Rather than relying on the common face-to-face, therapist-patient relationships, the unique treatments are self-managed, with the patient undertaking much of the therapy through reading material, structured homework, and diagnostic tools.

"It's the wave of the future," says doctoral research supervisor Edward B. Blanchard, director of the UAlbany Center for Stress and Anxiety Disorders. "The treatment is very accessible to people who have limited mobility or limited access to areas where therapists tend to locate, such as cities. It's self-managed and self-paced, and less expensive than traditional treatment. And it's done under the trained eye of a clinician, who can help assess progress."

Therapy for Crash Victims

Doctoral student Jill Sabsevitz is developing a treatment program for sufferers of PTSD specifically related to the aftermath of motor vehicle accidents (MVA). Some studies suggest that 45 percent of accident survivors who seek medical attention will develop PTSD within one year of the event, and an additional 15 to 30 percent will develop less overt, subclinical levels of PTSD. Sabsevitz' treatment utilizes the book Coping With Your Crash, by Blanchard and Edward Hickling, as the focal point of the self-managed program. After an initial consultation and assessment with a therapist, patients undergo a series of exercises described in the book designed to overcome feelings of anxiety, anger, vulnerability, and depression, as well as steps such as the incorporation of pleasant events into the daily routine. The patient mails in "homework" to his therapist, who then gives the okay for advancing to the next step. The last step is self-assessment, in conjunction with a trained therapist.

"With physical injuries often preventing people from traveling," said Sabsevitz, "and with PTSD symptoms also inhibiting accident victims from getting out, this type of therapy aims to meet their needs and get them on the road, literally, to better health, physically and mentally."

Web-based Treatment Reaches Worldwide Audience

Jonathan Lerner has taken the program one step further by researching entirely Web-based self-managed treatments for MVA-related PTSD. He offers a comprehensive assessment, treatment, and evaluation on his Web site www.afterthecrash.com, and to date has had responses from more than 100 MVA survivors on five continents. While his treatment does not offer an initial face-to-face consultation, he has high hopes for its efficacy. He notes, "To date, there's strong evidence indicating that a cognitive-behavioral intervention like the one developed by Dr. Blanchard can successfully decrease symptoms of PTSD and improve functioning in individuals who have survived a motor vehicle accident. There is also preliminary data showing positive clinical outcomes in individuals who have used Internet-based assessment and treatment for problem areas such as headache, panic disorder, substance abuse, weight loss, and smoking cessation."

Stress Management Key to Treating Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is the condition doctoral student Kathryn Sanders seeks to alleviate with her self-managed therapy program. Studies estimate that 11 to 22 percent of Americans suffer from IBS, a gastrointestinal disorder with symptoms that include abdominal pain and tenderness accompanied by either diarrhea, constipation or both. IBS affects roughly twice as many women as men, and as much as $25 billion is spent annually on treating symptoms. No drug therapy currently is available. For her treatment, Sanders utilizes the book Breaking the Bonds of Irritable Bowel Syndrome, by therapist Barbara Bradley-Bolen.

"Our goal," said Sanders, "is to help improve patients' health and quality of life through stress management. Patients will ultimately learn to deal with their stress, and with this self-managed therapy they can also learn to manage their IBS symptoms now and for the future."

Also included in her proposed therapy is an initial assessment by a trained clinician, homework based on the book, and the study of individual diet and various relaxation and stress management techniques, plus various follow-up contacts.

"These students are on the cutting edge of what could be a revolution in the treatment of certain conditions," said Blanchard. "But they're not developing radical alternative therapies. They're researching interventions that are based on traditional theories of therapy, but divert from tradition in ways that make alleviating patients' symptoms accessible, comfortable, widely available, and inexpensive, while still benefiting from the support of a qualified counselor."

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