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Moving Forward on the Foundation of the Past

A Friday Story
By Professor Shlomo Mor-Yosef

We all know how the days of our lives seem to flow seamlessly from past to present and on into the future. This week, when National President Marcie Natan visited us for the first time as Hadassah’s highest elected official, I remembered the many times we had welcomed her in the past, when we sat together, discussed the latest developments at the Medical Center and spoke about what lay ahead.

As Associate Director General Dr. Yair Birnbaum, HMO Board Chairman Yossi Rosen, Marcie and I walked through the new Promenade, it felt as if we were walking into the future – Marcie’s future as President and ours. The Sarah Wetsman Davidson Hospital Tower is the hub of the new Promenade that brings visitors, patients and staff directly into the Ein Kerem campus. The model of the Sarah Wetsman Davidson Hospital Tower stands directly behind the
Information Desk, bathed in the light that streams through the glass dome of the two-story Art Rotunda. When the Davidson Tower receives its first patients – in just 31 weeks – we will take a major step forward into the future. And when Marcie presides at the dedication of the Sarah Wetsman Davidson Hospital Tower in October 2012, the model will become a memento of the past. The building, the expertise it will contain and the skilled care our staff will continue to provide, will speak for itself.

* * * *

Revisiting the past while trying to live in the present is a common occurrence for people suffering from Post Traumatic Stress Disorder (PTSD). Their thoughts keep returning to the harrowing event they experienced. Paradoxically, not everyone who experiences the same trauma develops Post Traumatic Stress Disorder; however for the person who does, it means anxiety-filled days and sleepless nights.

During the years of the Intifada, when our Medical Center was filled with victims of terror, Hadassah became a world leader in diagnosing and treating PTSD patients. So much so that we were asked to help the survivors of the tsunami in Sri Lanka and the people traumatized by the World Trade Center bombings.

It was during those years that Prof. Arieh Shalev, then Head of the Department of Psychiatry, and his team of researchers looked for – and discovered – genetic markers for PTSD that can be identified with a simple blood test. This information enables psychiatrists to predict which victims will develop Post Traumatic Stress Disorder and provide immediate therapeutic intervention – considered the most effective method of reducing or eliminating the manifestations of PTSD.

Just as we have in so many other parts of our Medical Center, in our Department of Psychiatry the results of their outstanding research are combined with the latest technology for diagnosis and treatment.

“Some people think they’re fine when they’re not and sometimes conventional therapy is insufficient,” says Dr. Sara Freedman of the Cognitive Behavioral Therapy Center where she and her colleagues are taking advantage of the world of cyberspace to help Israeli bus bombing victims suffering from PTSD.

About the same time that the diagnostic blood markers were discovered, researchers developed Virtual Reality therapy to treat PTSD victims – victims of road accidents, terror incidents and other horrific experiences. This new form of treatment has many applications. The US Army found that Virtual Reality therapy helped Vietnam veterans and soldiers returning from Iraq and Afghanistan. Researchers found the therapy reduced PTSD symptoms for people in the aftermath of 9/11.

About five years ago, Israeli therapists began using a Virtual Reality program known as BusWorld. This application gradually depicts realistic simulations of a bus bombing in Israel, something we unfortunately have experienced too many times.

Working with Dr. Hunter Hoffman of the University of Washington, Dr. Azucena Garcia-Palacios of Jaume I of the University of Castellón, Spain, and Dr. Naomi Josman and Prof. Tamar Weiss of the University of Haifa, Dr. Freedman began using BusWorld at Hadassah. “The effective way to release their stress is to have people tell their story,” she says, “but some people with PTSD simply can’t or don’t. It can be difficult to get people to come in and relive their nightmare, but when they do, BusWorld facilitates the process of dealing with the trauma, especially where conventional interventional therapy has not been effective.”

Although it resembles a sophisticated computer game, Dr. Freedman cautions that BusWorld is anything but. It is a potent tool that must be introduced and directed by a trained therapist.

During conventional PTSD therapy, patients retell the story of the traumatic experience in the first person and the present tense. In Virtual Reality therapy, patients follow the same protocol, but tell their story while they are inside a virtual world, an immersive computer-generated program designed to replicate their experience. Before PTSD patients actually don the special goggles that project the visual and audio reminders, they meet with their therapist to prepare them for the experience.

The therapy brings them right into the environment of the event where – surrounded by the experience – the patient is cautiously encouraged to recount ‘what happened next.’ As treatment progresses, the therapist decides which of BusWorld’s twelve levels of difficulty is most appropriate – from just seeing a bus stop all the way up to the bus exploding, accompanied by the sounds of screams and sirens.

At each stage the patient must retell the experience for an  entire 60 minutes. Sometimes patients only manage to tell their story twice, sometimes they repeat it twenty times. As they do, bits of the story become more focused; the traumatic trigger more evident. Dr. Freedman and her colleagues described some of their success in using BusWorld in a 2010 paper published in the journal Cyberpsychology, Behavior, and Social Networking.

Even as they are conducting research and embracing the latest technologies to help our patients, a research team from our Department of Psychiatry is engaged in a monumental project that examines all the aspects of diagnosis and treatment for PTSD victims. Last month, the prestigious journal Psychiatric Services published the results of the first part of the study, which evaluated current interventional and follow-up processes for PTSD victims, identified weak spots in the system and recommended how treatment could be improved.

Just this week, the team learned that The Archives of General Psychiatry, the leading journal in the field, had accepted their paper on “The Prevention of PTSD by Early Treatment,” the second part of the study. The US National Institute of Mental Health is funding the majority of the research project.

* * * *

Throughout Hadassah, we are always looking for new ways to help our patients, integrating basic genetic research, like the discovery of the PTSD markers, with promising new technologies, like BusWorld – looking back at what we have learned to provide our patients with a better future.  

The walk we took through the new Promenade that ended by the model of the Sarah Wetsman Davidson Hospital Tower was a parallel kind of journey, a connection between the past and the future. I look forward to seeing you in October 2012, when that journey is completed and the future becomes the present.

Shabbat shalom,
Shlomo

Prof. Shlomo Mor-Yosef
Director General



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