PA) - Edna B. Foa, PhD, Professor of Psychology
in Psychiatry at the University of Pennsylvania School of
Medicine, will conduct training on responding to post-traumatic
stress disorder (PTSD) for a group of nine mental health professionals
from the region affected by the tsunami of December 2004. The training
will take place from October 5 to October 18, 2005 at the Penn School
Five psychiatrists from Indonesia and four psychologists from Thailand
will participate in the program. Upon completion, they will provide
training to other mental health professionals in their respective
countries to help those suffering from PTSD following the tsunami.
The Penn course of “training the trainers” grew out
of a post-tsunami conference for mental health practitioners held
in Bangkok, Thailand this past February at which Foa was a presenter.
PTSD is an extremely debilitating and chronic condition that often
follows a terrifying physical and emotional event. The PTSD sufferer
experiences persistent, frightening thoughts and memories, nightmares
or flashbacks, of the traumatic event, as well as a host of other
“We know that three months after a traumatic event, recovery
rates slow down,” explains Foa. “Usually after a year,
if severe symptoms are not treated, they become chronic, and natural
recovery is unlikely to happen. Since the tsunami occurred nine
months ago, people still suffering from PTSD are likely to need
some intervention to alleviate their symptoms and prevent persistent
The Penn training will center on prolonged exposure therapy, which
was developed by Foa. It has been widely used and studied in many
treatment centers. The Thai and Indonesian educators will first
be taught how to conduct prolonged exposure therapy themselves.
This includes teaching patients breathing exercises that will help
them relax. They will also be taught the importance of providing
patients with psychoeducation about the symptoms of PTSD, why some
people recover and others do not, and why exposure therapy reduces
PTSD symptoms. They will also learn to teach their colleagues prolonged
“The therapists educate the patients about common reactions
to trauma so that they don't feel that something is wrong with them
because they are having these symptoms,” says Foa. “Some
of the symptoms -- like the flashbacks, where a person actually
feels as if he is in the middle of the trauma again -- can be very
scary, and give the sense of going crazy. So educating patients
is very helpful in the sense that it gives them a way to understand
their symptoms and put them in perspective.
The Penn participants will also be taught the importance of asking
patients to think about the trauma and describe it in detail. If
people show symptoms of PTSD, it is an indication that the traumatic
memory has not been processed in a way that allows patients to acknowledge
the horrible nature of their experience while recognizing that it
is in the past, and that they can and need to resume their lives.
Foa noted, “In exposure therapy, patients invoke the memory
and describe it again and again. These repetitions provide opportunities
to gain perspective, to realize that patients are describing a past
experience, and that thinking about the trauma is not the same as
being in the trauma. These exercises should be part of every session.
This will be a key theme of the training we will be providing at
The Penn training will also highlight another goal of prolonged
exposure: to help patients deal with situations that they avoid
because they remind them of the traumatic event, such as going to
the beach or being in crowded places. For some people the fear is
so severe that they do not leave their homes; other people stopped
watching television, reading newspapers, or going to movies because
they are afraid that there will be a story that will remind them
of the traumatic event and its aftermath.
In this part of the treatment, therapists help patients identify
situations that they avoid and that are important for them to confront
in order to function. The therapist creates a hierarchy of these
situations and asks the patient to initially confront those that
are not as anxiety evoking. Gradually, the patient ascends the hierarchy
and confronts situations that are more and more anxiety evoking.
The overall treatment involves between eight to fifteen sessions.
Foa and other researchers have found that prolonged exposure therapy
helped at least 85 percent improve, and 50 percent of the patients
improve so much that they achieved a remission.
Foa is also Director of the Center for the Treatment and Study
of Anxiety at Penn and is an internationally renowned authority
on the psychopathology and treatment of anxiety. She is one of the
leading experts in the areas of post-traumatic stress disorders.
She has published several books and over 250 articles and book chapters,
has lectured extensively around the world, and is the recipient
of numerous awards and honors.
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