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Treatments for PTSD

Continued from: Post Traumatic Stress Disorder Treatments: Part 1

PTSD Article 1

The study by Ironson, Freund, Strauss and Williams (2002) compared the efficacy of two treatments for PTSD: EMDR and prolonged imaginal exposure. Data were analyzed for 22 patients who completed at least one active session of treatment after three preparatory sessions. The participants were taken from a university-based out-patient clinic. The participant eligibility criteria were: a single trauma, past spousal abuse, or being an adult survivor of childhood sexual abuse without dissociation. Of the twenty two participants, seventeen were women and five were men. Seven had a history of multiple traumas.

Patients were randomly assigned to PE or EMDR and were assessed at baseline, after six sessions, and at three month follow-up. To avoid a therapist-treatment type confound, therapist assignment to treatment was systematically varied.

The first three preparatory sessions were identical for participants in both conditions: evaluation, discussion of normal reactions to trauma and development of an in vivo behavioural exposure hierarchy list used to structure subsequent in vivo exposure homework assignments. In vivo exposure is very efficacious in treatment of avoidance symptoms in both EMDR and PE conditions. Exposure homework is part of PE protocol but not of EMDR and in order to make the techniques more comparable, exposure homework was used in both EMDR and PE conditions. As a result, the comparison of the two treatments was on what the participant underwent during the therapy sessions.

In sessions 4 to 6 participants received active treatment with either PE or EMDR. For the PE condition the instructions for imaginal exposure were to imagine reliving their trauma "as if it were happening again" (Ironson et al., 2003, p.117). The sessions were tape recorded and the participants were periodically asked to specify their Subjective Units of Distress (SUDS) score on a scale of 0 to 100. Homework for the PE condition was to listen to the taped session, practice breathing and relaxation exercises, and complete in vivo exposure tasks based on the behavioural hierarchy.

In active EMDR sessions patients were asked to visualize the worst part of their trauma and to generate one negative and one positive cognition about themselves associated with the trauma. Then the patients were to follow the movement of therapists' fingers while the initial image and negative cognition were held in mind. The image that emerged during this time would be used in the next set of eye movements. Homework in EMDR condition was to complete items from the in vivo hierarchy list and to practice breathing and relaxation exercises.

Results showed that both therapies produced a significant reduction in PTSD and depression symptoms. EMDR was both better tolerated - the dropout rate was significantly lower in the EMDR versus the PE group (0 of 10 vs. 3 of 12) - and more efficient - a larger number of people (7 of 10 vs. 2 out of 12) had a 70% reduction in PTSD symptoms after three EMDR active sessions. However all patients who remained in treatment with PE had a reduction in PTSD scores. SUDS ratings decreased during the initial session of EMDR, but changed little during PE. Post session SUDS were significantly lower for EMDR than for PE. Treatment effects have been well maintained, as seen at three-month follow-up.

Continued here: Post Traumatic Stress Disorder Treatments: Part 3