Magazine article Clinical Psychiatry News

Prolonged Exposure Is Best TX for Women with PTSD

Magazine article Clinical Psychiatry News

Prolonged Exposure Is Best TX for Women with PTSD

Article excerpt

HOLLYWOOD, CALIF. -- Results from the largest randomized controlled trial ever comparing two types of psychotherapy for posttraumatic stress disorder indicate that for women, therapy involving prolonged exposure to the original trauma is significantly better than therapy focusing on patients' present-day problems.

Prolonged exposure (PE) therapy was judged not only to be more efficacious but also more effective in the real world, considering that the therapists who administered the therapy were not experts and that the patients were from a heterogeneous population. For example, most comorbidities did not disqualify a patient from the study, with a few exceptions--such as active psychosis and current substance dependence.

The principal investigators discussed the study's results for the first time in a seminar at the annual meeting of the International Society for Traumatic Stress Studies.

The trial, sponsored by the U.S. Department of Veterans Affairs, involved 384 active-duty and veteran women with a current diagnosis of severe posttraumatic stress disorder (PTSD) as a result of any sort of trauma. The women were randomly assigned to receive PE therapy or present-centered therapy (PCT) by therapists who themselves had been randomly assigned to receive training in one of the two therapies, both of which were based on cognitive-behavioral principles. The therapy was conducted at 12 sites across the country.

The therapy was provided to the women in 10 weekly individual sessions of about 90 minutes each. As expected, both therapies resulted in significant improvements in several measures, particularly the Clinician-Administered PTSD Scale (CAPS). PE resulted in greater declines in CAPS scores than did PCT immediately after treatment and 3 months later, although the scores were not significantly different at the 6-month follow-up.

The effect sizes were relatively modest, but the remarkable thing was that there was any difference at all, said Patricia A. Resick, Ph.D., of Boston University, who served as a discussant during the seminar and did not herself participate in the study.

"This was a study that didn't have a waiting list control group," Dr. Resick said. "It had an active therapy [control], so we would not predict it to have a large effect size.... We have a clear finding here."

At the seminar, the speakers--including Dr. Matthew Friedman, executive director of the VA's National Center for Posttraumatic Stress Disorder; Paula Schnurr, Ph. …

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