Loosening the Reins on PTSD Treatment Produces Positive Results

There are a number of treatments for post-traumatic stress (PTSD) that have been shown to be moderately effective. Included among these are prolonged exposure, eye movement desensitization, and cognitive processing therapy (CPT). However, there are elements of these treatments that have made them less than desirable in the clinical community. For instance, they are driven by outcome rather than progress, require a specific number of sessions and are rigid in nature, allowing little room for deviation from their set protocols. The result of these stringent guidelines is a less than optimal client adherence rate and an even less attractive clinician adoption rate.

Tara Galovski of the University of Missouri at St. Louis theorized that perhaps modifying the standard CPT would make it more appealing to clinicians and more beneficial to clients. To test her theory, Galovski enrolled 100 participants with PTSD into the a modified version of CPT (MCPT) or a symptom measured delayed treatment (SMDT), all delivered by novice, rather than expertly trained, clinicians. The unique aspects of the MCPT, which allowed for longer or shorter treatment durations, insertion of stressor sessions to address symptoms as needed, and a protocol designed to focus on progress rather than outcome, proved to be quite effective at decreasing symptoms of PTSD in the participants.

Overall, Galovski found that the MCPT participants had lower levels of depression and PTSD upon completion when compared to the SMDT participants. Additionally, secondary symptoms of well-being, guilt, physical health appraisals, and general functioning also improved. She also discovered that over half of the participants reached positive outcome scores well before the traditional 12th session. Those who didn’t saw improvement with maintenance sessions that continued after the 12th session. These gains were maintained at the three month follow-up assessment. Galovski believes that this modified and more flexible version of CPT meets the needs of the clients and clinicians more comprehensively than some of the more traditional and fixed approaches. For individuals with PTSD who have not had success with existing treatment methods, MCPT may be a viable alternative. “Additionally, for those survivors who may not realize an early or efficient response, continuing the course of therapy may result in continued and substantial gains,” said Galovski.

Reference:
Galovski, Tara E., Leah M. Blain, Lisa Elwood, Juliette M. Mott, and Timothy Houle. Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy. Journal of Consulting & Clinical Psychology 80.6 (2012): 968-81. Print.

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  • glen

    glen

    January 15th, 2013 at 12:28 PM

    it should be routine and not exception to try and improve already existing therapy methods.there should be a continual progress in trying to improve and fine tune such methods that could benefit more and more people, while also making therapists comfortable with the approach.we could then hope for therapy that works for more people in a sample and hence more rates of recovery and successful treatment.

  • Gloria

    Gloria

    January 15th, 2013 at 12:55 PM

    You have to know that what treatment one responds best to is going to be so individualized and specific to that person that while it is great to have a general idea of what works, it is always critical to keep modifying to meet the needs of the patient. I like that this calls for a little pulling back on some of the treatment that has been de rigeur for so long, because for some who suffer, this intensity probably feels like it is too much. I think that for those who can handle the letting up of treatment then this speaks volumes about them, just how strong they are and their willingness to make real and healing strides.

  • Renny

    Renny

    January 15th, 2013 at 11:56 PM

    Fine tuning treatment based on the circumstances and the needs of the client sounds great. Not only does it ensure the best possible for the client but also keep the therapist involved. A modified treatment plan could then also serve as a base for further treatments down the line and knowing psychological problems can be related,it may even prove to be a winner in terms of helping multiple disorders co-occurring.

  • brooks

    brooks

    January 16th, 2013 at 3:59 AM

    A good mediator or therapist will know when the client is safe to pull back some from treatment. If you are working with someone very familiar with your case they are not going to let go of you before they know that you have the ability to deal with a little bit more on your own.

  • Lynda

    Lynda

    January 18th, 2013 at 3:32 PM

    While I can’t speak to therapies other than EMDR, the statement that EMDR is “driven by outcome rather than progress, require[s] a specific number of sessions and [is] rigid in nature, allowing little room for deviation from set protocols” is, in my opinion, erroneous.

    EMDR is VERY progress-oriented (Phase 8 of the protocol, done at the beginning of every session, is designed to evaluate target-specific as well as global adaptive integration of the therapeutic work), there is NO specific number of sessions required, and the specific protocols are related to the issue or population presented. Clinicians are taught to follow a three-pronged (past, present and future) treatment protocol composed of eight specific phases to ensure the most comprehensive resolution of the trauma possible. The clinician’s understanding of the Adaptive Information Processing Model guides case conceptualization and any deviations from standard protocols. Clinicians are strongly encouraged to be faithful to the model because research shows that fidelity to the model results in better results for the client.

    For a better understanding, I encourage clients and clinicians alike to read “Getting Past Your Past” by Francine Shapiro. Dr Shapiro does an excellent job of explaining how disturbing life events create dysfunctional memory networks that result in dysfunctional thoughts, behaviors, and emotions in the individual’s present-day life, in terms and language easily accessible to the layperson.

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