Going through the behavioural therapy and going through these mental exercises and things, it’s really helped me live with day-to-day problems, far better than [I] ever was without that kind of training and without that kind of ability to use CBT. I never even knew you could have group treatment for PTSD … People just share what it’s like living with it. Like the memory loss or whatever funny stories that come with PTSD, but not the trauma itself.
We also explored the budget impact of unguided and guided iCBT separately, and we examined the budget impact of adding more therapist support hours for guided iCBT. Diagnosis of PTSD is accompanied by direct and indirect public health consequences including suicide, secondary mental health disorders, substance abuse, impaired functioning, health problems and reduced life course opportunities (Roberts, Gilman, Breslau, Breslau & Koenen, 2011). Significant associations have also been reported between PTSD and depression, and cognitive behavioral therapy between PTSD and self‐reported health problems (Possemato, Wade, Andersen & Ouimette, 2010). PTSD has been shown to have a severe impact on functioning, leading to an increase in the risk of unemployment by as much as 150%, marital instability by 60%, and suicide for sufferers exceeding that of any other anxiety disorder (Galovski & Lyons, 2004). The potential negative impact of PTSD for the individual, their family, and wider society highlights a clear imperative for diagnosis and effective treatment of the disorder.
Cognitive Behavioral Therapy for PTSD
Before we explore cognitive behavioral therapy in more depth, let’s first review some common signs of PTSD and what we mean when we say that someone has post-traumatic stress disorder. The available evidence suggests that the clinical effectiveness of CBT delivered through teletherapy in group and one-on-one sessions is comparable with face-to-face delivery. As well, overall participant satisfaction appeared to be comparable between the two delivery modes of group session CBT. However, because of issues with methodologies and factors that limit the generalizability of the results, the evidence should be interpreted with caution.
- In addition to the RCTs used to determine recommended treatment in the guidelines, several meta-analyses have found that exposure therapy is more effective that non-trauma focused therapies (Bradley et al., 2005; Powers et al., 2010; Watts et al., 2013; Cusack et al., 2016).
- Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma.
- DSM-IV and DSM-IV-TR required that intense fear, helplessness, or horror were present in the individual’s response to the traumatic event, although it became evident that this was not universal, especially in military populations.
- APA’s Clinical Practice Guideline strongly recommends four interventions for treating posttraumatic stress disorder, and conditionally recommends another four.
We spoke with people who had experience with various treatment options for PTSD including iCBT. This process included checking for errors and ensuring the accuracy of parameter inputs and equations in the budget impact analysis. To contextualize the potential value of iCBT for PTSD, we reviewed relevant literature on patients’ preferences and values and spoke with people who have lived experience with PTSD to explore their values, needs, and priorities. Each study included for full review reported conducting formal diagnosis procedures to confirm PTSD in the sample. Britvić, Radelić and Urlić (2006), Lampe, Barbist, Gast, Reddemann and Schüßler (2014), Monson et al. (2006), Nacasch, Fostick and Zohar (2011), Sijbrandij et al. (2007), and Gilboa‐Schechtman et al. (2010) used the PTSD Symptom Scale – Interview Version (Foa, Riggs, Dancu & Rothbaum, 1993).
CBT interventions for PTSD
They found a within-group effect size (ES) of 2.59 for PTSD symptoms and 1.62 for depression (as secondary outcome measure). Benchmarking was done against three selected efficacy studies with a range of 1.90–2.50. Thus, the ES they found https://ecosoberhouse.com/ was somewhat higher than the upper limit of the efficacy studies. Later, Hans and Hiller (2013), in a similar meta-analysis including 9 PTSD studies, reported a within-group ES of 1.91 for PTSD symptoms and 1.09 for depression.
- All study designs were included in the review on the basis that PDT has few RCTs investigating its effectiveness.
- Nonetheless, the Cochrane criteria require that if a single rating of “some concerns” occurs, then the overall rating should be the same, despite the other domains being low.
- In scenario 6, we explored the influence of increased e-therapist hours on the budget.
- Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.
But there was a time when we didn’t know anything about how trauma can alter the neural pathways in the brain. APA’s Clinical Practice Guideline strongly recommends four interventions for treating posttraumatic stress disorder, and conditionally recommends another four. While it can be difficult to prevent PTSD, there are research-backed treatments — including cognitive behavioral therapy (CBT) — to help you manage your symptoms. In order to enable inclusion of both RCTs and pre-post trials in this meta-analysis we used the uncontrolled pre-post effect size, while being aware of the problems with this ES-measure.
Pre-post effect sizes should be avoided in meta-analyses
Psychodynamic (PDT)‐based interventions are one example of such preferred approaches, this is despite comparatively limited available evidence supporting their effectiveness for treating PTSD. Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed.
- Internet-delivered CBT may not be suitable for people who are suffering from severe symptoms of PTSD or ASD and who require specialized, intensive, multidisciplinary outpatient or inpatient care.
- A review by Ponniah and Hollon (2009) found one randomised control trial (RCT) (Brom et al., 1989) comparing PDT to a control condition; patients treated with PDT reported a significant decrease in PTSD symptoms compared to a control group and a waitlist control condition.
- Rates of participants who no longer met PTSD diagnosis criteria ranged from 30% to 97% and 51% more participants treated with CPT achieved loss of PTSD diagnosis, compared to waitlist, self-help booklet and usual care control groups (Jonas et al., 2013).