Prevention and treatment of PTSD: the current evidence base

Abstract

Post-traumatic stress disorder is a common condition that affects millions of people across the world. Up to date recommendations based on the best available evidence are vital to prevent and treat this debilitating condition. In this issue, we are bringing together a series of systematic reviews and meta-analyses that underpinned the development of the 2018 International Society for Traumatic Stress Studies Guidelines. The strongest evidence was found for psychological treatments for PTSD, in particular for cognitive behavioural therapy with a trauma focus (CBT-TF)(generic), cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation and reprocessing (EMDR) and prolonged exposure (PE). For the subgroup of military personnel and veterans, results were less impressive. Dropout from trauma-focused psychological treatments was higher than for other forms of psychological treatment for PTSD in adults. For early interventions, CBT-TF, CT and EMDR were recommended. With regard to pharmacological approaches, a number of them were effective but with a low effect size. Of the pharmacologically assisted psychotherapies, MDMAassisted psychotherapy was promising. Six complementary and alternative approaches showed emerging evidence. We now have an evidence base for a diverse range of pharmacological, psychological and other approaches that should facilitate their implementation and lead to the more effective management of people affected by traumatic events.

Moving Toward and Through Trauma: Participant Experiences of Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR)

“…While there is a common belief that the combination of TFTs and pharmacological options would improve treatment outcomes, there is limited research to support this belief (14,15). Recovery or improvement rates for these TFTs is estimated at 31%, with drop-out rates ranging from 25 to 48% (10)(11)(12)(14)(15)(16)(17). Avoidance of trauma-related feelings and memories has been identified as a key factor contributing to poor response and dropout (18)(19)(20).…”

“…These TFTs, however, have been found to be poorly tolerated by MMs and Veterans, have limited success and high dropout rates and result in no better outcomes than non-TFTs ( 10 , 11 ). Pharmacological treatment options have equally been shown to be problematic, with only two medications being approved as first-line treatment ( 12 ). Kelmendi et al ( 13 ) also noted that <30% of persons achieve full remission, and even then, approved pharmacological treatments often take weeks for therapeutic effect.…”

“…Recovery or improvement rates for these TFTs is estimated at 31%, with drop-out rates ranging from 25 to 48% ( 10 – 12 , 14 – 17 ). Avoidance of trauma-related feelings and memories has been identified as a key factor contributing to poor response and drop-out ( 18 – 20 ).…”

Effects of Mindfulness-Based Internet Intervention on ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder Symptoms: a Pilot Randomized Controlled Trial

“…Posttraumatic stress disorder (PTSD) is among the most often diagnosed mental disorders worldwide (Maercker et al, 2013), resulting in a high burden and high costs for society. Effective treatments for PTSD have been developed over the last decade (Bisson & Olff, 2021). Currently, American Psychological Association (APA, 2017) and International Society for Traumatic Stress Studies (ISTSS, 2018) include cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), prolonged exposure therapy (PE), eye movement and desensitization therapy (EMDR).…”

Pharmacological treatments for PTSD: where are we in 2020?

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Background: Forty years after the introduction of post-traumatic stress disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, only two selective serotonin reuptake inhibitor antidepressants -sertraline and paroxetine -have received approval for its treatment (Bisson & Olff, 2020). While evidence-based manualized psychotherapy approaches are now the first-line treatment for PTSD, they do not benefit all patients and are limited by the lack of availability of trained therapists in the community.

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