First‐line therapy for post‐traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches

Abstract

BackgroundDespite evidence supporting cognitive behavioural therapy (CBT)‐based interventions as the most effective approach for treating post‐traumatic stress disorder (PTSD) in randomised control trials, alternative treatment interventions are often used in clinical practice. Psychodynamic (PDT)‐based interventions are one example of such preferred approaches, this is despite comparatively limited available evidence supporting their effectiveness for treating PTSD.AimsExisting research exploring effective therapeutic interventions for PTSD includes trauma‐focused CBT involving exposure techniques. The present review sought to establish the treatment efficacy of CBT and PDT approaches and considers the potential impact of selecting PDT‐based techniques over CBT‐based techniques for the treatment of PTSD.ResultsThe evidence reviewed provided examples supporting PDT‐based therapy as an effective treatment for PTSD, but confirmed CBT as more effective in the treatment of this particular disorder. Comparable dropout rates were reported for both treatment approaches, suggesting that relative dropout rate should not be a pivotal factor in the selection of a PDT approach over CBT for treatment of PTSD.Conclusion/ImplicationsThe need to routinely observe evidence‐based recommendations for effective treatment of PTSD is highlighted and factors undermining practitioner engagement with CBT‐based interventions for the treatment of PTSD are identified.

Implementing solution‐focused brief therapy to facilitate hope and subjective well‐being among South African trauma survivors: A case study

“…The fact that most participants did not find it useful to talk about their trauma in detail highlighted criticism against pathology‐orientated approaches that potentially retraumatise clients (Paintain & Cassidy, 2018). It also emphasised the fact that SFBT therapists do not analyse traumatic experiences in detail, as they assume the client's problem is not necessarily related to the solution.…”

Which Trauma Treatment Suits me? Identification of Patients' Treatment Preferences for Posttraumatic Stress Disorder (PTSD)

“…Stabilization, for example, aims to empower the traumatized patient to deal with strong emotions and the trauma-related burden in general (Reddemann and Piedfort-Marin, 2017 ). Trauma-adapted psychodynamic therapies are also part of the psychotherapeutic care of traumatized patients, but the evidence for their efficacy is insufficient (Paintain and Cassidy, 2018 ). Meta-analyses and guidelines have identified trauma-focused psychological interventions as the most effective treatments for PTSD (Cusack et al, 2016 ; American Psychological Association, 2017 ), with the strongest evidence of effectiveness especially for prolonged exposure, CBT and EMDR (Lewis et al, 2020 ).…”

“…But in these studies, participants did not represent treatment seeking PTSD patients, meaning that their treatment choices were hypothetical. Furthermore, there is a lack of research exploring PTSD patients' preferences for stabilization and psychodynamic psychotherapy, that are often used in clinical practice, which is especially true for some European countries like Germany and France (Reddemann and Piedfort-Marin, 2017 ; Paintain and Cassidy, 2018 ). Moreover, prior research lacks the combination of comprehensive treatment preference data and qualitative data exploring underlying reasons for those preferences (Etingen et al, 2020 ).…”

Clinical Therapeutic Strategy and Neuronal Mechanism Underlying Post-Traumatic Stress Disorder (PTSD)

“…Patients with PTSD often show cognitive impairment, attention and/or learning deficits [13,14], which reduce the quality of life (QOL). According to clinical and animal studies, emotion- and fear-associated neuronal circuits are related to the development and retention of PTSD symptoms [11,15,16] and several therapeutics have been recommended [1,12,17,18]. However, mechanisms underlying enhanced susceptibility to impaired fear memory consolidation and extinction are not clear, and therefore, there are limited effective therapeutic approaches.…”