New Perspective on the Effectiveness of Current Treatments for PTSD

PTSD (post-traumatic stress disorder) is a medically serious form of anxiety that can occur in the weeks following exposure to a range of traumatic and/or life-threatening events and situations. According to figures compiled by the National Center for PTSD, roughly 6 to 7 percent of all Americans will develop the disorder during either childhood or adulthood.

Mental health professionals treat the symptoms of PTSD with a range of psychotherapeutic and medication-based options. According to the results of an extensive study review published in 2013 in the American Journal of Preventive Medicine, only two of the current psychotherapeutic treatment options for the disorder produce clearly effective real-world results.

PTSD Basics

People affected by PTSD commonly have symptoms such as flashbacks or nightmares that force them to relive their traumatic experiences, an intense desire to stay away from any reminders of a traumatic experience, an inability to recall certain aspects of a traumatic event or express feelings regarding that event, and an easily activated “fight-or-flight” response that produces feelings of edginess or jumpiness and interferes with the ability to concentrate or focus attention. According to guidelines established by the American Psychiatric Association, doctors can only diagnose PTSD a full 30 days after a traumatic experience occurs. Prior to that time, people seriously affected by such an experience commonly receive a diagnosis for a related, shorter-term condition called acute stress disorder or ASD.

Although any person exposed to a traumatic event may go on to develop post-traumatic stress disorder, the National Center for PTSD has identified several factors that increase the likelihood that a given event will later produce PTSD symptoms. These factors include exposure to an immediate threat to you or your family members, an inability to avoid the source of trauma, sustaining an injury as a direct result of a traumatic event, exposure to a prolonged or unusually extreme form of trauma, and development of a severe emotional reaction in the immediate aftermath of a traumatic event. Apart from these factors, some people have elevated risks for the onset of PTSD following a traumatic experience, including people previously exposed to significant trauma, people with preexisting mental health problems, people who heavily consume alcohol, people with relatively limited educational backgrounds, and women.

PTSD Treatments

The most common form of psychotherapeutic technique used to treat people with PTSD is cognitive behavioral therapy (CBT), a generalized approach that encompasses a number of specific therapies. In CBT, people affected by a range of psychiatric problems learn how to replace previously learned false or negative responses to stressful situations with a more aware or centered perspective that generates a sense of self-control and personal autonomy. Examples of specific treatments used by practitioners of CBT include exposure therapy—which helps patients learn new behaviors by gradually exposing them to the source of their traumatic reactions—and cognitive therapy, which helps patients change their perspective without a re-exposure to a triggering traumatic event. Additional forms of psychotherapy used in PTSD treatment include psychodynamic therapy, supportive psychotherapy, psychoanalysis, family therapy, and group therapy. Some doctors also use a technique called collaborative care, which combines facets of CBT with medications in a coordinated care program.

The most commonly used medications in PTSD treatment are antidepressants called SSRIs (selective serotonin reuptake inhibitors), which doctors use to help relieve the feelings of worry and/or sadness that often appear in affected individuals. Other medications sometimes adapted for treatment of the disorder include atypical antidepressants, tricyclic antidepressants, another group of antidepressants called MAOIs (monoamine oxidase inhibitors), antipsychotics, and mood stabilizers.

Treatment Effectiveness

In first phase of the review published in the American Journal of Preventive Medicine, a team of researchers from Research Triangle International and the University of North Carolina (RTI-UNC) examined more than 2,500 studies that attempted in some way to assess the effectiveness of various psychotherapeutic treatments for PTSD. After scrutinizing these studies, they concluded that only 19 of the 2,500+ provided enough information to accurately judge the usefulness of the treatments under discussion.

In the next phase of their review, the researchers from RTI-UNC further examined the information in the 19 remaining studies. They concluded that, based on the evidence contained in these studies, only two current psychotherapeutic PTSD treatments provide clear evidence of effectiveness. According to these findings, the most effective treatment is cognitive behavioral therapy, which (as we’ve seen) encompasses a number of specific methods united by a common overall treatment strategy. The only other effective psychotherapy-based treatment found by the RTI-UNC research team is collaborative care; again, as we’ve seen, this treatment combines CBT with the managed use of medications.

Considerations

The authors of the study review in the American Journal of Preventive Medicine openly state their discomfort at being able to find so few studies that truly assess the effectiveness of various PTSD treatments. They also note that both doctors and patients should be aware of the lack of evidence for many of the psychotherapeutic approaches used during PTSD treatment. In addition, they strongly recommend that mental health experts, public health officials, and researchers do all they can in the future to improve the quality of PTSD research and support studies that produce evidence-based results and can be assessed according to a clear set of real-world treatment criteria.