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  • The Research Behind PTSD Treatments
    By the Naval Health Research Center Health and Behavioral Sciences Team
     

    PTSD can develop in service members, civilians, or veterans as a result of a traumatic event such as an accident, physical or sexual abuse, or exposure to combat. 1 Based on research, we know that people with PTSD often experience distress and problems at work, with loved ones, and in completing daily tasks; they also are at increased risk of having other conditions, such as depression or substance use problems, which further complicate their lives. However, not everyone who experiences a traumatic event will develop PTSD; approximately 20% of individuals who experience a traumatic event will meet criteria for PTSD at some point in their lifetime. 2

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    PTSD is a mental health condition for which people often avoid seeking treatment; current research shows that fear of stigma, perceived inconvenience of treatment, and beliefs that treatment may not work are some of the most common reasons that individuals do not seek mental health treatment. 3 Some people may also avoid getting help for PTSD because they don’t know what to expect from treatment or because they don’t want to talk about their traumatic experiences. However, there is strong evidence that treatment can be very beneficial for reducing symptoms and improving quality of life. Effective options for treating PTSD include psychotherapy and medication, and alternative medicine approaches may also be beneficial. These different types of treatments may be used alone or in combination to reduce PTSD symptoms and improve patient outcomes.
     
    Psychotherapy
     
    The type of PTSD treatment with the most scientific support is psychological treatment, especially evidence-based individual psychotherapies. The two state-of-the-science treatments recommended by the Department of Defense/Department of Veterans Affairs (DoD/VA) and the International Society for Traumatic Stress Studies (ISTSS) Clinical Practice Guidelines are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). These two treatments are also the most frequently studied for military-related PTSD. Generally, these treatments involve thinking about and talking through the traumatic memory and engaging in practice assignments outside of sessions to help promote recovery.
     
    Present-Centered Therapy (PCT) is a psychological treatment that places less emphasis on the traumatic event. Emerging evidence indicates that PCT may be as effective as the existing, evidence-based PTSD treatments. Individuals who received PCT were also less likely to drop out of treatment compared to those who received CPT or PE. 4
     
    Cognitive Behavioral Conjoint Therapy (CBCT) is a form of psychotherapy for PTSD that includes a friend or significant other in treatment with the patient. CBCT has been shown in research studies to improve both PTSD symptoms and relationship satisfaction. 5
     
    Although approximately 49-70% of people who receive these treatments experience clinically-meaningful improvements in their PTSD and other symptoms, these psychotherapies do not work for everyone. 6 Fortunately, there are other options.
     
    Medication
     
    The DoD/VA and ISTSS Practice Guidelines identify one type of medication, called selective serotonin reuptake inhibitors (SSRIs), as having the best evidence as a treatment for PTSD; examples of SSRIs include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and fluoxetine (Prozac). Other medications besides SSRIs may be helpful for specific PTSD symptoms, and all medications may have side effects. Patients should talk with their providers to determine which medications might be the best option for them.
     
    Alternative Approaches
     
    Recently, researchers have begun to investigate alternative medicine approaches to treating PTSD. Alternative approaches that have been studied to date include acupuncture, yoga, physical exercise, and mantram repetition (silently repeating a spiritual word or phrase). Although more research is needed, initial results suggest that some individuals experience a reduction in symptoms following alternative approaches, and more alternative treatment approaches for individuals with PTSD may be on the horizon.  For example, researchers at Naval Health Research Center (NHRC) are currently studying whether surf therapy relieves symptoms of PTSD and related problems such as depression.
     
    Starting Treatment
     
    Once treatment is started, it is important to know that it may take some time before it begins to help. For some people, symptoms may get worse before they get better, although this increase is typically brief and temporary. 7 This pattern is common with many types of treatments and it’s important that  patients understand this so they do not to give up prematurely.  Most people who receive treatment start feeling better within the first few months.
     
    For those patients still experiencing symptoms after being in treatment for several weeks to months, they should discuss their progress with their treatment provider.  The DoD/VA Clinical Practice Guidelines recommend options including changing medication dose or treatment frequency, trying a different treatment approach, or getting a referral for other services.  
     
    While some individuals may recover from PTSD without medical intervention, treatment delivered by a qualified health care provider can help to reduce symptoms and improve daily living. Seeking professional assistance from a psychologist or psychiatrist can also help patients sort through the available treatment options to identify the ones that are best suited for them. Each patient should evaluate the available options and select the approach that seems to best fit his or her needs.
     
    When seeking help for PTSD, many patients want to learn more about their treatment choices. A good starting place to find information about evidence-based treatments for PTSD is the VA’s National Center for PTSD, www.ptsd.va.gov/public/index.asp.
     
     
     
    1  Breslau, N., Davis, G.C., Andreski, P. and Peterson, E. (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48 (3), 216–222.
    2  Resnick, H.S., Kilpatrick, D.G., Dansky, B.S. et al. (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61 (6), 984–991.
    3  Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.
    4  Frost, N. D., Laska, K. M., & Wampold, B. E. (2014). The evidence for present‐centered therapy as a treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 27(1), 1-8.
    5  Monson, C. M., Fredman, S. J., Macdonald, A., Pukay-Martin, N. D., Resick, P. A., & Schnurr, P. P. (2012). Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. JAMA, 308(7), 700-709.
    6  Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. Jama, 314(5), 489-500.
    7. Nishith, P., Resick, P. A., & Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70(4), 880–886.
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