Psychological Treatments for Posttraumatic Stress Disorder: Recommendations for the Clinician Based on a Review of the Literature

Abstract

This article reviews available research data supporting the use of psychotherapy in the treatment of posttraumatic stress disorder (PTSD). The authors highlight how this evidence might inform clinical choices in treating PTSD, as well as demonstrating how assumptions based on gaps in the available literature may be misleading. The authors first discuss findings concerning a number of interventions that are commonly used in the treatment of trauma victims or patients with PTSD: critical incident stress debriefing, psychoeducation, exposure therapy, eye movement desensitization reprocessing, stress inoculation therapy, trauma management therapy, cognitive therapy, psychodynamic psychotherapy, and hypnotherapy. They also discuss a number of treatment strategies that have recently been studied in PTSD, including imagery rehearsal, memory structure intervention, interpersonal psychotherapy, and dialectical behavior therapy. PTSD is associated with significant symptomatic morbidity, although desired outcomes in clinical practice are typically related more to reduction in social, interpersonal, and occupational impairment. The most methodologically robust studies, which have typically examined cognitive or behavioral treatments, indicate that psychotherapy helps to relieve symptom severity; however, there is no consistent information about whether these interventions are helpful in improving other domains of impairment and associated disability, even though these problems are often the greatest concern to patients. Nor does the available evidence indicate when, and for whom, various psychotherapeutic interventions should be provided, or whether different modalities of treatment can and should be combined, or sequentially offered, as is often done in specialized treatment programs. Clinicians should keep these issues in mind in reviewing the literature on current (and future) clinical research. Unfortunately, the current evidence base on psychotherapy for PTSD gives only limited guidance concerning clinical choices in managing PTSD. The authors therefore provide some clinical guidelines based on the literature for clinicians treating patients with PTSD.

Posttraumatic stress hyperarousal symptoms mediate the relationship between childhood exposure to violence and subsequent alcohol misuse in Mi'kmaq youth

“…For individuals with both PTS hyperarousal symptoms and alcohol-use problems, clinicians should give consideration to whether or not a trauma-specific therapy that reduces hyperarousal symptoms should be used as an adjunct to treatment for the alcohol misuse. A treatment like imaginal exposure therapy might be useful because it has been demonstrated to decrease all three DSM-IV symptom domains (Robertson, Humphreys, & Ray, 2004). In keeping with best practice guidelines, individuals who meet the diagnostic criteria for both PTSD and an alcohol-use disorder should receive an integrated treatment approach (Health Canada, Centre for Addiction and Mental Health, 2002) that targets the functional relationship between both disorders (Zahradnik & Stewart, 2008).…”

PTSD in Latino Patients: Illness Beliefs, Treatment Preferences, and Implications for Care

“…[57][58][59] Clinicians may find that educating patients to recognize and understand PTSD symptoms and talking about the link between trauma and physical health may make treatment seem more immediately useful to patients; identifying short-term treatment goals that focus on reducing the severity of these symptoms may further improve patients' acceptance of treatment and increase long-term adherence to effective therapies. 60,61 Many participants also noted the large impact that the symptoms had on their relationships and on their work functioning; one participant even reporting a serious injury due to his impaired concentration. Again, these issues make the impact of symptoms very real and offer practical and "quality of life" reasons for addressing them that the clinician may use to engage patients in a discussion about treatment.…”

Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis

“…For these reasons, it remains difficult to recommend one particular treatment approach over another. Researchers have studied the use of psychotherapy in the pediatric PTSD population, with the majority of studies evaluating the efficacy of CBT approaches (Robertson, Humphreys, & Ray, 2004). Researchers have investigated trauma-focused CBT and found efficacy of this intervention in both individual and group therapy formats for sexually abused youth (Leserman, 2005).…”