Psychotherapy for posttraumatic stress disorder in adults
- Barbara O Rothbaum, PhD
Barbara O Rothbaum, PhD
- Professor of Psychiatry
- Emory University School of Medicine
Posttraumatic stress disorder (PTSD) is a severe, often chronic and disabling disorder, which develops in some persons following exposure to a traumatic event involving actual or threatened injury to themselves or others. PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction.
Treatments for PTSD include medications and psychotherapy [1-5]. Among the psychotherapies, clinical trials most strongly support the use of various types of trauma-focused cognitive-behavioral therapy (CBT). CBT typically includes components of cognitive therapy, exposure, and coping skills training.
This topic addresses psychotherapy for PTSD. The epidemiology, pathophysiology, clinical manifestations, assessment, diagnosis, and pharmacotherapy for PTSD are discussed separately. Dissociative aspects of PTSD are also discussed separately. The epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of acute stress disorder are also discussed separately. (See "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Dissociative aspects of posttraumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Treatment of acute stress disorder in adults".)
COGNITIVE AND BEHAVIORAL THERAPIES
Cognitive and behavioral therapies used to treat PTSD include exposure therapy, cognitive therapy, and various combinations of these modalities, often with other components. These modalities are sometimes described collectively as trauma-focused cognitive-behavioral therapy (CBT) if they specifically focus on the traumatic material. Cognitive approaches help patients to correct erroneous cognitions, while behavioral approaches aim to decrease symptoms through exposure to reminders of the traumatic event.
Assessment is an important component of CBT in PTSD, initially to confirm the primary and co-occurring diagnoses and to establish baseline ratings of symptom and functional severity. Subsequent severity ratings with the same instrument provide information on the extent to which the patient is responding to treatment and if adjustments need to be made. Clinical evaluation and assessment instruments for PTSD are reviewed further separately. (See "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis", section on 'Assessment'.)
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- COGNITIVE AND BEHAVIORAL THERAPIES
- - Basic science of conditioned fear
- Cognitive therapy
- - Efficacy
- Exposure therapy
- - Efficacy
- Cognitive-behavioral therapy
- - Efficacy
- Eye movement desensitization and reprocessing
- - Efficacy
- Couples therapy
- Coping skills training
- INTERPERSONAL THERAPY
- MINDFULNESS-BASED STRESS REDUCTION
- ACCEPTANCE AND COMMITMENT THERAPY (ACT)
- PSYCHODYNAMIC PSYCHOTHERAPY
- ECLECTIC PSYCHOTHERAPY
- TREATMENT SELECTION
- COMPARING PSYCHOTHERAPY AND PSYCHOPHARMACOLOGY
- COMBINING PSYCHOTHERAPY AND PHARMACOTHERAPY
- Cognitive-behavioral therapy
- Exposure therapy
- Psychological debriefing
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS