What is the best treatment for PTSD? The jury is still out.

The first article written on this blog, was about exploring what might be the best treatment for PTSD. Five years later the conclusions are similar. Paula Schnurr, and colleagues (2022) compared prolonged exposure (PE) and cognitive processing therapy (CPT). They had a sample of 916 veterans with military-related PTSD. Participants were from outpatient mental health clinics at Veterans Affairs medical centres across the US. The 916 participants consisted of: 455 participants who undertook PE 461 participants involved in CPT They measured PTSD severity on the CAPS-5. They found that scores improved in both groups from before to after treatment. The mean improvement was greater in PE than CPT. But the difference was not clinically significant.  Results for self-reported PTSD symptoms were comparable with CAPS-5 findings. The difference between the two treatment types was statistically significant, but not clinically significant. What does this indicate? There is no clear ‘winner’.  The authors concluded that: “These findings highlight the importance of shared decision-making to help patients understand the evidence and select their preferred treatment.” (pg 2). Client choice was highlighted earlier in this blog .

Summary

We know that trauma focussed therapies are considered the front line interventions, often above medications. Now we can also be confident that two of the front line therapies are just as effective. Client choice is always an important factor in successful outcomes for therapy.

Some points to keep in mind (or the problem with research – its never perfect)

Nearly 80% of participants were men – so the results might not be generalisable to women. They were all veterans, so the results may not be generalisable to civilians. The CPT modality was CPT + A (A = written account).  The ‘preferred’ mode of CPT currently is CPT (without a written account).

Reference

Schnurr PP, Chard KM, Ruzek JI, et al. Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(1):e2136921. doi:10.1001/jamanetworkopen.2021.36921