Which PTSD Treatments Have Been Studied?
How Are Treatments for PTSD Tested?
We learn which treatments are effective for helping with PTSD by using scientific methods. The most rigorous way to determine the effectiveness of a treatment is to use a randomized controlled trial (RCT) design, in which participants are assigned randomly—or by chance—to one treatment or another. Random assignment improves our confidence that changes in PTSD symptoms are due to the treatments themselves rather than some other cause.
Which treatments are in the PTSD-Repository?
The PTSD-Repository includes RCTs of treatments for PTSD, which fall into six general categories. Psychotherapy is talk therapy with a licensed provider and can be classified as “trauma-focused” or “non-trauma-focused.” Pharmacotherapy uses medications; it can be grouped into drug classes such as antidepressants and antianxiety medications. Complementary and integrative health (CIH) treatments---sometimes referred to as “alternative medicine”---represent a wide category of approaches that are considered to be outside the standard in the current practice of Western medicine. Collaborative care treatments are those in which integrated medical and mental health treatment is delivered in primary care, often by nurse managers. Nonpharmacologic biological treatments use a medical device of some kind. Nonpharmacologic cognitive treatments teach cognitive skills to improve attention. Control treatments are comparison conditions such as a placebo pill, waitlist, and treatment as usual (i.e., when treatment as usual cannot be clearly defined as another specific treatment.)
How is treatment type coded?
First, studies were broken down by treatment arm (i.e., condition), each coded into one of the treatment categories, labeled as study class in the PTSD-Repository (i.e., psychotherapy, pharmacotherapy, CIH, collaborative care, nonpharmacologic biological, nonpharmacologic cognitive, or control). Two treatment types have sub-codes. Psychotherapy is coded as trauma-focused or non-trauma-focused. Pharmacotherapy is coded with several different sub-codes such as antianxiety, antidepressant, etc. Then the overall study was classified according to which active treatment(s) were being tested. For example, a study comparing a psychotherapy to a waitlist condition was coded as having two arms, Psychotherapy and Control, and then the overall study was coded as Psychotherapy. The arms and overall study could be “mixed,” meaning that more than one treatment type is represented. For example, a study might compare medication and psychotherapy, combined within the same arm, to just the psychotherapy. The medication-psychotherapy arm and study would be coded as “mixed-psychotherapy and pharmacotherapy.” Most of the information presented here is based on the overall study classification.
As shown below, there are 318 RCTs in the PTSD-Repository,half of which are psychotherapy trials (n = 158, 50%).There are fewer, but still many, pharmacotherapy studies (n = 83, 26%).Over time, more studies have examined CIH interventions and combination treatments.
Psychotherapies for PTSD
The most effective treatments for PTSD are trauma-focused psychotherapies, including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR).
"Trauma-focused" means that the treatment focuses on the memory of the traumatic event or its meaning.
You can find more information about these treatments on the National Center for PTSD website: PTSD Treatment Basics.
To the right, you can see that the majority of treatment arms in psychotherapy studies in the PTSD-Repository are trauma-focused. By clicking on the “Trauma-focused psychotherapies” bar, you can dig deeper to see the specific trauma-focused psychotherapies studied; PE, EMDR, CBT, CPT, and Narrative Exposure Therapy (NET) have been studied most frequently.
Medications for PTSD
Most studies of medications for PTSD have examined antidepressants, specifically selective serotonin reuptake inhibitors (SSRI).
Three of the four recommended medications for PTSD are SSRIs (sertraline, paroxetine, and fluoxetine). Venlafaxine, a selective norepinephrine reuptake inhibitor (SNRI), is also recommended. See the National Center for PTSD website for more information about Medications for PTSD.
By clicking on each slice, you can dig deeper to see the specific medications examined in studies within the PTSD-Repository.
The PTSD Decision Aid can help you decide which treatment is right for you.
This free online tool helps you see how different treatments measure up against one another. It also gives you tips on how to work with your provider to decide on a treatment. You can watch videos of providers explaining how treatments work, build a chart to compare the treatments you like the most, and print a personalized summary.
For more information, check out Choosing a Treatment on the National Center for PTSD website.
Complementary and Integrative Health Interventions
Complementary and integrative health (CIH) interventions, also called complementary and alternative medicine (CAM), include treatments not considered to be standard in the current practice of Western medicine. They are “complementary” in that they are often used in combination with conventional approaches.
Popular CIH interventions include yoga, meditation, relaxation, and acupuncture. Only 38 of the treatment arms in the PTSD-Repository are CIH interventions. Most of them fall roughly within these categories. Some people experience benefits from these approaches, but published research does not indicate that using CIH interventions alone improves PTSD.
For more information, see Complementary and Alternative Medicine for PTSD on the National Center for PTSD website.
Other Treatments in the PTSD-Repository
Collaborative care treatments are those in which integrated medical and mental health treatment is delivered in primary care, often by nurse managers. There are only 4 studies of collaborative care for PTSD in the PTSD-Repository. As described in the 2017 VA/DOD Clinical Practice Guideline for PTSD, these studies provided evidence of increased PTSD treatment compliance and patient satisfaction, with the benefits of collaborative care outweighing the risks.
Nonpharmacologic biological treatments use a medical device of some kind to treat PTSD symptoms. The most extensively studied nonpharmacologic biological treatment is repetitive transcranial magnetic stimulation (rTMS). Eleven treatment arms in the PTSD-Repository include active TMS, though the specific treatment protocols have varied from study to study. Other treatments include biofeedback, neurofeedback, stellate ganglion block, and others.
Nonpharmacologic cognitive treatments teach cognitive skills to improve attention. The treatments typically involve tasks completed on a computer that are intended to help patients change how they pay attention. For example, attention bias modification training was designed to teach patients strategies for orienting attention away from threatening images such as faces or words. To date, these treatments are not typically used outside of research settings.
Hear from Others Who Have Been There
On AboutFace, you can learn about PTSD and treatment from people who have been there. In the videos on this site, you can hear real stories from Veterans and their family members, and get advice from VA clinicians who have treated thousands of Veterans with PTSD.
Check it out: AboutFace