Re:Empirically Supported Treatments

At present, the following treatments can be said to have at least some support from reasonably well done studies in the treatment of PTSD: Prolonged exposure therapy, stress inoculation training, EMDR, and variations of cognitive therapy. While there is certainly room to discuss details of any particular study or any particular analysis, the big picture is that, compared to a waitlist condition, these treatments produce statistically and clinically significant improvement in the treatment of PTSD, with the strongest evidence coming from studies using predominately civilian populations. All of these are "trauma" focused in one way or another. Exposure therapy focuses on the trauma memory, stress inoculation training focuses on coping with trauma symptoms, cognitive therapy focuses on trauma-related cognitions, and EMDR seems to do a little of all three.

Several studies has attempted to directly compare different treatments and have looked at combined treatments (e.g., comparing prolonged exposure alone with prolonged exposure combined with stress inoculation training or prolonged exposure with formal cognitive therapy). Again, while there is room to discuss the details of a particular study or a particular set of analyses, the big picture is that these treatments all tend to do about as well as the others. Moreover, contrary to what a lot of people used to believe, the studies comparing individual treatments with combined treatments have not yet been able to produce any convincing evidence that combined treatments are any better.

There is some spotty evidence about the efficacy of one or more of these treatments compared to relaxation, supportive counseling, or "treatment as usual." Sometimes the target treatment is statistically better than the comparison treatment, and other times it is numerically superior but not statistically superior. Relaxation and supportive counseling have never been shown to be superior to one of these targeted treatments. However, the relaxation condition sometimes gets short shrift. In at least two studies (one comparing relaxation with exposure therapy plus cognitive therapy and one comparing relaxation with EMDR) the relaxation sessions were substantially shorter in duration than the target treatment.
Interestingly, in the treatment of Acute Stress Disorder, exposure therapy alone and exposure therapy plus stress inoculation training, has been pretty convincingly shown to be better than supportive counseling. Richard Bryant has shown this in two published studies and one study that has been presented at conferences and is "in press."

There are two FDA approved medications for PTSD. Despite claims from the van Etten and Taylor meta-analysis that EMDR, CBT, and medication are all pretty similar, we don't really know whether this is true (regarding med vs. therapy) because there is not one single study that has yet addressed this issue. Hopefully this will change at some point.

There are a group of studies that have looked into different treatments for PTSD (e.g., different forms of group therapy, different forms of eclectic treatments) but there has been no systematic replication of these treatments or comparisons with other, better validated treatments. So we don't know how reliable these treatments are or how they compare with the four target treatments I listed at the beginning of this post. There is no research on the efficacy of meditation in the treatment of PTSD.

Finally, you ask whether ?The popular treatment for PTSD, reciting the trauma to an interested listener, been shown to be less effective than once thought?? If you are referring to exposure therapy, then the answer is a) exposure therapy is a bit more intense and specialized than ?reciting the trauma to an interested listener, b) the data on the efficacy of exposure therapy are stronger than ever, with recent studies by Cloitre et al., Resick et al., and recently completed studies by Rothbaum et al. and Foa et al. that have been presented at conferences but not yet published, and c) unfortunately, exposure therapy has never received much popular acceptance. We have had quite a struggle to get therapists to consider learning and using this type of treatment.

Replies:

Re:Empirically Supported Treatments, by Sandra Paulsen Inobe, PhD, 01/21/03 Disseminating EMDR, by Cahill, 01/26/03 Re:Empirically Supported Treatments, by Barbara, 01/23/03 Always drink coffee, by Cahill, 01/23/03

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