There are a number of treatments available for combat-related posttraumatic stress disorder (PTSD). Some of the more common ones are prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, and stress inoculation training. There are indeed differences between the different psychotherapeutic treatments for PTSD, however, there is one commonality that they share-they are all about as equally effective.
Research is clear that trauma and non-trauma focused psychotherapies work for combat-related PTSD, but in reality, no specific treatment appears to be that much better than another. A recent article published in the journal Depression and Anxiety provides additional data to support this claim. But more importantly, the article highlights the importance of matching patients to particular psychotherapies as a way to improve adherence and outcomes.
What They Did
Researchers from academic institutions, the Veterans Administration, and other governmental organizations studied 108 Iraq and Afghanistan combat veterans diagnosed with PTSD. Participants were enrolled into a prolonged exposure treatment group or a virtual reality exposure (VRE) treatment group.
The latter is a method for delivering exposure-based therapies through the assistance of technological devices that mimic sights, sounds, and even smells related to previous combat trauma. For example, depending on the equipment being used, a combat veteran receiving VRE can don a headset that provides realistic images of a combat environment. In theory, this allows the patient greater access to the emotional content of the past traumatic event(s), which can then lead to habituation.
Participants were assessed with a several self-report and clinician-administered scales prior to treatment, after five sessions, and at the end of treatment. Measures used include the Beck Depression Inventory-II, Beck Anxiety Inventory, PTSD Checklist, and the Clinician Administered PTSD scale.
What They Found
Eighteen variables were considered during the study for the purpose of identifying treatment response in two groups: those who benefited more from PE and those who benefited more from VRE. Analysis revealed that these 18 variables fit within four composite groups. More specifically, those veterans more likely to respond (or be a better fit) for VRE were likely to be younger, not taking psychotropic medication, show increased hyperarousal (a relatively common PTSD symptoms associated with arousal criteria), and increased suicide risk.
What Does it Mean?
The authors make the point that “precision healthcare” continues to gain in popularity and credibility. As patients seek treatment for more complex physical health conditions, and insurers focus on ways to reduce costs, tailoring specific and targeted medical therapies improves outcomes and saves money. As importantly, it reduces the burden on patients related to unnecessary and ineffective interventions.
The authors also correctly point out that psychology and psychiatry lag behind medicine in this area. Treatments for PTSD (and other conditions) are based on broad assumptions and generalized treatment protocols. This study is a good example of how evidence-based and evidence-informed interventions can be tailored to specific patients suffering from PTSD. Theoretically, this increases the rate at which patients get better (time is not wasted on ineffective treatments), improves adherence (treatment dropout is high for trauma-focused PTSD therapies), and maximizes treatment outcomes and patient satisfaction.
Points to Remember
■ Evidence-based trauma and non-trauma psychotherapies for posttraumatic stress disorder appear to be equally effective.
■ Matching specific treatments to specific patients can improve outcomes and adherence.
■ The use of precision healthcare interventions in psychology and psychiatry lag behind medicine.
■ Combat veterans is heterogeneous group of men and women who have different preferences and needs with regard to treatment for PTSD.
Norr, A. M., Smolenski, D. J., Katz, A. C., Rizzo, A. A., Rothbaum, B. O., Difede, J., … Reger, G. M. (2018). Virtual reality exposure versus prolonged exposure for ptsd: Which treatment for whom? Depression and Anxiety, 35, 523-529.