Rationale:

• The psychotherapy of PTSD is somewhat specialized in that certain techniques (not routine talk therapy) are most effective; substantial clinical improvement is more likely when patients receive one of these treatments.
• Medications may reduce PTSD symptoms, but they are not recommended alone.

Evidence:

• Several types of psychotherapy are effective for PTSD, including cognitive and exposure therapies and anxiety management techniques. Other techniques are more controversial (1; 18; 19).
• In a recent trial of cognitive and exposure therapies, 80% of patients who completed treatment recovered to the point that they no longer met criteria for the diagnosis of PTSD (20). Another trial comparing cognitive-behavioral therapy and problem-centered therapy found that both were more effective than wait list, but cognitive-behavioral therapy was not superior to problem-centered therapy (21).
• Although some had expressed concern that exposure therapy might exacerbate symptoms, despite positive outcomes in many studies, a recent examination of dropout rates across 25 controlled studies found no difference in dropout rates between exposure and cognitive therapies (22).
• In a randomized trial of 21 patients with PTSD, virtual reality exposure provided significantly greater improvement in PTSD syndromes than in patients on a waitlist control group. Moreover, most of the patients had been unable to tolerate typical imaginal exposure (23).

Comments:

• Data on the effectiveness of a recently developed psychotherapy technique known as eye movement desensitization and reprocessing are mixed (18). This technique has many adherents, but there is no consensus among PTSD experts on its usefulness. No data support psychodynamic psychotherapy, the most common general form of psychotherapy, for PTSD. Hypnosis is not recommended.