research on a number of stress-related illnesses, including PTSD, and suggests new pathways for improving treatments. A study on mice showed that the ability to adapt to stress is driven by a distinctly different molec­ular mechanism than is the tendency to be overwhelmed by stress.

The NIH-funded researchers mapped out both mecha­nisms—components of which also are present in the human brain— which may one day help scientists learn how to enhance this naturally occur­ring phenomenon to promote resilience to psychological stress. In the last decade, rapid progress in research on the mental and biological foundations of PTSD has led scientists to focus on preven­tion as a realistic and import­ant goal.

Some of the prevention strategies currently being tested are: Exploring the optimal time to begin expo­sure therapy after trauma exposure to prevent the development of PTSD. This treatment involves education about trauma reactions and PTSD, breathing exercises, exposure to trauma-related stressors, and talking through the trauma.

Researchers will also seek to identify predictive mark­ers, such as hormone levels and genes, for the disorder. Using the medication hy­drocortisone, which mimics cortisol, to examine whether increasing cortisol levels may prevent or reduce PTSD symptoms. Related to pre­vention goals, research on resiliency — the ability for some people to recover from traumatic experiences or avoid adverse reactions en­tirely — may lead to ways to predict who is most likely to develop PTSD following highly stressful events. Treatment efforts could then be target­ed more efficiently toward those who need it most.

For improving response to mass trauma events, NIH researchers are testing cre­ative approaches to making cognitive and behavioural therapies and other interven­tions widely available, such as with Internet-based, self-help therapy and telephone assisted therapy. Emotional Surgery, the science of using colour code frequencies to remove what is not good from the human mind super­sedes all known and modern therapies.

By Robert Ekow Grimmond-Thompson