Breakthroughs in the treatment of PTSD
Friday, February 20, 2015
Posted by: Lorenzo Lorenzo-Luaces
Post-traumatic stress disorder (PTSD) is one of the most disabling, and unfortunately, common, mental disorders. Two recent big breakthroughs in the psychological and pharmacological treatment of PTSD are receiving attention in the psychotherapy community.
Most of the leading psychotherapies for fear and anxiety disorders share as a common features that they encourage patients to “face their fears” by engaging in “exposure” to things they are afraid of. Markowitz and colleagues (2015) recently adapted interpersonal psychotherapy (IPT) for PTSD. The PTSD-focused IPT does not focus on exposure to the trauma and related fear cues, but instead on the effect that trauma has had on a person’s interpersonal relationships. The authors compared IPT to prolonged exposure (PE), which has a high response rate but also a high risk of dropout. The treatments were also compared to applied relaxation which has been found to decrease symptoms of PTSD, but not as much as exposure-based treatments. Although exposure was slightly more effective than IPT, this difference did not meet a minimum clinical significance threshold set by the authors. Both treatments were more effective than relaxation. Interestingly. IPT had a lower rate of dropout than exposure, especially for patients who were depressed. If replicated, these findings suggest that IPT should be considered an evidence-based therapy for PTSD, especially for patients who are depressed or who are unwilling to engage in exposure. The study authors concede that even for patients who receive IPT, some exposure to their fears might be necessary. However, they argue that a focus on interpersonal relations may help patients improve in a way that later motivates them to face their fears.
The pharmacological treatment of PTSD is also interesting to the general psychotherapy community. This month’s issue of Monitor on Psychology features prominent researchers like Gregory Quirk and Stephan Hoffman discussing the erasing of traumatic memories in PTSD. Work by Roger L. Redondo and his colleagues, as well as work by Edward G. Meloni, suggests the possibility that trauma memories in PTSD can be erased following the administration of certain pharmacological agents. This suggests that patients with PTSD may be able to experience rapid relief of their symptoms which would otherwise require several sessions of therapy. Given how prevalent and disabling PTSD is, these new lines of research could significantly affect the lives of many patients in a positive way.