Cognitive and Prolonged Exposure Therapies Are Beneficial Treatments for PTSD

Treatments exist for those already suffering from Post-Traumatic Stress Disorder or PTSD, but are there treatments that could prevent a person who has experienced traumatic events from ever developing the disorder? If so, would it matter how soon the victim began treatment following their exposure? These were the questions scientifically addressed by physicians in the tumultuous Middle Eastern city of Jerusalem.

A team of doctors at Hadassah University Hospital in Jerusalem, Israel, conducted a study which compared early and delayed interventions for the prevention of PTSD. The study participants were culled from admittances to the hospital following involvement in traumatic events. From the list of trauma-related admittances, doctors conducted phone interviews within a 10-day period, listening for symptoms of acute stress disorder. Those whom the physicians identified as exhibiting symptoms were given a referral to receive further clinical assessment. During the assessments, those who met the criteria for PTSD were invited to join the study and receive treatment.

Treatment options included:
  • Prolonged exposure therapy (PE), in which patients are taught breathing techniques and increasingly asked to overcome avoidance issues associated with the trauma
  • Cognitive therapy (CT), which teaches patients to connect thoughts with feelings and utilizes regular homework assignments
  • A double-blind medicinal treatment involving selective serotonin reuptake inhibitors (SSRI) and placebo
  • A group assigned to a treatment waiting list 

Participants were advised that they could refuse treatment options, but would then be randomly assigned to any of the remaining treatments. The SSRI/placebo group (antidepressant therapy) experienced the highest degree of patient refusal which made for a smaller test group. The treatments were administered in 1.5-hour sessions with a clinical psychologist experienced in PTSD treatment over the course of 12 weeks.

Participants were then randomly assigned as follows: 40 received cognitive therapy, 46 received SSRI/placebo treatment, 63 were given prolonged exposure therapy, and 93 were placed on the treatment waiting list. Participants were then checked at five-month and nine-month intervals for instances of PTSD. 

At five months and nine months the prevalence of PTSD within each group measured:

                                      5 months                     9 months

Prolonged Exposure    21.4 percent                 21.2 percent

Cognitive Therapy      18.2 percent                 22.8 percent

Waiting List *             58.2 percent                 22.9 percent

*57 waiting list participants were diagnosed with PTSD at the five month interview who then received PE treatment

SSRI                         61.9 percent                  42.1 percent

Placebo                     55.6 percent                 47.1 percent

The results clearly indicate that PE and CT were effective in reducing occurrences of PTSD. In fact, at the five-month mark, the odds of developing PTSD were reduced by 80 percent for those receiving either of the two therapies as compared to participants who did not receive PE or CT. 

The worst results were to be seen in the antidepressant group at the nine-month mark. The waiting list group who later received PE demonstrated that delaying treatment does not put a person at greater risk for developing chronic PTSD since at nine months their rate of PTSD was nearly the same as for those who received the treatment initially.

Studies have repeatedly shown that Americans are hesitant to undergo antidepressant treatment for depression. Interestingly, the participants in the Hadassah Hospital study exhibited the same reluctance. The results of this PTSD treatment study appear to support reservations about pharmacology-only treatment for cases involving severe anxiety or depression. On the other hand, it is encouraging to see that whether early or delayed, both PE and CT therapies can be effective in preventing PTSD.