Eur J Psychotraumatol. 2016 Nov 8;7:33768. doi: 10.3402/ejpt.v7.33768. eCollection 2016.

What I have changed my mind about and why.

Yehuda R1,2, Spiegel D3, Southwick S4,5, Davis LL6, Neylan TC7,8, Krystal JH4,5.

• 1James J. Peters Veterans Affairs, New York, NY, USA.
• 2Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Rachel.yehuda@va.gov.
• 3Department of Psychiatry and Behavioral Sciences, Stanford University of Medicine, Stanford, CA, USA.
• 4Yale University School of Medicine, New Haven, CT, USA.
• 5Clinical Neuroscience Division of the National Center for PTSD, Veterans Administration, West Haven, CT, USA.
• 6Department of Psychiatry and Behavioral Neurobiology, University of Alabama Health System, Birmingham, AL, USA.
• 7Department of Psychiatry, University of California in San Francisco, San Francisco, CA, USA.
• 8San Francisco VA, San Francisco, CA, USA.

Abstract

This paper is based upon a panel discussion "What I Have Changed My Mind About and Why" held on 5 November in New Orleans, Louisiana (USA), as part of the ISTSS 2015 annual meeting "Back to Basics: Integrating Clinical and Scientific Knowledge to Advance the Field of Trauma."

The panel was chaired by Professor Dr. Rachel Yehuda of the Icahn School of Medicine at Mount Sinai and the James J. Peters Veterans Affairs, and included five clinician-scholars who exchanged thoughts about what they have changed their minds about over the years: Dr. David Spiegel, Dr. Steven Southwick, Dr. Lori Davis, Dr. Thomas Neylan, and Dr. John Krystal.

This paper provides a summary of the salient points made by each expert and the questions and discussion that ensured.

Major issues raised included the increasingly clear limitations to the fear-based model that has advanced the field. While treatments for PTSD have improved, there are some aspects of trauma exposure that cannot be entirely repaired.

Research providing an evidence base to treatment has led to overly specific treatment guidelines that may obscure more general principles of effective treatment.

Treatment might be viewed as a way to increase the plasticity of the brain in the context of processing social cues.

A variety of novel and integrative therapies include comprehensive holistic care, exercise, returning to competitive work, logotherapy, mindfulness, enhancing well-being and resilience, and medications with novel mechanisms, such as ketamine.

KEYWORDS:

PTSD; alternative treatments; evidenced based treatments; fear extinction; mindfulness; neurobiology; novel approaches; pharmacotherapy; randomized clinical trials; resilience

PMID:  27837585