Prenatal alcohol exposure can lead to a range of physical, neurological, and behavioral alterations referred to as fetal alcohol spectrum disorders (FASD). Variability in outcome observed among children with FASD is likely related to various pre-and postnatal factors, including nutritional variables. Choline is an essential nutrient that influences brain and behavioral development. Recent animal research indicates that prenatal choline supplementation leads to long-lasting cognitive enhancement, as well as changes in brain morphology, electrophysiology and neurochemistry. The present study examined whether choline supplementation during ethanol exposure effectively reduces fetal alcohol effects. Pregnant dams were exposed to 6.0 g/kg/day ethanol via intubation from gestational day (GD) 5-20; pair-fed and lab chow controls were included. During treatment, subjects from each group received choline chloride (250 mg/kg/day) or vehicle. Physical development and behavioral development (righting reflex, geotactic reflex, cliff avoidance, reflex suspension and hindlimb coordination) were examined. Subjects prenatally exposed to alcohol exhibited reduced birth weight and brain weight, delays in eye opening and incisor emergence, and alterations in the development of all behaviors. Choline supplementation significantly attenuated ethanol's effects on birth and brain weight, incisor emergence, and most behavioral measures. In fact, behavioral performance of ethanol-exposed subjects treated with choline did not differ from that of controls. Importantly, choline supplementation did not influence peak blood alcohol level or metabolism, indicating that choline's effects were not due to differential alcohol exposure. These data indicate early dietary supplements may reduce the severity of some fetal alcohol effects, findings with important implications for children of women who drink alcohol during pregnancy.

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Posttraumatic stress disorder (PTSD) is characterized by persistent symptoms of re-experiencing, avoidance and arousal related to a traumatic event in which an individual experienced intense fear, helplessness and/or horror. Prevalence rates for PTSD in a large, nationally representative sample reported an overall lifetime PTSD rate of 7.8%. 1, 2 PTSD is often more common in trauma-specific populations, such as those who experienced sexual assault, 3 natural disaster 4 or military combat. 5-8 Active-duty service members deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom are at high risk for exposure to traumatic events, with an estimated 12%-14% having PTSD. 6, 8, 9 Which psychological treatments are most effective? Cognitive behavioral therapies (CBT), such as stress inoculation training (SIT), 10 prolonged exposure (PE) 11 and cognitive processing therapy (CPT) 11 have shown the most promising results. Exposure therapy, a type of CBT, has the strongest support across a variety of populations. 12, 13 The U.S. Institute of Medicine has identified exposure therapy as having convincing evidence to support its use. 14 CPT is one of two manualized therapies known to adequately treat PTSD; the other is prolonged exposure (PE). 15, 16 Manualized therapies follow a predetermined protocol for therapy delivery. Such treatments are subjected to rigorous investigation, including randomized controlled trials (RCTs) and consistently yield strong results. 12 The focus of this paper is to familiarize the reader with the core components of CPT, to briefly summarize CPT research completed since its inception in 1992 and to highlight some unique benefits of CPT treatment. What are the fundamental elements of CPT? CPT was originally developed to treat rape and crime survivors suffering from PTSD. 17 Its three core components are psychoeducation, exposure and cognitive therapy, and it is designed to challenge maladaptive thoughts and feelings that prevent trauma survivors from coming to terms with their experiences, leading to a decrease in PTSD. There are various forms of CPT; however, the standard treatment consists of 12 60-minute sessions once or twice weekly. CPT also can be effectively administered in group format or modified to meet the needs of the individual.

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