Developing effective and efficient interventions for service members and veterans battling post traumatic stress disorder is a primary focus for many psychiatric researchers within governmental and civilian institutions.
Hundreds of millions of dollars have been funneled into these programs for the purpose of developing, refining and delivering a variety of psychosocial and pharmacological treatments.
However, to date, results have been modest at best. And based on new studies looking specifically at treatments like Cognitive Processing Therapy and Prolonged Exposure, results are arguably disappointing.
These results are discouraging considering the financial resources infused into research centers and the increasing number of military personnel diagnosed each year with PTSD.
The trauma-focused talk therapies touted as the “gold standard” treatments for PTSD provide relief for many veterans, but countless others continue to struggle with nightmares, intrusive thoughts and hyperarousal.
Although studies support the effectiveness of exposure therapy, this several decades old approach requires the patient to recount the most distressing aspect of their traumatic event in order to “desensitize” to it.
For many, this process is too difficult and leads to high dropout rates. In some cases, dropout rates may be as high as 50 percent.
Exposure Therapy Pitfalls
The problems with exposure therapy are not unique. The homework assignments associated with cognitive therapy is often viewed as unwieldy. This approach is problematic considering compliance rates with psychotherapy homework assignments is lacking in general. And if the assignments that are a core component of cognitive therapy are not completed outside of therapy, improvement is slow if it occurs at all.
Medications have not fared much better. In fact, they’re probably worse. Psychiatrist Richard Friedman eloquently made this point in a recent New York Times OP-ED piece titled, “Psychiatry’s Identity Crisis.”
Friedman pointed out the fact that psychiatric medications today are no more effective than their pharmacological brothers and sisters of the 1950s and 1960s.
Granted, the side effects of today’s medications are less severe, but they are still numerous and result in poor compliance.
Sexual dysfunction, sleep disturbances and gastrointestinal distress plague a significant minority of those who take them. And as highlighted by Dr. Friedman, most people would rather participate in psychotherapy than take a pill. This point is important as compliance, which is related to patient preference, is directly related to outcomes.
The good news is that researchers are studying other forms of therapy for PTSD.
One receiving recent attention is Interpersonal Psychotherapy. Interpersonal Psychotherapy, commonly referred to simply as IPT, is a talk therapy that has historically focused on depression.
Its core therapeutic component is the improvement of relationship conflicts. Preliminary results for Interpersonal Psychotherapy with trauma patients are promising, although supporting its use with service members and veterans are lacking.
Recently, researchers compared Interpersonal Psychotherapy, Prolonged Exposure and relaxation therapy in 110 unmedicated patients; results were reported in the May 2015 volume of The American Journal of Psychiatry.
Overall, fewer patients dropped out of the Interpersonal Psychotherapy group indicating greater tolerance of the treatment. Furthermore, a greater percentage of patients showed improvement from Interpersonal Psychotherapy compared to the other therapies.
Results were even more impressive when depression was a factor. Depressed patients were nine times more likely to drop out of exposure therapy compared to Interpersonal Psychotherapy. The effectiveness of Interpersonal Psychotherapy in depression is not surprising considering the data overwhelmingly supports its use for the depressive disorders.
As we continue to fund medication and psychotherapy research for PTSD, a portion of these monies should be funneled to researchers studying Interpersonal Psychotherapy. So far it has shown that is as effective as other mainstream talk therapies and medication.
And since it is better tolerated by those receiving it, fewer people will drop out of treatment and more people will get better.
For more information on Interpersonal Psychotherapy visit this website.
* This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
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