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News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences
Psychiatrist Una McCann is deeply interested in post-traumatic stress disorder because treatment for the vile, often lasting condition isn’t foolproof.
But, as a neuroscientist, McCann sees PTSD in rather a different light: Not only is she eager to map out its biology, but she believes it could prove useful to understand the workings of one of its most helpful treatments—cognitive behavioral therapy—and thus put the technique to best use.
McCann, who heads Hopkins’ Anxiety Disorders Clinic, has nudged cognitive therapy’s status in the clinic upward, combining it more routinely with medications. “Both,” she says, “are empirically proven for anxiety disorders.” She’s brought in psychologist James Fauerbach, who’s sharpened his CBT expertise from years of working with burn patients at Hopkins Bayview. Fauerbach now trains all of Psychiatry’s residents in the technique.
“PTSD is almost the perfect model for the behavioral medicine approach to psychiatric problems,” McCann explains, especially, she says, as it affects the burn survivors she and Fauerbach treat. “There’s a definite event—the burn trauma—with a before and an after. So you can follow patients and see who had a preexisting problem, see who develops an anxiety disorder, see who responds to which nuance of therapy.” Soon, she hopes, PET, fMRI and other forms of imaging will bring hard data on these patients.
But questions about PTSD itself linger. Studies suggest that two brain areas concerned with emotion, the amygdala and the anterior cingulate cortex, respond abnormally to stimuli seen as threats. Other data hint that the hippocampus, a memory-linked area, may change size in chronic patients. “We’d like to identify brain markers for people at risk of the disorder and, ideally, use targeted therapies—including cognitive ones—before PTSD sets in,” McCann explains.
Clarifying the biology will be especially satisfying, McCann says, because controversy dogs PTSD. “Even within Hopkins ranks, some psychiatrists see it as a natural response to trauma or, in some instances, evidence of a personality vulnerability. Science is a perfect way to get to the heart of the matter.”
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