Study finds first-line psychotherapies not as beneficial for military-related PTSD

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In a recent study, a group of researchers at New York University found that first-line psychotherapies for military-related post-traumatic stress disorder (PTSD) are no less or more beneficial than other available therapeutic options for active duty personnel and veterans.

The findings, as published in the peer-reviewed journal JAMA, determined that treatment not centered on traumatic events are equally as effective as first-line psychotherapies, prolonged exposure therapy and cognitive processing therapy, which are conventionally used in the veteran population.

The results were achieved through the probing of clinical trials focusing on the two conventional psychotherapies for PTSD.

“Cognitive behavioral therapy’s limited value for treating military service related PTSD suggests the need to go beyond the one-size-fits-all approaches rolled out in most VA and DoD healthcare settings and personalize treatment, accounting for pre-service vulnerabilities and complex, repeated exposures to warzone stressors,” said Charles Marmar, the study’s lead author.

Both psychotherapies, prolonged exposure therapy and cognitive processing therapy, are common practice in the US Department of Defense (DoD) and the US Department of Veterans Affairs (VA).

“Two well-established first-line cognitive-behavioral psychotherapies for posttraumatic stress disorder (PTSD), prolonged exposure therapy (PE) and cognitive processing therapy (CPT), are used in the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) based chiefly on good outcomes in randomized clinical trials (RCTs) with civilians,” the findings state.

“The prominence of PE and CPT in treating individuals with military-related PTSD has been increasingly challenged in recent years because RCTs of veterans and military personnel have yielded mixed results, with patients often not obtaining clinically meaningful symptom improvement,” researchers proclaimed.

“These findings have led to questions about the extent to which these therapies should be prioritized and how military-related PTSD is best conceptualized, namely as a disorder that can be reliably managed by brief (approximately 12 session) monotherapies or as a highly complex and multiform condition requiring more individualized and comprehensive intervention.”

Although both first-line psychotherapies could efficiently treat symptoms of PTSD, researchers noted the new findings point to only modest clinical improvement using such trauma-focused therapy among active duty personnel and veterans.

“Current clinical trials strongly suggest that treating military-related PTSD involves significant clinical complexity and heterogeneity. For many who have served in the military, a course of standardized, trauma-focused cognitive behavioral therapy for PTSD is emotionally demanding and likely to result in only modest clinical improvement,” Marmar concluded.

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