Page 707 - Total War on PTSD_FINAL

the original traumatic event. These “fear structures” include information about stimuli, responses, and meaning and are composed of harmless stimuli that have been associated with danger and are reflected in the belief that the world is a dangerous place. This belief then manifests itself in cognitive and behavioral avoidance strategies that limit exposure to potentially corrective information that could be incorporated into and alter the fear structure. Because escape from and avoidance of feared situations are intrinsically rewarding (albeit temporarily), PTSD (as well as phobic disorders) can perpetuate without treatment.
Complicating matters in the treatment of trauma is that triggers are often subconscious. Stored memories are not always apparent in the conscious mind. A person might only realize something is a cue when that cue appears outside the traumatic event
Imaginal Prolonged Exposure (PE) is considered to be a leading evidence-based treatment for PTSD and entails engaging mentally with the fear structure through repeatedly revisiting the feared or traumatic event in a safe environment. The proposed mechanisms for symptom reduction involve activation and emotional processing, extinction/habituation of the anxiety, cognitive reprocessing of pathogenic meanings, the learning of new responses to previously feared stimuli, and ultimately an integration of corrective non-pathological information into the fear structure. One of the challenges associated with this treatment is the reliance on patients to be able to effectively imagine their traumatic experiences. Many patients, however, are unwilling or unable to do this. In fact, this very tendency to avoid the cues and reminders of the trauma is one of the cardinal symptoms of PTSD (along with hyperarousal, intrusive thoughts and dreams, alterations in cognitive/emotional experiences). Thus, VR was seen, early on, to be a
707 of 837