Treatment of PTSD? When exposure therapy is not an option, imagine the scenario can help

According to a new study, your imagination – normally associated with the hobbies of your childhood – could help treat anxiety and fear.

Researchers at Mount Sinai's Icahn School of Medicine in New York have explored brain pathways that people use when they learn – and unlearn – how to respond to threats. They found that imagining a threatening scenario could provide similar benefits to exposure therapy for someone who has experienced a traumatic event.

Researchers hope to use this knowledge to improve treatments for people with post-traumatic stress disorder (PTSD).

"Unlearning" is the key to this research. In a dangerous situation, the natural "fight or flight" response makes hearts beat and causes adrenaline. However, some people continue to experience the same stress at smaller events, even when the threat has long passed. It's hard to unlearn that.

What is a stress disorder?

A stress disorder is a constellation of symptoms that a person experiences after a traumatic event. These experiences can range from a war fight to a car accident, and reactions can range from an acute stress disorder to its more serious counterpart, PTSD.

Acute stress disorder often occurs shortly after a traumatic event. This can cause a person to feel "numb" with their surroundings, frequently have thoughts about the trauma, actively avoid stress-sensitive things, and have a constant sense of nervousness. When these feelings persist beyond a month, they are defined as a PTSD. Both disorders can significantly affect the quality of life.

How are stress disorders treated?

Psychologists use a combination of Cognitive Behavioral Therapy (CBT) and Extended Exposure Therapy (PET).

Cognitive Behavioral Therapy is a speech therapy. It helps you learn ways of thinking that focus on the positive aspects of yourself and your surroundings. Exposure therapy involves repeatedly putting a person in a situation that causes him fear and anxiety because the brain learns to itself that no harm occurs.

Exposure therapy can eventually help a person feel more comfortable in a given situation. For example, if a person falls on a staircase and develops an acute stress response, exposure therapy may involve going up and down the stairs repeatedly.

Sometimes, however, exposing a patient to the scenario that causes the stress response can be difficult, even unethical, like being in a war zone. The new study aimed to prove that imagining a scenario can be as effective as reliving it.

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Why is this study important?

Although this technique has been used by psychologists for some time, this is the first study to confirm the findings by brain imaging.

The scary situation creates "a threat signature" in the brain, Daniela Schiller, PhD, professor of neuroscience and psychiatry and lead author of the journal, told ABC News. It is essentially a neurological pattern that recurs whenever a person feels threatened.

For this study, researchers exposed 68 adults to light but uncomfortable electric shocks, always accompanied by a specific sound. Then, they divided the participants into three distinct groups: a group imagining the specific sound (imagined re-exposure), another able to hear the sound (real re-exposure) and another one able to think of their own peaceful sounds, such as birds. chirps or falling rain (control group).

The researchers performed brain scans as participants reflected on their sounds. They found that imaginary thoughts and actual exposure were just as effective in reducing brain reactions to threats because they used the same brain pathways.

The new discoveries bridge what office psychologists do and what researchers do in the lab – they confirm that the brain patterns we use when we imagine things have a direct effect on our future action.

Although further research is needed, Schiller told ABC News that these discoveries pave the way for new ways to treat stress-related disorders. This "threat signature" will be a new target for measuring the effectiveness of different therapies, she said, allowing psychologists to individualize the therapy and maximize its effectiveness.

Dr. Sumir Shah is an emergency physician in New York and a member of ABC News Medical Unit.