Challenging Beliefs about the Psychotherapy of Post-Traumatic Stress Disorder (PTSD)

Abstract

Clinical guidelines for treating post-traumatic stress disorder (PTSD) have recommended using cognitive-behavioural therapy (CBT) only. This is not surprising given that almost all randomized clinical trials were conducted by CBT researchers examining the efficacy of CBT. The two types of standardized CBT -- trauma-focused and non-trauma-focused – were both found to be equally efficacious for treating PTSD. However, their observed efficacy is limited -- only partial PTSD remission in only 50% of informed and selected volunteers. Beyond a limited efficacy, claims of high efficacy are often made for trauma-focused CBT, although these modalities were repeatedly found to be associated with attrition and iatrogenic effects. Whenever dynamic and supportive therapies were included in controlled clinical trials, these therapeutic modalities were provided in non-representative ways. Furthermore, any differential findings between therapies disappeared at follow-up, invaliding any conclusion about the superiority of CBT. Only one randomized clinical trial had compared the efficacy of dynamic therapy vs. CBT for treating PTSD, but no differential efficacy was found (Brom et al., 1989). Taken together, these findings suggest that there is a pro- CBT bias in funding, research, and guidelines in the field of PTSD. This pro-CBT bias needs to be acknowledged and corrected. In the meantime, clinicians need to rely on their own judgment, using integrative approaches for treating PTSD in a flexible manner.