Psychotherapy not only significantly reduces symptoms of post-traumatic stress disorder (PTSD), it can also help many patients recover, a researcher has concluded.
PTSD is frequently treated with a variety of medications, including antidepressants, benzodiazepines (Valium-type drugs), beta-blockers, and anticonvulsants, but there is no consensus on which drugs or combination of drugs is most effective.
Now, analysis of 17 controlled studies by Jeffrey J. Sherman, PhD., of the University of Washington (Seattle), showed that "cognitive behavioral" psychotherapies appear to work effectively for a variety of traumatic events.
"The impact of psychotherapy on PTSD and psychiatric symptomatology was significant when measured immediately after treatments were administered," Sherman writes in the July issue of the Journal of Traumatic Stress. "Similarly, there was no decay in the effect of treatment at follow-up."
Sherman analyzed data from 17 controlled studies of psychotherapy to treat PTSD in 690 people between 1977 and 1996. In 11 studies, patients developed PTSD after combat in Vietnam or Lebanon. In six, they had experienced rape, assault, child abuse, other violent crimes, a car crash, or traumatic death.
People with PTSD tend to re-experience a traumatic event in nightmares, in response to reminders of the event, and in intrusive uncontrollable thoughts. They may avoid certain places and feel detached from others. Anxiety, difficulty concentrating, and angry outbursts are among "hyperarousal" symptoms that accompany PTSD. In seven of the studies examined, people were hospitalized for the disorder.
Thirteen of the 17 studies used variations of "cognitive behavioral" psychotherapy. Cognitive techniques help people reexamine and change distorted beliefs they have about the trauma in order to develop coping skills. Behavioral techniques encourage people to imagine and re-experience elements of the trauma and then learn relaxation and other skills to reduce symptoms. The other four studies combined cognitive behavioral techniques with other therapies.
Dr. Sherman found that participants experienced significantly fewer intrusive thoughts, avoidance behaviors, and other symptoms after psychotherapy. Participants also showed fewer symptoms of anxiety and depression. In studies that assessed the diagnosis before and after treatment, 43 percent of the participants improved enough that they no longer met the criteria for PTSD.
The benefits can also be long lasting. Sherman found that in the 12 studies that followed participants 3 months to 2 years after treatment, symptoms of PTSD and other psychiatric conditions remained consistently lower.
"When you look at the results and the overall effect size, this suggests that purely cognitive behavioral psychotherapy -- which is the most widely represented -- is quite reasonably effective in treating PTSD symptoms," Sherman said. "It is along the same lines as psychotherapeutic treatment for depression and anxiety disorders."
Dr. Sherman can be contacted by e-mail (jeffreys@u.washington.edu) or through Dr. Charles R. Carlson, Department of Psychology, University of Kentucky, 112 Kastle Hall, Lexington, KY 40506-0044. Telephone: (606) 257-4394.
The Journal of Traumatic Stress is the peer-reviewed journal of the International Society of Traumatic Stress Studies. For information about the society and the journal, contact the editor, Dean Kilpatrick, PhD, (843) 792-2945.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, contact Richard Hébert rhebert@cfah.org, (202) 387-2829.
Journal
Journal of Traumatic Stress