Propranolol Reactivation Mismatch (PRM) Treatment for PTSD

Inclusion Criteria • Convenience sample of pilot subjects between ages 18 and 65 with active PTSD Exclusion Criteria * Age \<18 or \>65; * Basal systolic blood pressure \<100 mm Hg or heart rate \<55 beats per minute; * Medical condition that contraindicates the administration of propranolol, e.g., history of congestive heart failure, heart block, insulin-requiring diabetes, chronic bronchitis, emphysema, or asthma. With regard to asthma, because many persons who say they have had an asthma attack, especially as a child, may only have had hay fever, another allergy, or another non-asthmatic episode, a blanket exclusion criterion may be overly restrictive. Therefore, asthma attacks will only be exclusionary if they a.) occurred within the past ten years, b.) occurred at any time in life if induced by a β-blocker, or c.) are currently being treated, regardless of the date of last occurrence; * Previous adverse reaction to, or non-compliance with, a β-blocker * Current use of medication that may involve potentially dangerous interactions with propranolol, including, other β-adrenergic blockers, antiarrhythmics, calcium channel blockers and benzodiazepines. Subjects taking an α-1-adrenergic antagonist (e.g., prazosin) or an α -1-adrenergic agonist (e.g., clonidine) will be asked to refrain from taking this medication on the day of a study medication visit. Note: Possible inhibition of CYP2D6 isoenzyme-dependent reactions will not be of concern in this study, because propranolol will only be administered once a week for six weeks; * Presence of drugs of abuse, including opiates, marijuana, cocaine, or amphetamines, as determined by saliva or urine testing; * Pregnancy or breast feeding. Women of childbearing age will have a pregnancy test prior to being administered study medication at study week 0, and again at study week 7, following study medication discontinuation; * Current PTSD from a traumatic event other than the event being treated, or another contraindicating psychiatric condition, e.g., current psychotic, bipolar, melancholic, or active substance dependence or abuse disorder; * Initiation of, or change in, psychotropic medication within the previous two months. For subjects receiving stable doses of pharmacotherapy, they and their providers will be asked not to change the regimen during the proposed two-month study (excluding the 6-month follow-up) except in clinically urgent circumstances; if this becomes necessary, a decision will be made on a case-by-case basis with regard to retaining the subject or terminating participation * Current participation in any psychotherapy (other than supportive). Subjects will be asked not to initiate new psychotherapy during the proposed two-month study (excluding the 6-month follow-up) except in clinically urgent circumstances; if this becomes necessary, a decision will be made on a case-by-case basis with regard to retaining the subject or terminating participation; * Inability to understand the study's procedures, risks, and side effects, or to otherwise give informed consent for participation; * Subject candidate does not understand English. This exclusion criterion is necessary because the procedures require a subtle dialogue with solely English-speaking investigators, which translation cannot accomplish. There is a need for rapid communication with English-speaking investigators in case of an adverse drug effect.