TREATING ADULT PTSD – The efficacy of exposure therapy and several holistic

considerationsBy Katherine French-Ewing

Research Issues in Treating PTSD

Randomized controlled trial issues Inherent problems in design Dropout rates between 20-50% (Barnes,

Rigg, Williams, 2013) Presentation focus

What is a CBT Approach?

“CBT is a broad term covering a number of interventions designed to challenge and modify erroneous cognitions, reduce the intensity and frequency of distressing negative emotional reactions via exposure to safe but feared situations and objects, and promote effective coping” (Cahill, 2007, para. 3).

Cognitive Restructuring

Cognitive-behavioral approaches most studied in PTSD treatment (Foa & Meadows, 1997).

Confronting erroneous cognitions and cognitive restructuring

It is not the event that causes distress, but what the client thinks about that event that is problematic.

Negative thoughts replaced with more realism

EMDR and PTSD

EMDR = Eye Movement Desensitization/Reprocessing 20 controlled randomized published studies (Korn,

2009) Caution that studies may have methodological issues

and some are not well controlled (Foa & Meadows, 1997)

Imaginal exposure to trauma, then reprocessing (cognitive restructuring)

Lateral focus such as tapping

How Does EMDR Work?

Amygdala may be overactive (Tucker & Trautman, 2000)

Korn (2009) found that PTSD symptoms subsided only after trauma-focused exposure work

EMDR Studies

EMDR more effective than CBT (Capezzani, Ostracoli, Cavallo, Carletto, & Ferndandez, 2013)

Exposure therapy is an effective long-term treatment for PTSD (Foa, Rothbaum, Riggs, & Murdock, 1991)

More EMDR Studies

Participants gained new memory association (Foa, et al, 1991)

Memory versus Experience (Weis, 2010) Recorded narrative sessions (Cahill,

2007)

Anxiety Sensitivity Training

Defined (Taylor, 2003, p. 181) First anxiety sensitivity training, then

exposure therapy Faster symptom reduction than with

exposure therapy alone

Holistic Therapies for Veterans

Acupuncture (Koffman & Helms, 2013) Dog training (Yount, Ritchie, Laurent,

Chumley, and Olmert, 2013) Transcendental meditation (Barns, Rigg,

& William, 2013)

References Barnes, V. A., PhD., Rigg, J. L., M.D., & Williams, J. J., L.C.S.W. (2013). Clinical case series:

Treatment of PTSD with transcendental meditation in active duty military personnel. Military Medicine, 178(7), e836-40

Cahill, S. P. (2007). PTSD: Treatment efficacy and future directions. Psychiatric Times, 24(3), 32. Capezzani, L., Ostacoli, L., Cavallo, M., Carletto, S., Fernandez, I., Solomon, R., Cantelmi, T.

(2013). EMDR and CBT for cancer patients: Comparative study of effects on PTSD, anxiety, and depression. Journal of EMDR Practice and Research, 7(3), 134-143.

Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-80.

Koffman, Robert L,M.D., M.P.H., & Helms, Joseph M,M.D., F.A.A.M.A. (2013). Acupuncture and PTSD: 'come for the needles, stay for the therapy'. Psychiatric Annals, 43(5), 236-239

Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278

Taylor, S. (2003). Anxiety sensitivity and its implications for understanding and treating PTSD. Journal of Cognitive Psychotherapy, 17(2), 179-186.

Tucker, P., & Trautman, R. (2000). Understanding and treating PTSD: Past, present, and future. Bulletin of the Menninger Clinic, 64(3), 15.

Yount, Rick,M.S., L.S.W., Ritchie, Elspeth Cameron,M.D., M.P.H., St. Laurent, Matthew, MS, OTR, Chumley, Perry,D.V.M., M.P.H., & Olmert, M. D. (2013). The role of service dog training in the treatment of combat-related PTSD. Psychiatric Annals, 43(6), 292-295.