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Terrorist events, natural and man-made disasters, and intra- and international conflicts over the past 10-15 years have led to increased attention to the prevalence and adverse health consequences of posttraumatic stress disorder (PTSD). PTSD has an estimated 2-5% point prevalence and 8-12% lifetime prevalence in the general population, with higher rates in primary care settings, and even more so in combat veterans [1-9]. It is especially common after terrorism and natural disasters: for example, 60% of those who sought care after terrorist sarin release still met PTSD criteria 6 months later [10], as did 41% of victims of a terrorist bombing in a Paris subway [11]. Likewise, 43% of earthquake survivors in Turkey were diagnosed with PTSD [12]. With 24-hour television news coverage, such events impact an entire society; after the terrorist attacks in the U.S. on September 11, 2001, one in six adults nationwide had persistent distress 2 months later, and this was associated with poorer function at work, avoiding public places, greater worries, and greater use of alcohol and drugs. [13-14] Persistent PTSD has in turn been implicated in reduced societal resistance, delayed communal recovery, and lesser income earned by the individuals with PTSD [15-18]. Preventing persistence of PTSD may help to alleviate these symptoms of distress that impact every corner of a society after war, terrorism, or disasters, and should materially increase the speed of societal recovery from these insults.

PTSD unfortunately often goes undiagnosed, and available diagnostic instruments tend to be either cumbersome and time-consuming, or insensitive. PTSD is associated with a variety of somatic symptoms, markedly higher rates of depression and other psychological conditions, poorer physical health, missing work, impaired function at work and at home, and significantly higher healthcare costs. [15-18] PTSD is not only associated with significant adverse impact on quality of life, but it has also proven to be relatively persistent, and it has been difficult to produce durable, full responses to therapy. Selective serotonin reuptake inhibitors result in improvement for many individuals, but remission is sometimes only partial, and there is a sizeable percentage of patients who do not respond or do not continue with pharmacotherapy due to side effects. Cognitive behavioral therapy that incorporates imaginal exposure elements has been found to be effective in multiple clinical trials, and recent expert consensus treatment guidelines characterize it as the non-pharmacologic treatment of choice. [19-20] Re

1 Corresponding Author: LTC Michael Roy. Uniformed Services University of the Health Sciences, Department of Medicine, 4301 Jones Bridge Road, A3062. Bethesda, Maryland, 20814, USA. Telephone: (301) 295 9601; Fax: (301) 295 3557; Email: [email protected].

cent technologic advances make it possible for virtual reality (VR) scenarios to be realistic enough to effectively confront individuals with stimuli associated with their traumatic experience through progressively more intense exposure, neutralizing behavioral cues. In recent years, virtual reality technology has been utilized to help patients overcome a variety of phobias, anxiety disorders and PTSD. In uncontrolled studies, small numbers of Vietnam War veterans and World Trade Center survivors with PTSD have each been reported to improve through the use of progressively more realistic and intense virtual reality exposures. Investigators in multiple nations have published case reports, as well as trials comparing therapeutic approaches that incorporate VR with usual care or waiting list controls, describing success with the use of VR to treat a variety of psychiatric disorders. There have not yet been studies that clearly define the added benefit that VR might provide when used in addition to pharmacotherapy or other approaches with demonstrable efficacy but still large numbers who have inadequate or incomplete responses.

PTSD was first defined in veterans of the Vietnam War, but the symptoms that constitute this disorder have been reported from many nations through centuries of warfare. PTSD and other psychologic sequelae often persist long after physical wounds have healed, preventing the return of sizeable numbers of military service members to the battlefield, and thus impairing readiness. Moreover, persistent PTSD often evolves into, or is accompanied by, depression and other psychiatric conditions, resulting in lower response rates once treatment is initiated, and consequently greater morbidity. Undiagnosed and/or untreated PTSD impairs the resilience of military service members both while they remain on active duty, and when they return to society at large. In 1998, the annual cost of PTSD and related anxiety disorders was estimated at $63 billion dollars (50 billion Euros), in the United States alone, with PTSD representing the most significant healthcare utilization and work limitations of all the anxiety disorders. [21-22]

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Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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