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This page contains information and summaries of
published research that are intended for people with professional training in
mental health. We urge caution since
it may be difficult to know how to interpret the information without advanced
training in psychology or psychiatry.
We recommend that readers interested in information intended for
the general public check other areas of this web site (such as Info
for Adults or Info
for Children). They contain similar information, but in a more readable
form. Also, elsewhere we have provided links
to other websites that we feel may be helpful.
CONTROLLED
RESEARCH ON TREATMENT EFFICACY:
Conclusion
of the International Society for Traumatic Stress Studies
Treatment
Guidelines Task Force:
“Comparing
the numbers and types of studies supporting each type of treatment EX
[Prolonged Exposure] has the most studies and the greatest number of
well-controlled studies to support its use.
EX has been tested in 12 studies, all finding positive results for this
treatment with PTSD. These are
also generally methodologically controlled studies, eight of which received
the AHCPT Level A rating, with many meeting many of the gold standards for
clinical outcome studies (Foa & Meadows, 1997); thus the strength of
evidence for EX is very conclusive. In
one study, EX was superior to SIT and SIT/PE.
Additionally, EX has been tested in a wider range of trauma populations
and more studies than any of the other treatments.
Thus, we strongly recommend the use of some form of EX in the treatment
of PTSD unless otherwise indicated. In
conclusion, the evidence is very compelling from many well-controlled trials
with a mixed variety of trauma survivors that EX is effective.
In fact, no other treatment modality has such strong evidence for its
efficacy. . . EX has received the strongest evidence for PTSD; thus, it should
be considered the first line treatment unless reasons exist for ruling it
out” (Foa
et al., 2000).
Psychosocial Treatments for PTSD That Have Been Studied
Through Controlled Clinical Trials
(Foa
et al., 2000; Foa & Rothbaum, 1998)
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Prolonged
Exposure (PE - Foa)
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12
empirical studies, 8 of which were “gold standard.”
Generally, about 75-80% of participants had at least a 70%
reduction in symptoms within the 9-12 session protocol.
Low relapse rates, and some indications that participants continue
to improve after therapy is over. Treatment
involves relaxation followed by structured, imaginal reexposure and in
vivo exposure exercises. “No
other treatment modality has such strong evidence for its efficacy” (ISTSS
Treatment Guidelines Task Force). (9-12
sessions)
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Stress
Inoculation Training (SIT - Meichenbaum)
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4
Studies, 2 of which were very well controlled.
Support and findings similar to, but not as strong as, those for
PE, but they take a firm second place.
Treatment has several components, including relaxation, skills
training, and exposure. (9-12
sessions)
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Combined
PE and SIT
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1
well-controlled study. Findings
are that a combination of SIT and PE are as effective, but not more
effective that either component alone.
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Cognitive
Processing Therapy (CPT – Resick)
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2-3
studies (although more in the pipeline).
Preliminary findings have shown promise, but more research is
needed. Preliminary evidence
suggests that it may be better than PE at reducing cognitions related to
guilt (9-12 sessions)
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Cognitive
Therapy
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2
well controlled studies demonstrating efficacy.
Evidence is considered preliminary by many researchers, however.
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Systematic
Desensitization (SD - Wolpe)
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6
studies that were not well controlled.
Outcomes have not given strong support to efficacy.
Generally abandoned in favor of PE since opinion seems to be that
the intermittent relaxation element of SD prolongs treatment but does not
enhance effectiveness. (9-12
sessions)
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Assertiveness
Training
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One
study, not well controlled. Not
significantly different from comparison treatments.
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Biofeedback
and Relaxation Training
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One
study for biofeedback and several for relaxation.
Findings indicate that they are less effective than comparison
treatments.
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Eye
Movement Desensitization and Reprocessing (EMDR)
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Proponents
have made remarkable claims (e.g., one session cures, etc), but these
claims have not been supported by controlled research trials.
Probably more effective than placebo or non-specific therapy, and
efficacy may be close to that of PE. But
most studies have not been well designed (e.g., no standardized measures,
not “blind,” etc.). Research indicates eye movements are not
necessary, leaving a protocol that bears some similarity to exposure-based
treatment.
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Unfortunately,
there are no studies that systematically examine the value of combining
psychotherapy with medication or combinations of medications.
In
one examination of inpatient Tx for Vietnam Vets with PTSD, no positive
results were found (Johnson
et al., 1996). Psychodynamic approaches, creative therapy, and marital therapy have
not been examined using well-controlled research.
Available studies have found that they do not appear to show
efficacy in treating PTSD. Research
on psychoanalytic psychotherapy is similar, with one study reporting
iatrogenic effects.
Writing
about the trauma, whether or not one focuses on affect or shares the
writing, is associated with reductions in dysphoria and social anxiety
(Brown & Heimber, 2001). Number
of words in the self-references in writing had a curvilinear relationship
with Sx reduction (moderate number of self references associated with
fewer Sx).
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