Summary of “Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions”

Summary of “Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions”

Article summary

In the article, Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions, (Watkins et al., 2018) evaluate the 2017 guidelines on the treatment of PTSD and the psychological therapies recommended. The subject of the article is a review of Posttraumatic Stress Disorder with a particular focus on diagnosis and treatment of the condition based on the guidelines set in 2017 by the American Psychological Association (APA) and the Veterans Health Administration and Department of Defense (VA/DoD). The paper is authored by Laura E. Watkins, Kelsey R. Sprang, and Barbara O. Rothbaum of the Emory University School of Medicine. The article is subdivided into four subsections that focus on the main aspects of the review. The four topics addressed in the article are the diagnostic criteria, treatment guidelines, recommended treatments, and the implications and future directions.

The first section of the paper includes an evaluation of the diagnostic criteria for PTSD. The authors note that diagnosis for PTSD has undergone several changes since inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3). The latest change is the reclassification of PTSD from an Anxiety Disorder to a Trauma and Stressor Related Disorder in DSM-5. The reclassification includes a change of requirements for the diagnosis of PTSD. The authors also found that the symptom clusters for PTSD have changed in the latest DSM-5 revision. The current DSM-5 guideline includes a four-symptom cluster, a change from the previous three-symptom cluster in DSM-4, and 3.

In the second section, (Watkins et al., 2018), conduct an in-depth review of the treatment guidelines for PTSD. They observe that several trauma-focused and non-trauma-focused psychological treatments for PTSD currently exist. As per the guidelines, trauma-focused therapies directly target the memories of the traumatic event and include cognitive processing therapy and prolonged exposure. On the other hand, non-trauma-based treatments have the aim of reducing PTSD symptoms without targeting the memories of the traumatic event. According to the authors, both guidelines on treatment guidelines for PTSD are grounded on the review of the literature on research involving PTSD treatment. However, none of the APA or VA/DOD guidelines includes a recommendation of a combination of medication and psychotherapy on treating PTSD.

In the next section, the authors explore three strongly recommended treatments for PTSD. The three psychotherapy treatments are prolonged exposure (PE), cognitive processing therapy (CPT), and cognitive behavioral therapy (CBT). Prolonged exposure is based on emotional processing theory and is strongly recommended by both guidelines for PTSD treatment. (Watkins et al., 2018) explain that the main focus of prolonged exposure treatment is the alteration of fear structures to ensure they are no longer problematic. Similarly, cognitive processing therapy is also highly recommended in both guidelines for effective PTSD treatment. The article defines CPT as a trauma-focused form of treatment that is based on informed information processing theory and social cognitive theory. This therapy assumes that after a traumatic event, patients try to make sense of what happened, which leads to distortion of their view on themselves, others, and the world. Based on the literature reviewed, the authors observe that CPT is widely supported as an effective remedy for PTSD. However, there is a difference between the two guidelines when it comes to cognitive-behavioral therapy (CBT). (Watkins et al., 2018) found that, recommendations by the APA include both trauma and non-trauma-focused CBT treatments while the VA/DoD guideline only recommends the trauma-focused CBT for PTSD. Further research by the authors found that the guidelines’ recommendation on the effectiveness of trauma-focused CBT was consistent with the literature reviewed.

The last section of the paper includes a summary of the review findings and future recommendations by the researchers. The authors conclusively found that CPT, PE, and trauma-focused CBT were strongly recommended as effective treatments for PTSD in both guidelines. They state that a substantial evidence base supported the effectiveness of each of the three treatments. The three treatments should, therefore, be used as the first line of treatment for patients with PTSD. According to the authors, future research on specific therapies for PTSD conditions is required. They also suggest that the DSM-5 criteria should be updated based on new research findings on PTSD diagnosis and treatment.

The authors conclude that PE, CPT, and CBT are the most effective treatments for PTSD based on the broad base of evidence leading to their strong recommendation in the APA and VA/DoD guidelines. Therefore, they contend that, whenever possible, the three treatments should be the first line of treatment for PTSD, with consideration for clinician expertise and patient preferences.

References

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 1-9