Conventional Psychotherapy May Fall Short for PTSD in Military
New research suggests some of the common first-line cognitive-behavioral psychotherapies show limited effectiveness for treating post-traumatic stress disorder (PTSD) in active duty military personnel and veterans.
Researchers at New York University Grossman School of Medicine led a review of recent clinical trials and discovered that commonly used therapy approaches —Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT) — were not as effective for PTSD as originally thought.
The research, which appears in the Journal of the American Medical Association (JAMA) Insights, suggest use of these treatment modalities provide limited effectiveness for treating PTSD in active duty military personnel and veterans.
Investigators discovered that emotionally demanding therapies like PE and CPT, which repeatedly activate and process memories of traumatic experiences, were not more beneficial than interventions which do not require patients to focus on their traumatic events.
Alternative therapies include present-centered therapy (a supportive, problem-solving treatment), transcendental meditation and biological treatments such as anti-depressants.
“Cognitive-behavioral therapy’s limited value for treating military service-related PTSD suggests the need to go beyond the one-size-fits-all approaches rolled out in most VA and DoD healthcare settings and personalize treatment, accounting for pre-service vulnerabilities and complex, repeated exposures to war zone stressors,” said senior author Charles R. Marmar, MD.
Lead author Maria M. Steenkamp, Ph.D., points out that more attention should focus on managing non-response to treatment.
“Research in this field needs to shift from confirmatory trials to studies that explore more flexible, multifaceted and long-term treatments, including biological therapies,” she says.
This retrospective review comes just months following the publication of a seminal study led by researchers at Stanford University in Science Translational Medicine — of civilians with PTSD and why a sub-group did not respond to prolonged exposure therapy.
The Stanford study, using functional brain imaging, found that civilian PTSD patients with altered neural circuit activity in the ventral attention network (VAN) in the brain had poor outcomes to prolonged exposure therapy. Whether this pattern of brain circuit abnormality is over-represented in those suffering from military service related PTSD remains to be studied.
“In the meantime, current clinical trials strongly suggest that treating military-related PTSD involves significant clinical complexity and heterogeneity. For many who have served in the military, a course of standardized, trauma-focused cognitive-behavioral therapy for PTSD is emotionally demanding and likely to result in only modest clinical improvement,” Marmar said.
Nauert PhD, R. (2020). Conventional Psychotherapy May Fall Short for PTSD in Military. Psych Central. Retrieved on February 28, 2020, from https://psychcentral.com/news/2020/02/04/conventional-psychotherapy-may-fall-short-for-ptsd-in-military/153947.html