Prolonged Exposure, CBT May Accelerate PTSD Recovery, But Not Change Long-Term Prevalence

Treating patients with posttraumatic stress disorder (PTSD) with exposure therapy or cognitive-behavioral therapy (CBT) appears to hasten recovery compared with antidepressant therapy, but the early interventions do not reduce the prevalence of the disorder three years later. The findings, published in the Journal of Clinical Psychiatry, emphasize the occurrence of persistent, treatment-refractory PTSD in a subset of survivors, according to the study authors.

For the study, the researchers randomly assigned adults with PTSD to receive exposure therapy (n=63), CBT (n=40), escitalopram (n=23), or placebo (n=23) for 12 weeks; an additional 82 patients declined treatment but were followed as well. The researchers evaluated PTSD in the participants (using the Clinician-Administered PTSD Scale, or CAPS) at five months and again three years later.

At the five-month assessment, the prolonged exposure and cognitive therapy groups showed lower levels of PTSD symptoms and prevalence of PTSD (21.4% and 18.2%, respectively) than the SSRI, placebo, and no-intervention groups (61.9%, 55.6%, and 43.8%, respectively). At the three-year assessment, however, the prevalence rates were closer together (between 28% and 46% among all groups); in addition, all the groups had similar CAPS scores (exposure therapy=31.51; cognitive therapy=32.08; escitalopram=34.31; placebo=32.13; and no intervention=30.59) and similar rates of secondary outcomes including depression status, employment status, and global functioning.

“What this study tells us at its core is that there is a significant public health challenge ahead. Individuals [who are] continually expressing initial PTSD symptoms and who are resistant to early treatment should be the focus of future research," said lead study author Arieh Shalev, M.D., the Barbara Wilson Professor of Psychiatry at NYU Langone Medical Center, in a press release.

To read about other therapies for patients with PTSD symptoms, see the Psychiatric News article “Attention-Control Training Reduces PTSD Symptoms.”

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