Drs. Sheila Rauch & Carmen McLean: The Neuroscience of Prolonged Exposure for PTSD

Thoughts on Record: Podcast of the Ottawa Institute of Cognitive Behavioural Therapy

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Prolonged Exposure (PE) therapy is among the most effective, empirically supported treatments for posttrauamtic stress disorder. Importantly, there is a growing literature around the neuroscience of PE which has important implications for the delivery of PE. Drs. Sheila Rauch & Carmen McLean, join us for a review of some of the core themes in their book Retraining the Brain: Applied Neuroscience in Exposure Therapy for PTSD. In this discussion we cover:

• why Drs. Rauch & McLean wanted to write this book
• a brief overview of Prolonged Exposure (PE) therapy
• comparing & contrasting the theoretical mechanism underlying PE vs. research findings
• considering the window of tolerance in PE through the lens of applied neuroscience
• impact of length of session on treatment from a brain lens
• the relative (and interactive) impact of in vivo &. imaginal exposure
• whether tailoring the clinical approach (e.g., PE vs CPT) is necessary depending on the client’s presentation
• the potential utility for PE in addressing moral injury
• a consideration of whether PE could be experienced differently within the brain depending on the client’s stance to the treatment i.e., high vs. low willingness
• the provision of PE through virtual platforms
• best practices around combining medications with PE
• Psychedelic/MDMA assisted psychotherapy - caveats and opportunities
• novel augmentation methods for PE
• avoiding clinician burnout/vicarious traumatization in the context of PE

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Sheila A.M. Rauch, Ph.D., ABPP, is Deputy Director of the Emory Healthcare Veterans Program and Director of Mental Health Research and Program Evaluation at the Atlanta VA Healthcare System. She has published scholarly articles, chapters, and books on anxiety disorders and posttraumatic stress disorder (PTSD) focusing on neurobiology and factors involved in the development, maintenance, and treatment of anxiety disorders, psychosocial factors in medical settings, and the relation between physical health and anxiety. She is an author of the second edition of the Prolonged Exposure manual and patient workbook as well as the PE for Intensive outpatient programs manuals. She is a fellow of the Association of Behavioral and Cognitive Therapy (ABCT), was granted membership in the American College of Neuropsychopharmacology, and serves as a member of the Board of Directors and Scientific Council of the Anxiety and Depression Association of America.

Dr. Carmen McLean is a licensed clinical psychologist and researcher with the Dissemination and Training Division of the National Center for PTSD at the Palo Alto VA Health Care System and a Clinical Associate Professor (Affiliate) at the Department of Psychiatry and Behavioral Sciences at Stanford University. Her research examines ways to increase the reach of exposure therapy for PTSD by addressing implementation barriers and testing eHealth interventions. She is currently Co-PI of a DoD-funded study testing a tailored process improvement approach to increasing the use of evidence-based treatment for PTSD in the U.S. military health system. She is PI of a FEMA-funded trial testing an intensive, integrated treatment for PTSD, insomnia, and nightmares in firefighters. Dr. McLean serves on several journal editorial boards and is currently Associate Editor of the Journal of Anxiety Disorders and Cognitive and Behavioral Practice. She has over 125 scholarly publications including a book on applied neuroscience in exposure therapy for PTSD co-authored wit