Therapies that teach coping skills such as stress management are nearly as effective as those that confront traumatic memories in reducing symptoms of post-traumatic stress disorder in service members and veterans, says a study released on Tuesday.
The findings, published in this month's Journal of the American Medical Association by researchers with the Cohen Veterans Center at New York University, suggest a wider variety of therapies can be offered to PTSD sufferers such as combat veterans and victims of sexual assault with little difference in effect.
Giving patients more alternatives in their treatment could reduce the number who drop out of treatment, the study's authors suggest. About a quarter of all patients in trauma-focused psychotherapy programs currently drop out of treatment.
Almost 13 percent of Iraq and Afghanistan veterans and 10 percent of Gulf War veterans are thought to have PTSD, according to studies, while 11 percent of Vietnam vets still report symptoms such as flashbacks, hypervigilance and nightmares. The condition is associated with high risks of suicide, depression and substance-abuse disorders.
The study found that two psychotherapies embraced in 2008 by the Department of Veterans Affairs were little better than nontrauma-focused therapies that emphasize coping skills.
Cognitive-processing therapy, or CPT, attempts to reframe negative feelings surrounding a traumatic memory, while prolonged exposure therapy aims to blunt the power of a traumatic event by having patients recount such an event repeatedly.
Both therapies had shown success in the treatment of sexual assault victims.
Researchers in the JAMA study reviewed clinical trials of both methods on military and veteran populations and compared results with several methods of nontrauma-focused therapy. Those methods include present-centered therapy, or PCT, which emphasizes problem solving and is often conducted in a group setting.
They found that CPT was "marginally superior" to the nontrauma-focused therapy, showing more immediate relief in the short term but little difference in outcomes in follow-up visits. Prolonged exposure therapy outcomes also showed little difference from nontrauma-focused therapies, although the number and size of clinical trials were limited, researchers noted.
The study emphasized the limits of all current therapies, which frequently relieve symptoms but rarely reverse a PTSD diagnosis.
The availability of alternative therapies may improve patient outcomes, clinician David J. Kearney and Tracy L. Simpson wrote in an editorial in the same issue of JAMA.
"Preference for one mode of therapy or another may influence the willingness of a patient to initiate and remain in treatment, which in turn may affect therapeutic efficacy," they wrote.
Another study published in JAMA's August issue suggests that mindfulness therapy, which teaches sitting and yoga meditation with breathing exercises, can lead to modest improvement in PTSD symptoms in military members and veterans. Participants in the clinical trial attended a 2.5-hour class for eight weeks and a daylong retreat. Their symptoms were later compared with those of a group enrolled in present-centered therapy. The study found fewer self-reported PTSD symptoms among the mindfulness therapy group after two months but no significant difference in the rate of PTSD remission.
The study of mindfulness therapy was based on a randomized clinical trial of 116 veterans with PTSD recruited at the Minneapolis Veterans Medical Center. It was conducted between March 2012 and 2013, with a follow-up in April 2014.