LENS

Revisiting Trauma

Options for treating PTSD

Many people suffering from post-traumatic stress disorder (PTSD) in the United States don't improve with existing treatments, according to Case Western Reserve's Norah Feeny, PhD. And she knows a key reason why.

A professor of psychological sciences, Feeny studies how to treat the often-debilitating disorder and what methods yield the most success.

She said therapies with the best track records aren't used as frequently as they should be. Instead, techniques such as supportive counseling and relaxation are more common, despite being largely ineffective for people with chronic PTSD.

Practitioners might use these techniques for various reasons, including clinic preferences, a lack of training or concerns that alternative approaches might make patients worse, Feeny said.

"But I think we have an obligation to use treatments that have been tested and shown to be efficacious," she said.

Even the best treatments— those focused on thoughts and behavior—don't have the success rates Feeny and others would like. But the rates are considerably lower for therapies not backed by evidence—and the problem is, that's what "most people" are getting, Feeny said.

"If I had a heart problem and someone said, 'You could have an echocardiogram or something we don't really know works,' I would want the echocardiogram—it's been tested to a known standard," she said. "Mental-health treatments should be held to similar standards."

Feeny's latest study is contributing directly to that objective. It's comparing two types of treatment: In the first, called "prolonged exposure" (PE), patients repeatedly talk through their trauma with a trained therapist to reduce their intense distress in response to those memories. Patients also have homework, such as making a list of situations they avoid, and then gradually work to face them with the help of their therapist. The second treatment combines PE therapy with the drug sertraline, an antidepressant.

"One of the things we've found in our research is that people with PTSD typically want to talk about what happened to them, even though it's difficult and even when offered an 'easier' treatment like medication," Feeny said. "People want to make sense of what has happened to them."

—David Levin