“I’m not a veteran, I’ve never served our country. But it feels good to have a set of skills that I know I can use to support veterans,” said Dr. Kristi Salters-Pedneault. As a professor of psychology at ECSU, she continues to search for effective treatments for veterans. Her recent work includes two projects on the disorder, one of which is funded by the Department of Defense and the National Center for PTSD. “I love working with the veterans. It is very meaningful and rewarding work. I’m really grateful I get to continue that.”
The Department of Defense funded project is a study of 1,500 veteran volunteers from Fort Drum in New York. The goal is to help veterans deal with intrusive thoughts, one of the most disruptive symptoms of PTSD. “Thoughts of combat leap into their heads out of the blue,” explained Dr. Salters-Pedneault who is a co-investigator on the project. In the study, veterans are divided into four groups. Two groups are taught a method for dealing with intrusive thoughts. One group is taught about intrusive thoughts but receives no skills training. The final group is the control, which receives no extra instruction.
PTSD is famously tough to manage. Without treatment symptoms intensify over time and affect more areas of the veteran’s life. Unfortunately, most veterans do not seek help until they have had symptoms for a year or more. “One of the major obstacles for returning veterans is that there is a massive stigma about seeking treatment or admitting symptoms,” said Dr. Salters-Pedneault.
One treatment being tested at Fort Drum is an acceptance-based behavior therapy called RESET. “It teaches soldiers to be more accepting of symptoms they might have, particularly intrusive thoughts. They’re taught how to have the thoughts without trying to push them away and recognize those thoughts as just thoughts. They’re not something to fix. It doesn’t mean you are crazy. It’s a natural response and these are just thoughts that can’t hurt you,” she said.
Relearning that certain things no longer pose a threat is the basis many therapies designed to treat PTSD. “There is an approach called imaginal exposure. It’s meant to target memories that pop in. The clinician has the client repeatedly imagine themselves back in the traumatic experience until memories feel less powerful,” said Dr. Salters-Pedneault.
Imaginal therapy is a form of “exposure therapy,” wherein patients are exposed to something they fear in a safe context. Exposure therapy is one of the most established treatments for PTSD. It is based on fear extinction, when the mind is trained to no longer perceive a stimulus as something to fear. “If you are exposed to something you are afraid of over and over you will get over that fear,” Dr. Salters-Pedneault explained.
At ECSU Dr. Salters-Pendeault, her colleague Dr. James Diller, and undergraduate student research assistants have recently conducted an experiment to find the quickest way to make a fear extinct. Experiment participants are given small electrical shocks whenever they see one of two human faces. They develop a mild fear response to the face. “After we train up this fear response, we start showing the picture, but it is no longer paired with electric stimulations. So after a time they stop showing fear.
The researchers use music to induce different moods. “There is some indication that if people receive extinction training under different moods it will stick around longer. Because they’ve extinguished in multiple contexts the learning is more generalized,” said Dr. Salters-Pedneault. After completing the small pilot study, Dr. Salters-Pedneault will apply for a grant and to do a larger study that will also involve student researchers.
It is difficult to predict who will develop PTSD symptoms. Even after a highly traumatic experience like combat, only about 10% develop PTSD. There are certain risk factors, including previous traumatic experiences. “I think that’s important. It suggests that cumulative trauma does not have a protective effect. People might say ‘wow, you’ve been through things like this before so you will be stronger.’ But we have evidence of the opposite,” said Dr. Salters-Pedneault.
Many veterans try to avoid being exposed to things that cause them to experience PTSD symptoms, a tactic called emotional avoidance. Avoidance actually hurts in the long run. “The classic example in veterans is that they avoid driving, especially if they did convoy work. That’s because when driving you are significant risk of IED explosions. In Iraq, trash bags on the side of the road could be a bomb. So they’ll avoid driving because trash on the road produces a huge fear response. If you drive under safe conditions over and over you can extinguish that fear,” she said.
More effective means of fear extinction can help veterans more quickly learn that things like driving and loud noises (such as fireworks) no longer pose a danger. This can help them no longer fear normal activities.
For family members of veterans with PTSD, Dr. Salters-Pedneault believes the most helpful thing they can do is fight the stigma around the condition. “Make it very clear that they are in support of the person seeking treatment, that it’s okay for them to ask for help, that it’s courageous to ask for help in that context. Really encourage the veteran to seek treatment early, before there are downstream consequences.”