Trauma Survivors Deserve Therapy
That Actually Works
Executive
director, Association for Psychological Science in Washington, D.C.
The
mind-boggling events of the past month — the Boston Marathon bombings, the
fertilizer plant explosion near Waco, a deadly collapse of a garment factory in
Bangladesh — will undoubtedly leave in their wake a host of survivors
suffering from post-traumatic stress disorder. Many victims will get over the
short-term trauma of those events, but others — in the coming weeks and months
–will begin experiencing the chronic bad dreams, flashbacks, sleep
difficulties, and frightening thoughts that characterize PTSD. Those
individuals will likely avoid places, events or objects that remind them of the
experience.
In the United
States alone, PTSD affects nearly 8 million adults in
any given year, federal statistics show. Fortunately, clinical research has
identified certain psychological interventions that effectively ameliorate the
symptoms of PTSD. But most people struggling with the disorder don’t receive
those treatments.
One of the most
widely-researched treatments for PTSD is
prolonged exposure therapy (PE), pioneered by psychological scientist Edna Foa
of the University of Pennsylvania. In PE, patients approach — in both imaginary
and real-life settings — situations, places, and people they have been
avoiding. The repeated exposure to the perceived threat disconfirms
individual’s expectations of experiencing harm and over time leads to a
reduction in their fear.
Another approach
is cognitive processing therapy (CPT), which focuses on helping the patient
question and challenge the negative thoughts and feelings about the trauma.
PE, CPT and similar treatment
programs are relatively short-term, and have proven effective in a variety of
settings. And health economics studies suggest that providing such
evidence-based treatments for PTSD result in reduced health-care costs
— partly because they are relatively short-term but also because they tend to
ward off substance abuse, suicides, depression and other byproducts of trauma.
So why aren’t
they being commonly delivered to the people who need them?
One reason is
that far too few graduate programs provide students with the training to
competently provide these treatments. And many therapists, embracing therapy as
more of an art than a science, view evidence-based treatments as antithetical
to good treatment. A large, professional bias holds that therapy should be
individualized and should focus on the underlying causes of one’s problems and
symptoms. But studies show scant evidence that psychodynamic therapy — which
focuses on such issues as difficult childhood relationships with parents —
effectively eases PTSD symptoms.
The U.S. mental
health care system needs to change its attitude about effective therapies,
given that traumatic events such as natural disasters and gun violence are
pushing concerns about PTSD to the front of public consciousness. More than 286,000 Iraq and
Afghanistan war veterans have sought treatment for post-traumatic stress
disorder over the past decade, the U.S. Department of Veterans Affairs reports.
Researchers at Harvard Medical School found that roughly one-third of residents in the path of Hurricane
Katrina suffered some form of post-traumatic stress after the 2005 storm. And
in the two months following last year’s tragic mass shooting at Sandy Hook
Elementary School in Connecticut, more than 16 percent of
Newtown, Connecticut’s police force had missed work because of PTSD-related
issues, according to news reports.
There are
plenty of ways to better disseminate proven treatments for PTSD. The federal
government could demand the use of these interventions for Medicare and
Medicaid reimbursements, or pay less for treatments lacking empirical support. Private
medical insurers can take similar steps. State licensing boards could require
training in scientifically-backed treatments in order to grant a license to
practice.
For more information go to: http://www.huffingtonpost.com/alan-g-kraut/ptsd-treatment_b_3177364.html
