Cognitive Behavioral Therapy Is an Effective, but Short-term Treatment for PTSD in Female Veterans
]]>Posttraumatic stress disorder]]> (PTSD) is an ]]>anxiety]]> disorder that can develop after exposure to a traumatic event such as assault, rape, disaster, or military combat. People with PTSD frequently relive their ordeal, may feel detached or numb, and are often easily startled. In the US, PTSD is more prevalent in women, and even more so in women who have served in the military.
In an article published in the February 28, 2007 Journal of the American Medical Association , researchers compared the use of cognitive behavioral therapy (CBT) to supportive intervention to treat PTSD in female veterans and active-duty personnel. They found that women who received CBT had a significantly greater reduction in PTSD symptoms than the other women in the study, but that these benefits were short-lived.
About the Study
The researchers recruited 277 female veterans and seven female active-duty personnel with PTSD. The women were randomly assigned to receive 10 weekly 90-minute sessions of either prolonged exposure (141 women) or present-centered therapy (143 women). Prolonged exposure is a type of CBT in which patients repeatedly recount a traumatic memory with the goal of eventually decreasing their emotional response to the memory and to reminders of the trauma. Present-centered therapy focuses on current life problems that stem from PTSD, rather than on the initial trauma. The researchers assessed symptom severity at the start of the study, immediately after the end of treatment, and then three and six months after the end of treatment.
Women who received prolonged exposure had significantly greater reductions in their symptom severity than women who received present-centered therapy. They were also significantly more likely to no longer be diagnosed with PTSD at some point in the study and to achieve total remission. The beneficial effects of prolonged exposure were significant immediately after the end of treatment, but not at three or six months after treatment.
This study is limited by the fact that it allowed participants to continue taking previously prescribed medication for PTSD. This may have made it more difficult to separate the effects of therapy from the effects of medication.
How Does This Affect You?
This study found that prolonged exposure was significantly better for the treatment of PTSD in female veterans and active-duty personnel than present-centered therapy, at least in the short term. More studies are needed to determine whether a longer period of treatment would extend the benefits of CBT and how CBT compares to the use of selective serotonin reuptake inhibitors (SSRIs) which, along, with CBT, are a primary treatment for PTSD.
When asked what initiated their PTSD, 68.3% of the women in this study listed sexual trauma, 15.8% listed physical assault, and 5.6% listed war-zone exposure. The average time since the initial trauma in this group was 23 years. Clearly, women are suffering through painful ordeals during their military service, and carrying that pain with them for decades afterwards. More studies like this one will hopefully help address the protracted anguish experienced by some of our servicewomen.
National Center for Posttraumatic Stress Disorder
US Department of Veterans Affairs
National Institute of Mental Health
National Institutes of Health
Schnurr PP et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA . 2007; 297:820-830.
Last reviewed April 2007 by ]]>Richard Glickman-Simon, MD]]>
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