The evidence base for the best second- and third-line line treatment approaches for PTSD falls substantially, and more reliance is placed on expert opinion rather than empirical information. Depending on the specific cognitive behavioral treatment and the study sample, the percentage of responders can be as high as 90% and as low as 50% ( Kar, 2011), and treatment outcomes are stable over time (e.g., Foa et al., 2005). The percentage of responders varies among studies, types of traumas, definitions of response, magnitudes of intent to treat, and completer analyses. On the Clinician-Assisted PTSD Scale (CAPS), subclinical PTSD is indicated by a score of 50, and remission by a score of 20 or less ( Tucker et al., 2001). Some studies use at least a 50% reduction in PTSD symptoms to indicate a satisfactory response another indicator of a satisfactory response is a score of 15 on the Posttraumatic Stress Diagnostic Inventory to indicate subclinical PTSD severity and a score of 10 to indicate remission ( Foa et al., 1993). There is no widely accepted definition of what constitutes satisfactory response. Some guidelines offer recommendations on levels of care or stages of treatment in the event that the first evidence-based approaches fail to produce a satisfactory response.
Not all people who have PTSD respond satisfactorily to initial treatment, and many remain treatment-resistant to varied degrees. It should be noted that many of the treatments discussed in this chapter, even those with a robust body of evidence, may not have been tested specifically on military personnel who had PTSD, but in the absence of a well-reasoned argument against it, it is safe to hypothesize that treatments that were effective in well-controlled studies of a variety of civilian populations that had PTSD will also be effective in military personnel. The committee believes it is prudent to offer treatment supported by robust evidence before offering treatments that are not so supported. Not having RCTs supporting a particular treatment does not necessarily mean that it is not effective. There are numerous interventions for chronic PTSD, and not all of them have a robust database to support their efficacy for ameliorating PTSD symptoms. A synopsis of the many PTSD treatment guidelines is then given, including the Department of Veterans Affairs (VA)/Department of Defense (DoD) guideline for the management of posttraumatic stress that might assist the health care provider in selecting a treatment plan for a patient with PTSD.
#THOUGHT FIELD THERAPY INSTRUCTIONS MANUAL#
These include manualized treatments (that is, those that have a manual of instructions) such as couple psychotherapy in which one or both persons have PTSD, and complementary and alternative medicine (CAM) treatments, most of which do not have a structured manual, such as yoga, acupuncture, and animal-assisted therapy. The committee then looks at emerging treatments that are being used or being considered for use in the management of PTSD. The efficacy of combinations of cognitive behavioral therapy and pharmacotherapy for PTSD is also discussed.
The efficacy of pharmacotherapy for PTSD is then considered, including the use of antidepressants-serotonin reuptake inhibitors (SRIs) and others- and the use of multiple drugs for PTSD and comorbid conditions. That is followed by a discussion of treatments that have been studied in open trials and for which RCTs have not been conducted. Among the psychosocial treatments discussed are exposure therapy, cognitive therapy, and group therapy. The chapter begins with a description of the many psychosocial therapies whose efficacy is supported by an established evidence base-randomized controlled trials (RCTs). This chapter provides critical reviews of the various approaches to treatment for chronic posttraumatic stress disorder (PTSD), that is, PTSD lasting more than 3 months, although many of the treatments may be used with patients who suffer from acute PTSD (lasting more than 1 month and less than 3 months) and even those who have symptoms within 2 weeks after a traumatic event.
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