Certain cognitive behavioral therapy appears
beneficial for female veterans with PTSD
Using a cognitive behavioral therapy called "prolonged exposure" appears
more effective than "present-centered" therapy, a supportive
intervention to treat female military veterans and active duty women
with posttraumatic stress disorder, according to a study in the February
28 issue of JAMA.
"Events such as the terrorist attacks on September 11, 2001, the war in
Iraq, and hurricane Katrina have focused attention on posttraumatic
stress disorder (PTSD), an anxiety disorder that can result from
exposure to traumatic events like combat, rape, assault, and disaster.
Posttraumatic stress disorder is characterized by symptoms of
re-experiencing the traumatic event, avoiding reminders of the event or
feeling emotionally numb, and a state of increased psychological and
physiological tension. The disorder is associated with psychiatric and
physical illnesses, reduced quality of life, and substantial economic
costs to society", according to background information in the article.
"Lifetime prevalence in U.S. adults is higher in women (9.7 percent)
than in men (3.6 percent) and is especially high among women who have
served in the military." There has been no prior study to evaluate
treatment for PTSD in this group.
Paula P. Schnurr, Ph.D., of the Department of Veterans Affairs (VA)
National Center for PTSD, White River Junction, Vt., and Dartmouth
Medical School, Lebanon, N.H., and colleagues conducted a study to
compare the effectiveness of two types of treatments for PTSD, prolonged
exposure and present-centered therapy. Prolonged exposure is a cognitive
behavioral therapy (CBT) in which a patient is asked to vividly recount
a traumatic event repeatedly until the patient's emotional response
decreases and to gradually confront safe but fear-evoking trauma
reminders. Present-centered therapy, a supportive intervention which is
typically used by VA clinicians to address the problems of female
veterans with PTSD, includes discussing and reviewing general daily
difficulties that may be manifestations of PTSD.
The randomized controlled trial included female veterans (n = 277) and
active-duty personnel (n = 7) with PTSD who were recruited from nine VA
medical centers, two VA readjustment counseling centers, and one
military hospital, from August 2002 through October 2005. Participants
were randomly assigned to receive prolonged exposure (n = 141) or
present-centered therapy (n = 143), delivered in 10 weekly 90-minute
sessions. PTSD symptom severity data were collected before and after
treatment and at 3- and 6-month follow-up.
The researchers found that women who received the prolonged exposure
therapy were more likely than women who received the present-centered
therapy to no longer meet criteria for the diagnosis of PTSD (41.0
percent vs. 27.8 percent) and were more than twice as likely to achieve
total remission (15.2 percent vs. 6.9 percent). Self-reported PTSD,
depression, and overall mental health improved from pretreatment to
post-treatment in both groups. Anxiety decreased and quality of life
improved with prolonged exposure.
"Practice guidelines for PTSD recommend prolonged exposure and other CBT,
but the treatments are not widely used. Along with recent findings, our
study demonstrates the feasibility of implementing CBT across a range of
clinical settings. With the high prevalence of PTSD among military
personnel returning from service in Iraq and Afghanistan, the challenge
for large health care systems like those of the VA and the Department of
Defense is to find efficient ways to train personnel to promote
dissemination of these effective treatments," the authors conclude.
###
Editor's Note: This study was conducted with support from the VA
Cooperative Studies Program and the Department of Defense. Please see
the article for additional information, including other authors, author
contributions and affiliations, financial disclosures, funding and
support, etc.
For More Information: Contact the JAMA/Archives Media Relations
Department at 312-464-JAMA or email:
mediarelations@jama-archives.org.
---------------
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