Efficacy of PTSD treatments questioned?

SPC Jan Allbright, M.Sc., R.S. — Thu, 20 Aug 2015 09:30:35 -0400

Two treatments for post-traumatic stress that are considered the gold standard for treating the condition in combat veterans are not significantly more effective than some other approaches, including medication, stress management therapy and mindfulness, according to a new study.

Two types of therapy that focus on confronting and dealing with trauma — cognitive processing therapy and prolonged exposure therapy — are largely considered front-line treatments for PTSD.

But a review of PTSD treatment studies dating back to 1989 found that while the two therapies reduce symptoms, they also have high dropout rates and low follow-through, making them less effective and less likely to completely alleviate symptoms.

According to the research, published in the Journal of the American Medical Association on Aug. 4, nearly a quarter of patients who tried CPT or PE dropped out.

Still, nearly 70 percent of those who received one of the two front-line therapies saw a decrease in symptoms, even as two-thirds still met the criteria for having PTSD after treatment.

“When we looked hard at how effective these two treatments were, as well as some other psychotherapies, we found they are reasonably effective — but they are not as definitively helpful as we would like,” said Dr. Charles Marmar, a psychiatrist at NYU Langone and one of the article's authors.

According to the review, conducted by Marmar and other researchers at the Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury and NYU Langone Medical Center, medications, as well as therapies that teach personal skills and coping strategies or focus on relaxation, mindfulness, yoga and exercise, were nearly as effective as the CPT and PE therapy.

Roughly 13 percent of Iraq and Afghanistan veterans have been diagnosed with PTSD, while 10 percent of Persian Gulf War veterans and 11 percent of Vietnam veterans still have symptoms, according to the study.

To treat the disorder — characterized by intrusive thoughts such as anxiety and nightmares, feeling "on edge" or hyper-aroused, or being detached or disconnected, among other symptoms — clinical practice guidelines used by the Veterans Affairs and Defense departments recommend trauma-related exposures like CPT and PE to treat PTSD.

But other therapies, including conventional medications like antidepressants and some complementary and alternative treatments, appear to help many affected veterans nearly as much as those frontline treatments and could help those who have tried either but failed to respond, according to the study authors.

Marmar recalled two World War II veterans whom he treated while working at the San Francisco VA Health System: One had experienced daily nightmares for 40 years with medication, the other sought marriage counseling with his wife for marital problems that began as soon as he returned from the war.

Neither therapy cured the veterans' PTSD. But they helped eliminate symptoms, Marmar said.

A dose of medication let the first veteran sleep peacefully, with the intrusive nightmares retreating to twice a month. The couple embraced coping strategies that improved their marriage, even after nearly 50 years together.

"My experience is one of great optimism," Marmar said. ”Don’t give up if the first treatment or second treatment doesn’t work. ... It's a lot of trial-and-error work, but with persistence, flexibility and compassionate commitment for the veteran, every patient should to be able to get the assistance they need."

For some veterans, treatment may mean group therapy in a structured mindfulness session. Another study published in the same JAMA edition found that in a group of 116 veterans with PTSD, those treated with mindfulness-based stress reduction experienced a greater reduction of symptoms than those treated with "present-centered" therapy, which focuses on managing current problems in a patient's life.

That study was conducted by the Minneapolis Veterans Affairs Health Care System,

Dr. David Kearney and psychologist Tracy Simpson with the VA Puget Sound Health System, said the two articles indicate that proven alternative therapies could be beneficial to veterans.

"Given the large number of individuals with PTSD, not all of whom will opt for or benefit sufficiently from existing approaches, additional treatments suitable for broad implementation are needed," wrote the two in an editorial accompanying the studies.

http://www.militarytimes.com/story/military/benefits/health-care/2015/08/19/efficacy-ptsd-treatments-questioned/31195621/

Efficacy of PTSD treatments questioned

Two treatments for post-traumatic stress that are considered to be the gold standard for treating the condition in combat veterans may reduce symptoms but aren’t significantly more effective than other treatments like medication, stress management an

Response by SGT Ben Keen made Aug 20 at 2015 9:34 AM

SGT Ben Keen — Thu, 20 Aug 2015 09:34:20 -0400

I've gone through prolonged exposure therapy...it isn't fun. While some of my triggers have reduced, I can see why there is a large dropout rate when it comes to this approach.

Response by CMSgt Mark Schubert made Aug 20 at 2015 9:46 AM

CMSgt Mark Schubert — Thu, 20 Aug 2015 09:46:08 -0400

As no two cases of PTSD are the same, no single treatment is right for every case. I do believe there can exist an effective treatment for all cases of PTSD, you just have to find the right one that works for you - beleive in it, and give it all you got. If it doesn't work, try another until you succeed. In the article above, it stated that "two-thirds still met the criteria for having PTSD after treatment" - that means 1/3 did NOT meet the criteria for having PTSD! :-) I think that is GREAT!

Response by MAJ Ken Landgren made Aug 20 at 2015 11:26 AM

MAJ Ken Landgren — Thu, 20 Aug 2015 11:26:41 -0400

I am going to make 3 points:
1. The first step to recovery is to escape the dark deep place of hell.
2. The endstate to recovery varies by individuals.
3. Often times therapy is random in nature.

Response by LCDR Rabbah Rona Matlow made Aug 20 at 2015 11:56 AM

LCDR Rabbah Rona Matlow — Thu, 20 Aug 2015 11:56:13 -0400

It's important to remember that this study was written by DOCTORS. There is a long history of dislike and distrust between the medical establishment and the psychological establishment, so of course doctors will be less than positive about psychological therapies, even though these therapies are necessary for the management of PTSD and other behavioral issues.

There are many reasons why veterans drop therapy modes. From veterans I've worked with, it often surrounds therapists whom the patient/client doesn't connect. Getting a good therapist is a very personal quest, and if your therapist doesn't "get you" the therapy will fail.

In addition, many of these direct confrontation methods can be extremely painful for veterans to process. Yet, relaxation techniques such as exercise and meditation, while managing stress, won't do anything to relieve the underlying cause of combat PTSD - the adrenaline response of the "Fight or Flight" response in your brain.

And the reality is that combat PTSD will likely never be "cured" but only managed...

Response by LTC Stephen Kubiszewski made Aug 22 at 2015 12:43 PM

LTC Stephen Kubiszewski — Sat, 22 Aug 2015 12:43:08 -0400

Jan, the important thing is for those knowing they need assistance to get it and those around them to support them thru a often rough cycle as you know. Easily said, but places across the nation have few good and accessible resources.

Response by LCDR Gordon Brown made Oct 20 at 2017 1:40 AM

LCDR Gordon Brown — Fri, 20 Oct 2017 01:40:59 -0400

If you have been involved with multiple different therapies for the treatment of PTS and nothing seems to work, you may have a traumatic brain injury (TBI) and not PTS. Many of the symptoms of PTS and TBI are very closely related. I am a 15-year survivor of a near fatal TBI (I flat-lined twice post-op from grand mal seizures). So many Veterans have been misdiagnosed with PTS when they actually have a physical brain injury (TBI). Have you ever been told to "Get use to the new you?" Maybe you can get the original YOU back. WHY should you have to get use to the "new you" how about returning the "new you" back to the "original you"?

Response by LCDR Gordon Brown made Oct 20 at 2017 1:52 AM

LCDR Gordon Brown — Fri, 20 Oct 2017 01:52:03 -0400

IF a Veteran that actually has a Traumatic Brain Injury (TBI) and has been diagnosed with PTS, the Veteran will NEVER get better because psychotherapy or any other PTS therapy modality will NOT work! The TBI Veteran cannot remember the previous sessions to begin the process of building the "steps or ladder" to get out of the emotional hole a PTS Veteran is in because of the Traumatic event they have witnessed.

Response by SSgt Richard Kensinger made Apr 26 at 2019 2:29 PM

SSgt Richard Kensinger — Fri, 26 Apr 2019 14:29:00 -0400

As a clinical psychologist here are my thoughts. CPT and PET are standard interventions for so called single episode Acute Stress Disorder. Combat vets experience complex PTSD w/ layers of trauma along w/ Clinical Depression and Compacted Grief. Many VA clinicians have no military experience let alone combat. A clinician must dedicate prolonged psychotherapy for it to be efficacious. And I think consistent group therapy is useful as it recapitulates the essential psycho-social unit: the squad.
Rich

Response by MAJ Ken Landgren made Oct 19 at 2019 12:50 PM

MAJ Ken Landgren — Sat, 19 Oct 2019 12:50:10 -0400

This is my PTSD road map:
- Complete devastation to include suicidal thoughts
- A few years of group and individual therapies
- Identifying each symptom and finding a way to mitigate those symptoms and feelings
- Becoming numb to my suffering
- Feeling my heart with love and beauty
- My wings heal and I can fly now

Response by 1st Lt Mark Marshall made Oct 4 at 2021 1:49 PM

1st Lt Mark Marshall — Mon, 04 Oct 2021 13:49:51 -0400

Thank you for providing this information