Military Times

The U.S. needs to revisit our PTSD treatment guidelines

Post-traumatic stress disorder is arguably the most challenging problem combat veterans face. Estimates vary, but experts believe that between 10 and 20 percent of Iraq and Afghanistan veterans suffer from the disorder. This puts the actual number of men and women affected in the hundreds of thousands.

Considering that PTSD wreaks havoc on the veteran and their loved ones, and costs billions of dollars each year, finding and using the most effective treatments are critical.

Historically, medications and talk therapy have been considered "first-line treatments." This basically means they should be used first, and if they fail, then you try something else.  In fact, the joint treatment guidelines published by the Department of Defense and Veterans Affairs Department puts medications and psychotherapy on equaling footing. The same is true for the American Psychiatric Association.

Not all agree.

Organizations from the United Kingdom and Australia and the World Health Organization take the position that trauma-focused psychotherapies such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing are most effective when it comes to PTSD treatment. Basically, their stance is that the evidence for meds is just not as strong. A recent study carried out by military and VA researchers, and published in the journal Depression and Anxiety, supports this position.

After weeding through more than 60,000 possibilities, the researchers identified 55 psychotherapy and medication studies for PTSD. This added up to around 6,300 total study participants.

What did they find? Trauma-focused psychotherapies outperformed psychotherapies that do not specifically discuss the trauma. They also beat out medications.

This does not mean other psychotherapies are useless. For example, the researchers noted that stress inoculation training is effective for PTSD. SIT is a credible talk therapy that has been around for decades. It just may not be as effective as the trauma-focused therapies.

The same is true for medications. Zoloft and Effexor are commonly used for PTSD, and they do work for some people. But again, they may not be as useful as certain psychotherapies.

The bottom line is that the current United States-based treatment guidelines for PTSD may need to join the ranks of their European and Australian counterparts. Specifically, medications likely need to be identified as "second-line" treatments. In other words, they should only be used if an effective talk therapy is not available.

The results of this study challenge the current status quo with regard to treating our combat veterans. It is time to take a close look at how we prioritize PTSD treatments and make adjustments to our national treatment guidelines as necessary.

Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance.

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