Show notes
EPISODE DESCRIPTIONDr. Barbara O. Rothbaum, PhD, is a tenured professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, where she holds the Paul A. Janssen Chair in Neuropsychopharmacology. She is director of the Trauma and Anxiety Recovery Program, director of the Emory Healthcare Veterans Program, and as of 2025, science director of the Emory Center for Psychedelics and Spirituality. With more than 400 scientific papers and multiple books to her name, Dr. Rothbaum is one of the foremost authorities on PTSD treatment in the world. In this episode, she joins host Ben Everett to reflect on four decades at the frontier of PTSD research, from the earliest days of the field's recognition as a disorder to the cutting edge of psychedelic-assisted therapy and virtual reality exposure.PTSD remains one of psychiatry's most consequential and undertreated conditions, affecting a substantial portion of combat veterans, survivors of sexual trauma, and countless others who have never received an accurate diagnosis. In this conversation, Dr. Rothbaum covers the evidence base for first-line trauma-focused therapies — prolonged exposure, cognitive processing therapy, and EMDR — and the intensive outpatient model that has dramatically improved treatment retention. She then turns to the stalled landscape of PTSD pharmacotherapy, her translational research combining MDMA with prolonged exposure, the emerging role of psilocybin and ketamine, and the evolution of virtual reality exposure therapy from her laboratory's 1993 pilot to the Brave Mind system now deployed across more than 50 VA health systems.KEY EPISODE HIGHLIGHTS🧠 PTSD TREATMENT IS ABOUT APPROACHING, NOT AVOIDING [09:00]"There's no way to the other side of the pain except through it."Dr. Rothbaum explains the core mechanism underlying all empirically supported PTSD therapies — and why avoidance is the central obstacle to recovery.💊 SSRIs ARE NOT REALLY THE TREATMENT FOR PTSD [24:30]"I personally will think of them like weak coffee for PTSD. Maybe you can get a little bit of effect, maybe on mood, maybe on thinking."Despite being the only FDA-approved pharmacotherapy for PTSD, SSRIs fall well short of the evidence base for trauma-focused psychotherapy — and combination treatment offers no advantage.🥽 VIRTUAL REALITY EXPOSURE THERAPY GIVES CLINICIANS TOTAL CONTROL [43:30]"If my patient's not ready for turbulence, I can guarantee there won't be turbulence. When they are ready for turbulence, I can guarantee there will be turbulence."From fear of heights to virtual Iraq and Afghanistan combat environments, VR allows therapists to precisely calibrate stimulus intensity — closing the gap between imaginal exposure and real-world treatment.CHAPTERS00:00 - Introduction and Guest Biography03:30 - Career Origins: Starting with Edna Foa05:30 - A Career at the Intersection of Therapy, Technology, and Pharmacology08:00 - First-Line Psychotherapies: PE, CPT, and EMDR13:30 - Comparing the Therapies: Evidence and Patient Fit15:30 - The Emory Healthcare Veterans Program and the IOP Model21:00 - Recognizing PTSD in Primary Care23:30 - Pharmacotherapy: The Limits of SSRIs27:30 - Recent Drug Development Setbacks: MDMA and Brexpiprazole31:00 - Translational MDMA Research and Combining with Prolonged Exposure37:30 - Lessons from Australia's MDMA Approval39:00 - The Broader Psychedelic Landscape: Psilocybin, Ketamine, and Others43:00 - Virtual Reality Exposure Therapy and the Brave Mind System49:30 - Resilience, Hope, and the Future of PTSD TreatmentLINKSFull transcript and show noteshttps://www.psychiatrist.com/jcp/ep16-forty-years-ptsd-frontier-barbara-o-rothbaum/Journal of Clinical Psychiatryhttps://www.psychiatrist.com/jcp/Dr. Barbara O. Rothbaum — LinkedInhttps://www.linkedin.com/in/barbara-rothbaum-9339546 Emory Healthcare Veterans Programhttps://www.emoryhealthcare.org/lp/veterans-ptsdThe intensive outpatient program for post-9/11 veterans discussed throughout this episode.Wounded Warrior Project — Warrior Care Networkhttps://www.woundedwarriorproject.org/programs/warrior-care-networkFunds the four IOP programs, including Emory's, discussed in the episode. No cost to veterans.#PTSD #TraumaTherapy #MDMAAssistedTherapy #VirtualRealityTherapy #Veterans