PTSD treatments grow in evidence, effectiveness

By | May 16, 2018

This January 2008 article lists the best treatments for PTSD. I’ve been struggling with it for several years now and still need more therapy to stop being emotionally triggered by innocuous things. Some days are better than others. If you struggle with trauma of your own, check out these options. I’ve tried most of them.

Treatments that make a difference

The fact that several treatments made the “A” list is great news for psychologists, says Keane. “Having this many evidence-based treatments allows therapists to use what they’re comfortable with from their own background and training, and at the same time to select treatments for use with patients with different characteristics,” he says.

Moreover, many of these treatments were developed by psychologists, he notes.

They include:

  • Prolonged-exposure therapy, developed for use in PTSD by Keane, University of Pennsylvania psychologist Edna Foa, PhD, and Emory University psychologist Barbara O. Rothbaum, PhD. In this type of treatment, a therapist guides the client to recall traumatic memories in a controlled fashion so that clients eventually regain mastery of their thoughts and feelings around the incident. While exposing people to the very events that caused their trauma may seem counterintuitive, Rothbaum emphasizes that it’s done in a gradual, controlled and repeated manner, until the person can evaluate their circumstances realistically and understand they can safely return to the activities in their current lives that they had been avoiding. Drawing from PTSD best practices, the APA-initiated Center for Deployment Psychology includes exposure therapy in the training of psychologists and other health professionals who are or will be treating returning Iraq and Afghanistan service personnel (see “A unique training program“).
  • Cognitive-processing therapy, a form of cognitive behavioral therapy, or CBT, developed by Boston University psychologist Patricia A. Resick, PhD, director of the women’s health sciences division of the National Center for PTSD, to treat rape victims and later applied to PTSD. This treatment includes an exposure component but places greater emphasis on cognitive strategies to help people alter erroneous thinking that has emerged because of the event. Practitioners may work with clients on false beliefs that the world is no longer safe, for example, or that they are incompetent because they have “let” a terrible event happen to them.
  • Stress-inoculation training, another form of CBT, where practitioners teach clients techniques to manage and reduce anxiety, such as breathing, muscle relaxation and positive self-talk.
  • Other forms of cognitive therapy, including cognitive restructuring and cognitive therapy.
  • Eye-movement desensitization and reprocessing, or EMDR, where the therapist guides clients to make eye movements or follow hand taps, for instance, at the same time they are recounting traumatic events. It’s not clear how EMDR works, and, for that reason, it’s somewhat controversial, though the therapy is supported by research, notes Dartmouth University psychologist Paula P. Schnurr, PhD, deputy executive director of the National Center for PTSD.
  • Medications, specifically selective serotonin reuptake inhibitors. Two in particular-paroxetine (Paxil) and sertaline (Zoloft)-have been approved by the Food and Drug Administration for use in PTSD. Other medications may be useful in treating PTSD as well, particularly when the person has additional disorders such as depression, anxiety or psychosis, the guidelines note.

Spreading the word

So promising does the VA consider two of the “A” treatments-prolonged exposure therapy and cognitive-processing therapy-that it is doing national rollouts of them within the VA, notes psychologist Antonette Zeiss, PhD, deputy chief consultant for mental health at the agency. ..