What is the most effective treatment for PTSD?
Cognitive Behavior Therapy (CBT): CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT for PTSD is trauma-focused, meaning the trauma event(s) are the center of the treatment.May 18, 2020
What is the first line treatment for PTSD?
SSRIs are considered first-line therapy for PTSD, in view of treatment guideline recommendations and the results of numerous clinical trials. Sertraline and paroxetine are the only antidepressants approved by the FDA for the treatment of PTSD and are the most extensively studied SSRIs for this indication.
Is EMDR the gold standard of treatment for PTSD?
Both meta-analyses demonstrated the efficacy of EMDR therapy in treating symptoms of PTSD. Both studies concluded that EMDR therapy was more effective in treating symptoms of PTSD than various interventions and control conditions (Chen et al., 2014), including forms of CBT (Chen et al., 2015).Jun 6, 2018
What is the best mood stabilizer for PTSD?
Antidepressants. While no single pharmacological agent has emerged as the best treatment for PTSD, research and testimonials strongly recommend serotonin reuptake inhibitors (SRIs). The FDA has only approved two SRIs for the treatment of PTSD: sertraline and paroxetine.Sep 9, 2013
What is the second line treatment for PTSD?
Second-line — For patients who have a poor or partial response to psychotherapy and do not want a trial of another trauma-focused psychotherapy that includes exposure, we suggest second-line treatment with an SRI (either a selective serotonin reuptake inhibitor [SSRI] or venlafaxine, a serotonin norepinephrine reuptake ...Nov 8, 2021
How effective is Eye Movement Desensitization and Reprocessing for PTSD?
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.
Why is EMDR so controversial?
The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment.
How many sessions of EMDR do you need for PTSD?
6-12 sessionsEMDR is an individual therapy typically delivered one to two times per week for a total of 6-12 sessions, although some people benefit from fewer sessions. Sessions can be conducted on consecutive days.Jul 31, 2017
What is prolonged exposure?
Abstract– Prolonged exposure (PE) is an effective first-line treatment for posttraumatic stress disorder (PTSD), regardless of the type of trauma, for Veterans and military personnel . Extensive research and clinical practice guidelines from various organizations support this conclusion. PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single- and multiple-incident traumas. The PE protocol includes four main therapeutic components (i.e., psychoeducation, in vivo exposure, imaginal exposure, and emotional processing). In light of PE–s efficacy, the Veterans Health Administration designed and supported a PE training program for mental health professionals that has trained over 1,300 providers. Research examining the mechanisms involved in PE and working to improve its acceptability, efficacy, and efficiency is underway with promising results.
Is exposure therapy a first line treatment for PTSD?
In this update, exposure therapy (ET) remains a first-line treatment for posttraumatic stress disorder (PTSD), with increased evidence supporting its use regardless of the type of trauma and comorbidities. In this article, we examine the evidence used to support this update to the guideline as well as review additional evidence of the effective use of ET with Veterans within the VA. Our discussion of ET will be focused on prolonged exposure (PE) because it is the most widely studied manualized version of ET for PTSD and is currently being disseminated in VA and DOD as a first-line intervention for PTSD.
What is psychoeducation in PTSD?
Psychoeducation occurs primarily in the first three sessions and focuses on PTSD symptoms and the patient–s experience of those symptoms. Psychoeducation conveys the overarching idea that avoidance maintains PTSD symptoms, while confronting trauma-related stimuli and memories can reduce PTSD symptoms.
Is PE effective for PTSD?
PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single- and multiple-incident traumas. The PE protocol includes four main therapeutic ...
What is imaginal exposure?
Imaginal exposure involves revisiting trauma reminders and engaging with the emotional content of the memory. During imaginal exposure, the patient closes his or her eyes and goes through the memory in the present tense with all the thoughts, feeling, and details he or she can include from the time of the trauma.
What is PE treatment?
PE is a gold standard treatment for PTSD that has been subjected to many clinical trials supporting its effectiveness in reducing PTSD even among complex and comorbid patients. Thus, if PTSD is primary for a patient and the patient is not in imminent risk of harm (from self or others), PE may be indicated and should be considered as a critical part of the treatment plan. With the dissemination efforts of VA and DOD as well as other community training, clinicians are now able to receive high-quality training in the use of PE, making this treatment more widely available than ever before to address the needs of returning Veterans from the conflicts in Iraq and Afghanistan, previous era Veterans, and all trauma survivors.
Is PTSD a disorder?
PTSD has increased substantially in the past several decades. First explored as a disorder of military members during wartime, it is now understood as also arising from many other types of trauma, such as natural disasters, terrorist incidents, interpersonal violence, child abuse, car and industrial accidents, and life-threatening illness.
What is dissociative PTSD?
Additionally, the dissociative subtype of PTSD identifies symptoms such as feeling detached from one's mind or body, and experiences in which the world seems unreal, dreamlike, or distorted. Persistence of symptoms for over a month and marked decline in functioning are also required.
Is PTSD treatment effective?
Overall, current research indicates that PTSD treatments work better than treatment as usual; average improvement (effect sizes) are in the moderate to high range; and various treatments are identified as effective, with no one treatment having clear superiority [3].
What is PTSD treatment?
PTSD treatments generally fall into two broad categories: past-focused and present-focused (or their combination) [4]. Past-focused PTSD models ask clients to explore their trauma in detail to promote “working through” or processing of painful memories, emotions, beliefs and/or body sensations about the trauma.
What is CPT 8?
CPT [8] was first developed for female rape victims [9], but has since been tested in other populations. The model draws heavily on McCann and Pearlman's 1990 trauma themes of safety, trust, power, esteem, and intimacy [10].
What is prolonged exposure?
Prolonged exposure is heavily promoted by the VA, which describes it as the “gold standard” treatment for PTSD. Advertisement.
Where was the IED hit?
Medics carry a soldier hit by an IED in 2011 in Kandahar, Afghanistan. The U.S. Department of Veterans Affairs is the world leader in research on post-traumatic stress disorder. No organization spends more money or expends more resources to treat it than the VA. Yet its efforts to stamp out the disorder, which afflicts upward of 30 percent ...
Who is Bruce Wampold?
But in his book The Great Psychotherapy Debate, Bruce Wampold, a professor at the University of Wisconsin , uses one of Foa’s experiments as a case study to examine much of what is wrong with therapy research today. In a 1991 study, Foa compared prolonged exposure against another kind of PTSD therapy known as “supportive counseling.”.
What is the best treatment for PTSD?
Cognitive-behavioral therapy is to gold standard treatment for PTSD, with a wealth of research supporting it as the most effective treatment for the disorder. Most individuals with PTSD no longer meet the criteria for the disorder after as few as 12 sessions of trauma-focused CBT. The American Psychological Association also recently determined ...
What is prolonged exposure?
Prolonged Exposure: Prolonged exposure is a treatment that helps people no longer experience the anxiety and distress associated with the trauma, by helping people repeatedly expose themselves to memories of the trauma.
Is CPT effective for PTSD?
Also considered a gold standard treatment for PTSD, the research in support of CPT suggests it is as effective as prolonged exposure in reducing PTSD symptoms. Seeking Safety: Many people experience intense emotional dysregulation following a trauma.
What is cognitive processing therapy?
Cognitive Processing Therapy: This therapy identifies thoughts about the trauma as the primary target of treatment. People who develop PTSD often go on to develop maladaptive assumptions that maintain their trauma response.
Is a syringe harmful?
It is not harmful, and many people in fact have benefitted from it. However, it is unclear why people persist in providing this antiquated treatment given what we now know about the active ingredients in therapy, other than not being familiar with the research about what works in therapy.
What is prolonged exposure?
Prolonged exposure (PE) is an effective first-line treatment for posttraumatic stress disorder (PTSD), regardless of the type of trauma, for Veterans and military personnel. Extensive research and clinical practice guidelines from various organizations support this conclusion. PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single- and multiple-incident traumas. The PE protocol includes four main therapeutic components (i.e., psychoeducation, in vivo exposure, imaginal exposure, and emotional processing). In light of PE's efficacy, the Veterans Health Administration designed and supported a PE training program for mental health professionals that has trained over 1,300 providers. Research examining the mechanisms involved in PE and working to improve its acceptability, efficacy, and efficiency is underway with promising results.
Is PTSD a complication of pregnancy?
Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn
What is IPT therapy for PTSD?
Exposure-based, cognitive-behavioral approaches have received ample research, but other PTSD therapies require further empirical attention. Interpersonal psychotherapy (IPT) targets affective awareness, life circumstances, and social support. IPT has shown efficacy for civilians with PTSD but awaits rigorous testing among military personnel; only two small military pilot studies and two case reports have been published. Military family members have received minimal attention from clinical outcomes research. Addressing these gaps, this open trial examined IPT for PTSD among veterans, service members, and family members, including a patient subset with comorbid PTSD and depression. Methods: Fifty U.S. military service members, veterans, and family members (age ≥18 years) were offered 14 sessions of IPT for PTSD. Individuals with psychosis, bipolar disorder, moderate or severe substance use disorders, or high suicide risk were excluded. PTSD and depressive symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. Results: Clinician-assessed PTSD (Clinician-Administered PTSD Scale) and depression (Hamilton Depression Rating Scale) symptoms decreased over time in the full sample and the comorbid PTSD/depression subset (p<0.05). Service members, veterans, and family members had similar treatment responses. Conclusions: Patients receiving IPT showed reductions in PTSD and depressive symptoms. These open trial findings provide preliminary support for the utility of IPT in reducing PTSD symptoms among veterans and family members. This largest IPT trial to date for PTSD in military patients also bolsters the literature on treating military family members.
Is masculinity associated with PTSD?
Endorsement of traditional masculinity ideology is frequently associated with interference in the treatment of posttraumatic stress disorder (PTSD); however, there is little empirical basis for this association. Moreover, there is increasing attention on masculinity ideology being contextual in nature, which may have important implications for our understanding of its impact on treatment. Here, we examine how the outcome of a group-based treatment for veterans with PTSD was impacted by traditional masculinity facets held at the individual level, and among other group members. Our sample consisted of (N = 255) Canadian veteran men. Results indicated that the degree of individual self-reliance and dominance attenuated positive treatment outcomes, with respect to total PTSD symptom change and PTSD-related avoidance symptoms. Self-reliance also attenuated symptom change in negative alterations in cognitions and mood and hyperarousal clusters. Other group members’ degree of masculinity did not appear to impact individual participants’ pre- to post-treatment PTSD symptom change. The R² for significant results ranged from .01-.05. This study provides evidence that, within the context of group-based treatment, an individual’s endorsement of traditional masculinity ideology may impede reduction of PTSD symptomatology, but the effect of other group members’ masculinity endorsement does not.
What is MST in the military?
Military sexual trauma (MST), defined as sexual assault or repeated, threatening sexual harassment while in the military, is associated with increased risk of long-term mental and physical health problems, with the most common being symptoms of post-traumatic stress disorder (PTSD) and depression. In addition to PTSD and depression, MST is linked to difficulties in emotion regulation as well as poor treatment engagement. Thus, it is important to examine these correlates, and how they affect postintervention symptom reduction in this vulnerable population. The current study presents secondary data analyses from a randomized clinical trial comparing the efficacy of in-person versus telemedicine delivery of prolonged exposure therapy for female veterans with MST-related PTSD ( n = 151). Results of the study found that changes in difficulties with emotion regulation predicted postintervention depressive symptoms but not postintervention PTSD symptoms. Neither postintervention depressive nor PTSD symptoms were affected by treatment dosing (i.e., number of sessions attended) nor treatment condition (i.e., in-person vs. telemedicine). Findings from the current study provide preliminary evidence that decreases in difficulties with emotion regulation during PTSD treatment are associated with decreases in depressive symptom severity.
What is a social worker?
Social workers are more than just discharge planners within a hospital setting. In fact, licensed social workers are credentialed to provide therapeutic interventions such as counseling to enhance the discharge planning process. This case study narrative examines prolonged exposure therapy (PE) as an intervention for the discharge of a female veteran psychiatrically hospitalized for one year. The methodology was selected in response to the dearth of research regarding the psychotherapeutic use of PE during the discharge planning process. The veteran in this study experienced both guilt and shame related to her psychiatric hospitalization and was avoidant of her discharge. There is a scarcity of research that examines the impact of distorted beliefs associated with a prolonged hospital stay and the psychotherapeutic approaches within discharge planning in either the medical or psychiatric hospital settings. This article attempts to fill in the gaps in research by specifically reviewing the use of PE to reduce distorted thoughts of guilt and shame because of the fear of returning home posthospitalization.
What are the best psychotherapies for trauma?
The trauma-focused psychotherapies with the strongest evidence are: 1 Prolonged Exposure (PE)#N#Teaches you how to gain control by facing your negative feelings. It involves talking about your trauma with a provider and doing some of the things you have avoided since the trauma. 2 Cognitive Processing Therapy (CPT)#N#Teaches you to reframe negative thoughts about the trauma. It involves talking with your provider about your negative thoughts and doing short writing assignments. 3 Eye Movement Desensitization and Reprocessing (EMDR)#N#Helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).
What is the best treatment for PTSD?
Trauma-focused Psychotherapies. Trauma-focused Psychotherapies are the most highly recommended type of treatment for PTSD. "Trauma-focused" means that the treatment focuses on the memory of the traumatic event or its meaning. These treatments use different techniques to help you process your traumatic experience.
Do psychotherapists focus on trauma?
Some psychotherapies do not focus on the traumatic event, but do help you process your reactions to the trauma and manage symptoms related to PTSD. The research behind these treatments is not as strong as the research supporting trauma-focused psychotherapies (listed above).
What is CPT therapy?
It involves talking about your trauma with a provider and doing some of the things you have avoided since the trauma. Cognitive Processing Therapy (CPT) Teaches you to reframe negative thoughts about the trauma.
What is trauma focused psychotherapy?
Read Full Article. Hide Full Article. There are other types of trauma-focused psychotherapy that are also recommended for people with PTSD.
What are the medications used for PTSD?
These are antidepressant medications called SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors).
What is riluzole used for?
Riluzole is a neuroprotective drug that blocks glutamatergic neurotransmission in the CNS. Glutamate dysregulation has been implicated in the pathophysiology of PTSD, so medications that regulate brain glutamate concentrations may be an effective treatment strategy for PTSD.
How long does ketamine last?
It’s important to note the limitations associated with ketamine: Benefits may last only a few weeks and there is a potential for patients getting addicted to this treatment.
Is MDMA used for PTSD?
In MDMA-assisted therapy, the medication MDMA is only administered a few times, and the talk therapy component remains an integral part of this combination treatment.
What is SGB in PTSD?
In 2008, media reports started to emerge about how a stellate ganglion block (SGB), an invasive manipulation of sympathetic nerve tissue, helped PTSD sufferers. The procedure, which consisted of injecting a local anesthetic into sympathetic nerve tissue in the neck, led to immediate symptom relief in a small group of patients.
Is MDMA a phase 3 drug?
Furthermore, unlike most medications for mental illnesses which are often taken daily for a substantial length of time, MDMA is only taken a few times. A second phase 3 trial is currently underway and, if results continue to be encouraging, a drug application with the FDA is anticipated in 2022.
Is ketamine a barbiturate?
Repeated Ketamine Infusions. Ketamine is a non-barbiturate anesthetic and antagonist at the NMDA receptor. It is typically administered intravenously and has been used for years to provide pain relief to patients with severe burns. It was in this use that its dissociative properties became apparent.
Can ketamine help with PTSD?
In a 2021 study published in the American Journal of Psychiatry (in Advance), researchers from Icahn School of Medicine at Mount Sinai suggested that repeated ketamine infusions may lead to rapid symptom improvement in people with PTSD.
What is EMDR treatment for PTSD?
Zimmermann, et al. (2007) investigated inpatient EMDR treatment for German soldiers with PTSD following non-combat deployments. They reported that “The Impact of Event Scale showed that inpatient trauma therapy with eye movement desensitization and reprocessing significantly improved the course of post-traumatic stress disorder. In addition, the Impact of Event Scale indicated a significantly poorer longterm outcome for patients who had been confronted with death during their traumatic experience.” However, the authors acknowledge that their small sample size limits the generalizability of this finding. See Alliger-Horn, et al. (2015) and Köhler, et al. (2017) further below for more recent data on EMDR treatment of German soldiers.
How many RCTs have been conducted for PTSD?
RCTs remain the standard for evaluating evidence-based treatment. Out of more than 30 RCTs in which EMDR therapy has been evaluated as a treatment for PTSD, only six have examined the treatment of those with combat related PTSD. These include Ahmadi, et al. (2015), Boudewyns, et al. (1993) Carlson, et al. (1998), Devilly (1998), Jensen (1994), and Pitman et al. (1996). The Jensen, the Devilly and the Boudewyns studies provided only two sessions of EMDR therapy, which is unlikely to have been enough treatment for this multiply traumatized population whereas in the Carlson study, after 12 sessions of EMDR therapy, 78% no longer met full criteria for PTSD (Shapiro, 2018, p 389). Pitman et al. was a dismantling study of a nonstandard eye movement condition with concurrent, but non-bilateral, finger tapping versus an eye fixation condition. The authors claimed the results showed modest improvement in both groups, but data from the standardized testing were not disclosed. Independent treatment fidelity rating revealed low to moderate fidelity to standard EMDR procedures. The Ahmadi study reported a high dropout rate of 31% and evaluated eight sessions of EMDR or REM desensitization with a wait list control. Differential dropout rates by group were not disclosed. REM desensitization is a previously unpublished procedure that uses glasses that track REM sleep and plays 30 seconds of music during REM sleep. The music played had previously been paired with soothing images during awake desensitization-conditioning sessions. Ahmadi et al. reported similar symptom reduction with REM desensitization compared to the EMDR condition and both were superior to the wait list control. Thus, of these six RCTs, at best only two (Ahmadi, et al., 2015; Carlson, et al., 1998) may have specific relevance for evidence of EMDR therapy’s effectiveness with combat-related PTSD. Clearly more controlled research with combat related PTSD is needed.
Is EMDR good for stress?
The first by Russell (2006) discussed four combat veterans, casualties from the Iraqi war, evacuated to a field hospital in Spain and treated with a single session of EMDR which led “to significant improvement in their acute stress disorder and posttraumatic stress disorder symptoms.” Russell provided detailed descriptions of their treatment and suggests that “Compared to other early interventions, EMDR may be better suited for combat veterans.” He highlighted the need for further research. The second, by Wesson and Gould (2009), presents a single-case study on the use of the EMDR recent event protocol (Shapiro, 1995) used in theatre two weeks post trauma “with a 27-year-old active-duty U.K. soldier who was experiencing an acute stress reaction after treating a land mine casualty.” After four sessions on consecutive days, “the soldier [was] able to return immediately to frontline duties.” Four standardized measures were used at pretreatment, posttreatment, and 18-month follow-up and showed stable effects at the 18-month follow-up.
Who published the study of scientific resistance to research, training and utilization of EMDR therapy in treating post-war disorders
In 2008, Russell published “Scientific resistance to research, training and utilization of EMDR therapy in treating post-war disorders.” “ [An] analysis of scientists’ resistance to discoveries is examined in relation to an 18-year controversy between the dominant cognitive-behavioral paradigm or zeitgeist and its chief rival – eye movement desensitization and reprocessing (EMDR) in treating trauma-related disorders…”
Does EMDR therapy require homework?
He emphasized the benefits of EMDR therapy which does not require the “extensive homework or self-disclosure that some military patients may resist” and called for further research. The same year Russell (2008) published a case study on the use of EMDR therapy for phantom limb pain.
Is EMDR therapy effective?
The authors concluded that “EMDR therapy is an effective treatment to reduce symptoms of PTSD and depression.”. They add that “in the military context it needs to be complemented by treatment options that specifically address further conditions perpetuating the disorders.”.
