Public Release:  Certain cognitive behavioral therapy appears beneficial for female veterans with PTSD

The JAMA Network Journals

Using a cognitive behavioral therapy called "prolonged exposure" appears more effective than "present-centered" therapy, a supportive intervention to treat female military veterans and active duty women with posttraumatic stress disorder, according to a study in the February 28 issue of JAMA.

"Events such as the terrorist attacks on September 11, 2001, the war in Iraq, and hurricane Katrina have focused attention on posttraumatic stress disorder (PTSD), an anxiety disorder that can result from exposure to traumatic events like combat, rape, assault, and disaster. Posttraumatic stress disorder is characterized by symptoms of re-experiencing the traumatic event, avoiding reminders of the event or feeling emotionally numb, and a state of increased psychological and physiological tension. The disorder is associated with psychiatric and physical illnesses, reduced quality of life, and substantial economic costs to society", according to background information in the article. "Lifetime prevalence in U.S. adults is higher in women (9.7 percent) than in men (3.6 percent) and is especially high among women who have served in the military." There has been no prior study to evaluate treatment for PTSD in this group.

Paula P. Schnurr, Ph.D., of the Department of Veterans Affairs (VA) National Center for PTSD, White River Junction, Vt., and Dartmouth Medical School, Lebanon, N.H., and colleagues conducted a study to compare the effectiveness of two types of treatments for PTSD, prolonged exposure and present-centered therapy. Prolonged exposure is a cognitive behavioral therapy (CBT) in which a patient is asked to vividly recount a traumatic event repeatedly until the patient's emotional response decreases and to gradually confront safe but fear-evoking trauma reminders. Present-centered therapy, a supportive intervention which is typically used by VA clinicians to address the problems of female veterans with PTSD, includes discussing and reviewing general daily difficulties that may be manifestations of PTSD.

The randomized controlled trial included female veterans (n = 277) and active-duty personnel (n = 7) with PTSD who were recruited from nine VA medical centers, two VA readjustment counseling centers, and one military hospital, from August 2002 through October 2005. Participants were randomly assigned to receive prolonged exposure (n = 141) or present-centered therapy (n = 143), delivered in 10 weekly 90-minute sessions. PTSD symptom severity data were collected before and after treatment and at 3- and 6-month follow-up.

The researchers found that women who received the prolonged exposure therapy were more likely than women who received the present-centered therapy to no longer meet criteria for the diagnosis of PTSD (41.0 percent vs. 27.8 percent) and were more than twice as likely to achieve total remission (15.2 percent vs. 6.9 percent). Self-reported PTSD, depression, and overall mental health improved from pretreatment to post-treatment in both groups. Anxiety decreased and quality of life improved with prolonged exposure.

"Practice guidelines for PTSD recommend prolonged exposure and other CBT, but the treatments are not widely used. Along with recent findings, our study demonstrates the feasibility of implementing CBT across a range of clinical settings. With the high prevalence of PTSD among military personnel returning from service in Iraq and Afghanistan, the challenge for large health care systems like those of the VA and the Department of Defense is to find efficient ways to train personnel to promote dissemination of these effective treatments," the authors conclude.

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(JAMA. 2007;297:820-830. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was conducted with support from the VA Cooperative Studies Program and the Department of Defense. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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