What about the treatment of subthreshold PTSD Symptoms?


Clients often present with a range of reactions to trauma, and sometimes these don’t meet criteria for a diagnosis. It can be difficult to know what choices to make regarding therapy in these cases. In a December 2013 article in the Journal of Traumatic Stress this question was addressed. The authors examined the question can subthreshold PTSD be treated with an evidence-based therapy?

What is subthreshold PTSD?
In this study subthreshold PTSD was deemed present if one item from each of the three DSM-IV PTSD criteria below were present.

Criterion B: The traumatic event is persistently reexperienced in one (or more) ways

Criterion C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)

Criterion D: Persistent symptoms of increased arousal (not present before the trauma)

These DSM-IV PTSD criterion would translate to the following DSM 5 PTSD criterion

B. The presence of intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred.

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred.

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred.

Threshold PTSD was determined by the presence of all the diagnostic criteria (A-F) for the DSM-IV definition of PTSD.

Process and outcome of the research
Cognitive Processing Therapy was offered to two groups of military veterans receiving care at an outpatient specialty clinic. The first group with subthreshold PTSD and the other with full, diagnostic PTSD.

Both groups experienced a significant decrease in PTSD symptoms over the course of therapy. In other words, the effectiveness of Cognitive Processing Therapy did not differ between subthreshold and threshold groups.

Clients presenting with only a few symptoms of PTSD after traumatic events, such as intrusion, avoidance and arousal have been effectively treated with Cognitive Processing Therapy.

Dickstein, B. D., Walter, K. H., Schumm, J. A., & Chard, K. M. (2013). Comparing response to cognitive processing therapy in military veterans with subthreshold and threshold posttraumatic stress disorder. Journal of traumatic stress26(6), 703–709. https://doi.org/10.1002/jts.21869