A short but intensive approach to "talk therapy" can help many combat veterans overcome post-traumatic stress disorder (PTSD), a new clinical trial has found.
The study tested "compressed" formats of a standard PTSD treatment called prolonged exposure therapy, in which patients learn to gradually face the trauma-related memories they normally avoid.
Traditionally, that has meant therapy once a week, over the course of a few months.
But while prolonged exposure therapy is often effective for PTSD, there is room for improvement, according to Alan Peterson, a professor of psychiatry at the University of Texas Health Science Center at San Antonio.
In general, he said, prolonged exposure (PE) therapy does not work as well for combat veterans as it does for civilians with PTSD. In an earlier trial, Peterson and his colleagues found that about 60% of combat vets still met the criteria for PTSD six months after therapy.
So for the new trial, his team tested the effects of two compressed PE formats, where vets attended therapy every weekday for three weeks. It's a concept that some PTSD programs have been offering in recent years.
The general idea, Peterson explained, is that the short time window will help more patients stick with therapy. And the intensity of daily sessions, with patients devoting their time and energy toward getting better, might also boost effectiveness, he suggested.
For the study, the researchers randomly assigned 234 veterans with combat-related PTSD to one of two groups. One received 90-minute PE therapy sessions, five days a week, for three weeks.
Essentially, Peterson explained, PE encourages people to dig into their trauma-related memories, retelling their stories and learning to face — rather than avoid — situations and feelings that remind them of their trauma.
The other study group also had daily PE sessions, plus various "modules" that extended the treatment to a full day.
Some of those enhancements included education sessions that involved family members or friends, onsite "homework" assignments, and feedback from therapists.
In the end, the trial found, both groups fared equally well. More than 60% of patients saw a substantial reduction in their PTSD symptoms soon after therapy ended, and the improvements were largely maintained for six months.
Meanwhile, more than half of the vets no longer met the criteria for PTSD six months after treatment ended.
Sheila Rauch is deputy director of the Emory HealthCare Veterans Program, one of four academic medical centers in the United States that is part of the Warrior Care Network. It offers a two- to three-week intensive program for vets with PTSD.
It's quite similar, Rauch said, to the approaches tested in this trial — with PE sessions forming the "core."
Rauch, who was not involved in the study, said high dropout rates are a key challenge with all PTSD treatments. In her experience, she said, many veterans prefer getting a "big bolus of treatment," meaning a large, concentrated regimen.
"They can say, 'I'm doing PTSD treatment right now, and that's my job,'" Rauch said, noting that her program retains more than 90% of patients.
Based on the current trial, Peterson said, the prolonged exposure therapy itself appears key, rather than the enhancements. That suggests the longer days, and added expense, might not be warranted.
Rauch said she thinks more research is needed on that question, because there were signs the more-intensive program could have longer-lasting effects: Some of the symptom improvement in the PE-only group was waning by six months.
The bottom line, both experts said, is that effective treatment is available.
"PTSD treatments work for a lot of people," Rauch said. "And if you're able to stick with it, you're more likely to be one of those people."
That said, the intensive PE formats studied in this trial are not yet widely available — and, Rauch noted, may not be covered by insurance.
Veterans, however, can receive treatment through the Warrior Care Network free of charge. They can also contact Department of Veterans Affairs for help in finding additional options, Rauch said.
According to the VA, all of its medical centers provide PTSD treatment.
The findings were published online Jan. 5 in JAMA Network Open.
The U.S. Department of Veterans Affairs has more on PTSD.
SOURCES: Alan Peterson, PhD, professor, psychiatry and behavioral sciences, University of Texas Health Science Center at San Antonio; Sheila Rauch, PhD, professor, psychiatry, deputy director, Emory Healthcare Veterans Program, Emory University School of Medicine, Atlanta; JAMA Network Open, Jan. 5, 2023, online