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Post Traumatic Stress Disorder Treatments

Continued from: Post Traumatic Stress Disorder Treatments: Part 2

PTSD Article 2

The study by Taylor et al. (2003) examined the efficacy, speed, and incidence of symptom worsening for three treatments of PTSD: PE, relaxation training, and EMDR. The participant eligibility criteria were: DSM-IV-TR (American Psychiatric Association, 2000) diagnosis of PTSD as the primary problem; age over 18 years; willingness to suspend any other psychological treatment and to keep doses of any psychotropic medication constant throughout the course of the study. Exclusion criteria were mental retardation, current psychotic disorder, and beginning or change in dose of psychotropic medication within the past 3 months. Sixty five percent of the participants had a history of multiple traumas.

Participants meeting study criteria were randomized to eight 90-min individual sessions of exposure therapy, EMDR, or relaxation training.

Exposure therapy involved four sessions of imaginal exposure to traumatic events, followed by four sessions of in vivo exposure to harmless but distressing trauma-related stimuli. Exposure exercises were hierarchically arranged and occupied 60 min of each 90-min session. During imaginal exposure, participants were to talk in the first person and present tense about the traumatic event. Sessions were audio-taped and participants were asked to listen to the tapes for an hour each day for the first 4 weeks of treatment.

In vivo exposure consisted of therapist-assisted exposure during the sessions and also exposure homework assignments. The latter consisted of live exposure for an hour each day for 4 weeks.

Relaxation training involved practicing three different relaxation exercises, one per session for the first three sessions. The participant then selected an exercise to practice in subsequent sessions. This consisted of either one of the three exercises or some combination thereof. Relaxation training occupied about 60 min of each 90-min session. In each session a relaxation script was read by the therapist. The script was audio-taped, and the participant was asked to listen to it for an hour each day.

During the first session of EMDR participants were trained in the Safe Place exercise (a coping strategy for reducing distress). This exercise was practiced as a homework assignment and used afterwards as needed. In the following sessions processing of a traumatic memory was done. The participant was asked to recall the memory and its associated features (e.g., negative self-statements) and then lateral sets of eye movements were induced by the therapist moving her finger across the participant's field of vision. The new image that arose would be used in the next set of eye movements. The process continued until the distress from the memory had diminished. Other EMDR methods (e.g., cognitive interweave) were also used.

Treatments did not differ in the rate of symptom worsening or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy produced significantly larger reductions in avoidance and re-experiencing symptoms, was faster at reducing avoidance, and produced a greater proportion of participants not meeting criteria for PTSD after the treatment. EMDR and relaxation did not differ from one another in speed or efficacy. Treatment effects have generally been well maintained on the three month follow-up.

Continued here: Discussion on Post Traumatic Stress Disorder Treatments