First-line treatments for post-traumatic stress disorder (PTSD) often require many treatment sessions and delivery by extensively trained therapists. Now, research supported by the National Institute of Mental Health (NIMH) has shown that a shorter therapy may be just as effective as lengthier first-line treatments. The study appeared in the March 2018 issue of JAMA Psychiatry.
First-line treatments for PTSD consist of psychotherapies that focus on exposure and/or cognitive restructuring. One such therapy is cognitive processing therapy (CPT), which is widely acknowledged as an effective treatment for PTSD. Patients being treated with CPT take part in 12 weekly therapy sessions that are delivered by a highly-trained practitioner. During these sessions, patients learn to recognize and challenge dysfunctional thoughts about their traumatic event, themselves, others, and the world. In addition, patients are given homework to complete between sessions.
“While of proven efficacy, structured therapies, such as CPT, require extensive training of therapists, a relatively long series of treatments, and, as a further burden on patients, homework exercises between treatment sessions,” said Matthew Rudorfer, M.D., program chief of adult interventions in the NIMH Division of Services and Intervention Research. “A more streamlined intervention that requires less specialized therapist training and fewer sessions while maintaining therapeutic effectiveness would, therefore, be appealing for treatment of PTSD in the community.”
In this study, the researchers examined whether another trauma-focused therapy—called written exposure therapy (WET)—may provide practitioners and patients with an equally effective, but shorter, treatment option. WET consists of five treatment sessions during which patients write about their specific traumatic event. Patients follow scripted instructions directing them to focus on the details of the event and on the thoughts and feelings that occurred during the event. WET requires less specialized practitioner training and no homework assignments between therapy sessions. While WET has been shown to be effective in treating PTSD, it had not yet been tested against more commonly used first-line treatments for PTSD, such as CPT.
To compare the efficacy of WET with CPT, the researchers randomly assigned participants with PTSD to either WET or CPT. Participants were assessed for PTSD symptom severity at baseline and at 6-, 12-, 24-, and 36-weeks after the first treatment session. WET was found to be as effective as CPT at all time points. In addition, individuals assigned to WET were less likely to drop out before completion of the treatment (6.3 percent) than participants in the CPT group (39.7 percent). Participants in both treatment groups reported high levels of satisfaction with the treatment they received.
“The findings of the study suggest that PTSD can be treated with fewer sessions than previously thought and with less burden on the patient and the therapist,” said lead study author Denise Sloan, Ph.D., an associate director at the National Center for PTSD in the VA Boston Healthcare System and professor of psychiatry at Boston University School of Medicine. “Moreover, the brief treatment was well-tolerated—demonstrated by the small number of patients that dropped out. We look forward to better understanding for whom written exposure therapy works best.”
Dr. Rudorfer added that while more research is needed to identify who might require standard, more intensive therapy, the availability of the new WET intervention “offers additional options for personalizing treatment to meet the needs of the individual.”
Sloan, D. M., Marx, B. P., Lee, D. J., & Resick, P. A. (2018). A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial. JAMA Psychiatry. 2018;75(3):233-239. doi: 10.1001/jamapsychiatry.2017.4249