Gotta get bad before it gets good?
Thursday, January 21, 2016
Posted by: Lorenzo Lorenzo-Luaces
Some patients who receive empirically-supported treatments for post-traumatic stress disorder (PTSD) experience worsening of their symptoms in treatments and these patients benefit less from therapy, a new study finds.
Psychotherapies for PTSD ask individuals to recount painful traumatic memories. It is believed by some clinicians that these therapies can actually make patients worse, although there are few studies that speak to this question. A team of researchers led by Sadie E. Larsen looked at the exacerbation of symptoms in women who underwent prolonged exposure (PE) or one of two different version of cognitive processing therapy (CPT). As the authors note, CPT and PE are “extensively researched, empirically-supported, cognitive-behavioral treatments for PTSD” but the question of whether the treatments make some people worse is still relatively unexplored, particularly for CPT. In this research study, of the 192 women in the sample, 20% of those in PE experienced symptom worsening. For the women receiving a full version of CPT, 28.6% experienced symptom worsening, compared to 15% who received a version of CPT without the written account (CPT-C). The seeming differences between the treatments were not statistically significant suggesting that all three of these treatments can be safe for most patients.
When the researchers tried to predict who would go on to have a worsening of symptoms, they found weak evidence that having an alcohol use disorder or having been sexually abused as a child predicted who would go on to have an early worsening of symptoms. Importantly, the participants who experienced symptom exacerbations experienced worse outcomes in all three of the therapies. Although this was so, these participants actually did benefit from therapy. For example, 53% no longer had a PTSD diagnosis at the end of treatment. The study authors thus conclude that “these findings should provide reassurance that patients are very unlikely to experience lasting negative effects from trauma-focused treatments, even if they experience short-term exacerbations.”