PSYCHOTHERAPY VERSUS PHARMACOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER: SYSTEMIC REVIEW AND META-ANALYSES TO DETERMINE FIRST-LINE TREATMENTS

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Abstract

Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as first-line treatment. Direct head-to-head comparisons are lacking.

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Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial.

B Chow, Paula O′Shea, Patricia Resick … (2007)

The prevalence of posttraumatic stress disorder (PTSD) is elevated among women who have served in the military, but no prior study has evaluated treatment for PTSD in this population. Prior research suggests that cognitive behavioral therapy is a particularly effective treatment for PTSD. To compare prolonged exposure, a type of cognitive behavioral therapy, with present-centered therapy, a supportive intervention, for the treatment of PTSD. A randomized controlled trial of female veterans (n=277) and active-duty personnel (n=7) with PTSD recruited from 9 VA medical centers, 2 VA readjustment counseling centers, and 1 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 according to standard protocols in 10 weekly 90-minute sessions. Posttraumatic stress disorder symptom severity was the primary outcome. Comorbid symptoms, functioning, and quality of life were secondary outcomes. Blinded assessors collected data before and after treatment and at 3- and 6-month follow-up. Women who received prolonged exposure experienced greater reduction of PTSD symptoms relative to women who received present-centered therapy (effect size, 0.27; P = .03). The prolonged exposure group was more likely than the present-centered therapy group to no longer meet PTSD diagnostic criteria (41.0% vs 27.8%; odds ratio, 1.80; 95% confidence interval, 1.10-2.96; P = .01) and achieve total remission (15.2% vs 6.9%; odds ratio, 2.43; 95% confidence interval, 1.10-5.37; P = .01). Effects were consistent over time in longitudinal analyses, although in cross-sectional analyses most differences occurred immediately after treatment. Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. clinicaltrials.gov Identifier: NCT00032617.

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Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis.

Mathew Hoskins, Jennifer Pearce, Andrew Bethell … (2015)

Pharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.

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A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.

Christopher Gross, James Holmes, Daniel Warren … (2007)

Excessive brain responsiveness to norepinephrine appears to contribute to post-traumatic stress disorder (PTSD), particularly at night. Prazosin, a brain active alpha-1 adrenergic receptor antagonist, significantly reduced trauma nightmares and sleep disturbance in 10 Vietnam War combat veterans in a previous placebo-controlled crossover study. The current parallel group trial in a larger sample of veterans evaluated prazosin effects on trauma nightmares, sleep quality, global clinical status, dream characteristics, and comorbid depression. Forty veterans (mean age 56 +/- 9) with chronic PTSD and distressing trauma nightmares and sleep disturbance were randomized to evening prazosin (13.3 +/- 3 mg/day) or placebo for 8 weeks. In the evaluable sample (n = 34), primary outcome measures demonstrated that prazosin was significantly superior to placebo for reducing trauma nightmares and improving sleep quality and global clinical status with large effect sizes. Prazosin shifted dream characteristics from those typical of trauma-related nightmares toward those typical of normal dreams. Blood pressure changes from baseline to end study did not differ significantly between prazosin and placebo. Prazosin is an effective and well-tolerated treatment for trauma nightmares, sleep disturbance and global clinical status in veterans with chronic PTSD.

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Author and article information

Journal

Title: Depression and Anxiety

Abbreviated Title: Depress Anxiety

Publisher: Wiley

ISSN: 10914269

Publication date Created: September 2016

Publication date (Print): September 2016

Publication date (Electronic): April 29 2016

Volume: 33

Issue: 9

Pages: 792-806

Affiliations

[1 ]Office of Evidence Based Practice; JBSA Fort Sam Houston; San Antonio Texas

[2 ]Department of Psychiatry; Uniformed Services University of the Health Sciences; Bethesda Maryland

[3 ]Department of Behavioral Health; Bayne-Jones Army Community Hospital; Fort Polk Louisiana

[4 ]National Intrepid Center of Excellence; Walter Reed National Military Medical Center; Bethesda Maryland

[5 ]Headquarters U.S. Marine Corps; Health Services; Arlington Virginia

[6 ]Women's Health Science Division, National Center for PTSD, VA Boston Healthcare System; Boston University School of Medicine; Boston Massachusetts

[7 ]Department of Veterans Affairs; Boston University School of Medicine; Boston Massachusetts

[8 ]Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts

[9 ]Center for Psychiatry and Neuroscience; Walter Reed Army Institute of Research; Silver Spring Maryland

Article

DOI: 10.1002/da.22511

PubMed ID: 27126398

SO-VID: 5c5d0d42-a2ec-49ca-8964-33f8c21ca411

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PSYCHOTHERAPY VERSUS PHARMACOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER: SYSTEMIC REVIEW AND META-ANALYSES TO DETERMINE FIRST-LINE TREATMENTS : Research Article: Comparison of PTSD Guidelines

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Creative methods for psychotherapy

Most cited references 49

Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial.

Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis.

A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.

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