Treatments for PTSD

From Wikipedia, the free encyclopedia
Treatments for PTSD
Specialtypsychiatry, clinical psychology

PTSD is a psychiatric disorder characterized by intrusive thoughts and memories, dreams, or flashbacks of the event; avoidance of people, places, and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes, and persistent feelings of anger, guilt, or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.[1] PTSD is commonly treated with various types of psychotherapy and pharmacotherapy.

Exposure to trauma induces an intense amount of stress as a result of an individual directly or indirectly experiencing some type of threat,[2] also referred to as a Potentially Traumatic Experience (PTE). PTEs can include—but are not limited to—sexual violence, physical abuse, unexpected death of a loved one, witnessing another person badly hurt, exposure to natural disaster, being a victim of a serious crime, car accident, combat, interpersonal violence and many other stressful experiences. PTEs can also include learning that a traumatic event occurred to another person or witnessing the traumatic event; an individual does not have to experience the event themselves to develop Posttraumatic Stress Disorder (PTSD). PTEs are labeled as such because not everyone who experiences one or more of the events listed will develop PTSD. However, PTSD is estimated to develop in about 4% of individuals who experience some type of traumatic experience.[3] Approximately 8% of adults the United States (U. S.) population will have PTSD at some point in their lives.[4] That means about 8 million U.S. adults have PTSD during a given year, which is only a small portion of individuals who experience traumatic events. Biological stress responses can be adaptive at the time of the traumatic event, but prolonged biological stress responses can lead to impairing symptoms known as PTSD.[2]

Medication[]

Drug therapy, known as pharmacotherapy, is widely used as a treatment for PTSD. Drug therapy is considered less time consuming and easier to continue than psychotherapy (talk therapy). The only two medications for PTSD that are approved by the FDA are sertraline and paroxetine, both antidepressants of the selective serotonin reuptake inhibitors (SSRI) class.[5]

Medication is conditionally recommended for treatment of PTSD by the American Psychological Association.[6]

Antidepressants[]

Antidepressants are widely used in the treatment of PTSD and have consistently shown efficacy, though the magnitude of improvement is often modest. The most popular types of antidepressants are SSRIs, atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).[5] SSRI are most often used as they are considered safer than TCAs and MAOIs.[7] To date, only sertraline and paroxetine carry FDA approval for PTSD, though in general, all SSRIs seem similarly effective. These medications appear to be helpful across all PTSD symptoms.[8] According to the APA Practice Guidelines, "SSRIs have proven efficacy for PTSD symptoms and related functional problems".[9]

Other medications[]

Prazosin, an alpha-adrenoceptor antagonist, is also widely prescribed, particularly for sleep-related symptoms. Early studies had shown evidence of efficacy,[5] though a recent relatively large trial failed to show a statistically significant difference between prazosin and placebo.[10] Antipsychotic medications have also been prescribed to treat PTSD, though clinical trials have not yielded consistent evidence for their efficacy.[5]

Glucocorticoids may be useful for short-term therapy to protect against neurodegeneration caused by the extended stress response that characterizes PTSD, but long-term use may actually promote neurodegeneration.[11]

Cannabinoids[]

As of 2019 cannabis is specifically not recommended as a treatment.[12][13] However, use of cannabis or derived products is widespread among U.S. veterans with PTSD.[14]

The cannabinoid nabilone is sometimes used for nightmares in PTSD. Although some short-term benefit was shown, adverse effects are common and it has not been adequately studied to determine efficacy.[15] Currently, a handful of states permit the use of medical cannabis for the treatment of PTSD.[16]

MDMA[]

See also: MDMA-assisted psychotherapy
See also: MDMA § Research

In 2018, the US Food and Drug and Drug Administration granted "Breakthrough Therapy" designation[17] for MDMA-assisted psychotherapy trials.[18] Initial research on MDMA-assisted psychotherapy has shown the treatment to be efficacious and well tolerated.[19] For example, in a pooled analysis of phase II trials, two-thirds of patients suffering from PTSD assessed 12 months following MDMA-assisted psychotherapy treatment no longer exhibited sufficient symptoms to be diagnosed with PTSD.[20]

Benzodiazepines[]

Benzodiazepines are not recommended for the treatment of PTSD due to a lack of evidence of benefit and risk of worsening PTSD symptoms.[21] Some authors believe that the use of benzodiazepines is contraindicated for acute stress, as this group of drugs can cause dissociation.[22] Nevertheless, some use benzodiazepines with caution for short-term anxiety and insomnia.[23][24][25]

While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD, and they may actually increase the risk of developing PTSD 2–5 times.[26] Additionally, benzodiazepines may reduce the effectiveness of psychotherapeutic interventions, and there is some evidence that benzodiazepines may actually contribute to the development and chronification of PTSD. For those who already have PTSD, benzodiazepines may worsen and prolong the course of illness, by worsening psychotherapy outcomes, and causing or exacerbating aggression, depression (including suicidality), and substance use.[26] Drawbacks include the risk of developing a benzodiazepine dependence, tolerance (i.e., short-term benefits wearing off with time), and withdrawal syndrome; additionally, individuals with PTSD (even those without a history of alcohol or drug misuse) are at an increased risk of abusing benzodiazepines.[27][28]

There are a number of other treatments for PTSD that have greater efficacy and fewer risks than benzodiazepines. These include psychotherapy modalities such as prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, cognitive restructuring therapy, trauma-focused cognitive behavioral therapy, narrative therapy, brief eclectic therapy, and stress inoculation training. Some of these are outlined below. Other kids of pharmacological therapy can be more effective than benzodiazepines as well, e.g. serotonergic antidepressants, adrenergic inhibitors such as Prazosin, antipsychotics, and even anticonvulsants). Benzodiazepines should be considered relatively contraindicated until all other treatment options are exhausted.[29][30]

For those who argue that benzodiazepines should be used sooner in the most severe cases, the adverse risk of disinhibition (associated with suicidality, aggression and crimes) and clinical risks of delaying or inhibiting definitive efficacious treatments, make other alternative treatments preferable (e.g., inpatient, residential, partial hospitalization, intensive outpatient, dialectic behavior therapy; and other fast-acting sedating medications such as trazodone, mirtazapine, amitripytline, doxepin, prazosin, propranolol, guanfacine, clonidine, quetiapine, olanzapine, valproate, gabapentin).[27][30][31]

Psychotherapy[]

Exposure therapy[]

Exposure therapy involves exposing the patient to PTSD-anxiety triggering stimuli, with the aim of weakening the neural connections between triggers and trauma memories (aka desensitisation).

Forms include:

  • Flooding – exposing the patient directly to a triggering stimulus, while simultaneously making them not feel afraid.
  • Systematic desensitisation (aka "graduated exposure") – gradually exposing the patient to increasingly vivid experiences that are related to the trauma, but do not trigger post-traumatic stress.

Exposure may involve a real life trigger ("in vivo"), an imagined trigger ("imaginal"), or a triggered feeling generated in a physical way ("interoceptive").[32]

Researchers began experimenting with virtual reality therapy in PTSD exposure therapy in 1997 with the advent of the "Virtual Vietnam" scenario. Virtual Vietnam was used as a graduated exposure therapy treatment for Vietnam veterans meeting the qualification criteria for PTSD. A 50-year-old Caucasian male was the first veteran studied. The preliminary results concluded improvement post-treatment across all measures of PTSD and maintenance of the gains at the six-month follow up. Subsequent open clinical trial of Virtual Vietnam using 16 veterans, showed a reduction in PTSD symptoms.[33]

Cognitive Behavioral therapy[]

Cognitive behavioural therapy (CBT) focuses on the relationship between someone's thoughts, feelings, and behaviours. It helps people to understand the discrete nature of their thoughts and feelings, and to be better able to control and relate to them.

It is strongly recommended for treatment of PTSD by the American Psychological Association[34] and when CBT is combined with exposure therapy, there is a high strength of evidence that together they can reduce PTSD symptoms, lead to a loss of PTSD diagnosis, and reduce depression symptoms.[35]

Cognitive Therapy[]

Ehlers and Clark (2000)[36] developed a cognitive model that explains what prevents people from recovering from traumatic experiences and thus why people develop PTSD.[37] The model suggests that PTSD develops when individuals process the traumatic event in a way that makes him/her feel like there is serious current threat. This perception of threat is followed by reexperiencing and arousal symptoms and persistent negative emotions like anger and sadness. Differences in how the individual appraises the event ("I cannot trust anyone anymore" or "I should have prevented what happened") and the most intense moments of the trauma being poorly integrated into memory contribute to the distorted way people with PTSD make sense of what happened to them.

Cognitive therapy involves the therapist helping the patient develop and believe a new, less threatening understanding of their trauma experiences. Patients gain an increased understanding of how they perceive themselves and the world around them and how these beliefs motivate their behavior before beginning the process of changing these cognitions. Thus, three goals drive cognitive therapy for PTSD:

  1. Modify negative appraisals of the trauma
  2. Reduce reexperiencing symptoms by discussing trauma memories and learning how to differentiate between types of trauma triggers
  3. Reduce behaviors and thoughts that contribute to the maintenance of the "sense of current threat" stat

One specific practice is imagery rescripting. Adult patients with childhood traumas are encouraged to imagine their trauma from the point-of-view of an adult rescuing and protecting the vulnerable child.

Imagery rehearsal therapy helps people with nightmares. They document their nightmares, then work out how they would like them to change. They then regularly act out the improved dream scenarios.

Cognitive therapy is strongly recommended for treatment of PTSD by the American Psychological Association.[38]

Narrative exposure therapy[]

Main article: Narrative exposure therapy

Narrative exposure therapy creates a written account of the traumatic experiences of a patient or group of patients, in a way that serves to recapture their self-respect and acknowledges their value. Under this name it is used mainly with refugees, in groups.[39] It also forms an important part of cognitive processing therapy.

It is conditionally recommended for treatment of PTSD by the American Psychological Association.[39]

Relaxation techniques[]

Relaxation techniques may be the earliest behavioural treatment for PTSD,[40] and are often included as part of PTSD treatment.[41]

Prolonged exposure therapy[]

Prolonged exposure therapy (PE) was developed by Edna Foa and from 1986. It has been extensively tested in clinical trials. While, as the name suggests, it includes exposure therapy, it also includes other psychotherapy elements. Foa believes this therapy to incorporate all the efficacious elements of other known PTSD cognitive therapies. Foa was chair of the PTSD work group of the DSM-IV.

In prolonged exposure therapy, there will most likely be from 8 to 15 sessions. Patients will first be exposed to a past traumatic memory; following is an immediate discussion about the traumatic memory and, "in vivo exposure to safe, but trauma-related, situations that the client fears and avoids".[40]

Slowed breathing techniques and educational information is also touched on in these sessions.

PE is theoretically grounded in , which proposes "a hypothetical sequence of fear-reducing changes evoked by emotional engagement with the memory of a significant event, particularly a trauma."[42][43] While PE has received substantial empirical support for its efficacy (albeit with high dropout rates), emotional processing theory has received mixed support.[44]

The American Psychological Association strongly recommends PE as a first-line psychotherapy treatment for PTSD.[45]

Cognitive processing therapy[]

Cognitive processing therapy (CPT) is an evidence-based treatment protocol designed using techniques from Cognitive Behavioral Therapy and is designed specifically for individuals diagnosed with PTSD ([46]). CPT is based on the idea that over time, individuals exposed to trauma will "naturally" recover from traumatic events. For some survivors, however, this natural recovery process has been impaired in some way, thus leading to continued symptoms of PTSD. CPT involves writing and verbally reciting written passages that are either related to why the Client thinks he/she was exposed to the traumatic event or a trauma narrative that outlines the traumatic event in explicit detail. CPT is typically completed over 12 one-hour weekly session with a practitioner[15]. The treatment phases consist of: 1. Education about PTSD and the role of thoughts and emotions as they relate to cognitive theory 2. Processing the actual traumatic event or reasons the person believes the event happened to them 3. Identifying "stuck points" that are holding the person back from recovering from PTSD 4. Challenging and modifying "stuck points" 5. Exploration of "stuck points" related to the themes of safety, trust, power and control, esteem, and intimacy.

It is strongly recommended for treatment of PTSD by the American Psychological Association.[47]

Eye movement desensitization and reprocessing[]

Eye movement desensitization and reprocessing (EMDR) was developed by Francine Shapiro from 1988. It involves a patient thinking of upsetting images while they track a therapist moving their fingers back and forth in front of the patient. Patients are also asked to think of positive thoughts while they follow the fingers back and forth, then they write down what they are thinking.[40] This treatment is found to be similarly effective as exposure therapy.

A proposed neurophysiological basis behind EMDR is that it mimics REM sleep, which plays a vital role in memory consolidation. Imaging studies suggest that "eye movements in both REM sleep and wakefulness activate similar cortical areas."[48] Thus, the reorientation facilitated by EMDR "shifts the brain into a memory processing mode" without "integration of traumatic memories into associative cortical networks without interference from hippocampally mediated episodic recall."[48] The information can then be integrated completely, which consequently weakens the episodic memory of the event and the associations it produced. The restoration of the pathway can lead to recovery from PTSD.

EMDR for PTSD is supported by moderate quality evidence as of 2018.[35]

It is conditionally recommended for treatment of PTSD by the American Psychological Association.[49]

The Australian Psychological Society considers it a Level I (strongest evidence) treatment method.[50]

Brief eclectic psychotherapy[]

Brief eclectic psychotherapy for PTSD (BEPP) was developed by and from 1994. It has an emphasis on the emotions of shame and guilt. It involves the patient creating a detailed account of the primary trauma experience (narrative exposure therapy) and writing a letter to person or organisation believed to be most responsible for the trauma. This occurs over sixteen sessions.[51]

It is conditionally recommended for treatment of PTSD by the American Psychological Association.[52]

Trauma-focused cognitive behavioral therapy[]

Trauma-focused cognitive behavioral therapy (TF-CBT) was developed by , and to help children and adolescents with PTSD. This was done from the mid 1990s.

It involves working through memories of the trauma in a safe and structured environment, trying to change unhelpful beliefs and thoughts, and gradual exposure to triggers which are being avoided. It is held over eight to 25 sessions with the child/adolescent and caregiver.

TF-CBT has repeatedly been demonstrated to be effective and is currently recommended as a first-line treatment for PTSD by the American Psychiatric Association,[34] Australian Centre for Posttraumatic Mental Health,[53] and the National Institute of Clinical Excellence (NICE).[54]

The Australian Psychological Society considers it a Level I (strongest evidence) treatment method.[50]

Stress inoculation training[]

Stress inoculation training was developed to reduce anxiety in doctors during times of intense stress by from 1985.[55] It is a package of techniques (relaxation, thought stopping and real-life exposure to feared situations) that has been used in PTSD treatment.[40]

Occupational therapy[]

Occupational therapy (OT) is a profession that helps all people participate in the meaningful daily activities that occupy their time. OT empowers active engagement in life tasks and teaches skills in order to help people maximize their strengths and overcome barriers in order to live their fullest potential.

Sleep disturbances such as insomnia, night terrors, and inconsistent REM sleep impact the lives of many with PTSD.[56] Occupational therapists are equipped to address this meaningful area through sleep hygiene. Some examples of sleep hygiene are decreasing electronic screen time, creating a night time routine, and creating an environment within the bedroom that is free of light and noise.[57] Another meaningful area is self-care. Occupational therapists provide education and adaptation/modification in self-care to maintain independence and prevent triggers that may cause flashbacks.[58] Occupational therapists help clients with PTSD engage in meaningful life roles (school, work, family) through healthy habit formation and structuring stable daily routines while managing PTSD triggers.[58] Life roles require social engagement which can be challenging to those with PTSD. Occupational therapists work with clients to help build a supportive social network of family and friends who can assist in reducing the need to self-isolate. Occupational therapy interventions also include teaching stress management and relaxation techniques such as deep breathing, mindfulness, meditation, progressive muscle relaxation, and biofeedback.

Dialectical behavioral therapy[]

The Australian Psychological Society considers dialectical behavioral therapy (DBT) to be a Level II treatment method.[50]

Emotion-focused therapy[]

The Australian Psychological Society considers emotion-focused therapy (EFT) to be a Level II treatment method.[50]

Metacognitive therapy[]

The Australian Psychological Society considers metacognitive therapy (MCT) to be a Level II treatment method.[50]

Mindfulness-based stress reduction[]

The Australian Psychological Society considers mindfulness-based stress reduction (MBSR) to be a Level II treatment method.[50]

Alternative and complementary psychotherapies[]

Alternative medicine is any practice that is put forward as having the healing effects of medicine.[59][60] Its characteristics are that it does not originate from evidence gathered using the scientific method.[59][60] Over the last decade, alternative treatment has become increasingly common in treating veterans with post-traumatic stress disorder. It is often used selectively in clinical trials. While it is not yet accepted medical treatment, there are often studies being done to test its effectiveness. Usually, it is used as a last resort due to the failure of conventional treatment.

Yoga therapy treatment[]

Yoga may be useful as a treatment for PTSD, but the evidence for this is weak.[61]

Trauma group therapy[]

In trauma group therapy, the groups range from 12 to 18 members and are completed over a 10- to 12-week period. Group therapy is cost-effective, and allows the participant to know they are not alone which can help in building another support system beside their family, and help in the development of people skills (communication, adversity, and confidence).[62] Group cognitive behavioral therapy is based on participants connecting and sharing past experiences while developing trust. Since World War II, the method of having soldiers come together and converse amongst each other has been in practice.[63] Patients remember and examine their war experiences and are encouraged to provide a clear picture without hiding or omitting details.[64] In “A Meta-Analytic Review of Exposure in Group Cognitive Behavioral Therapy for Posttraumatic Stress Disorder,” written by Barrera, she mentions that there are some three concerns with group therapy. Barrera mentions that members in the group can develop secondary post-traumatic stress disorder from hearing others traumatic events and that one participant may think their traumatic event is not comparable to another member’s event. These concerns can cause a delay in recovery, and there may not be enough time in a session for participants to talk about their experiences.[62]

Animal-assisted therapy[]

Clinicians can recommend animal-assisted therapy (AAT) to PTSD-affected patients when there are issues of isolation, anger management, and difficulty with social interactions.[65] AAT consists of a treatment plan of human-animal therapy interaction. Animals, like dogs, typically interact with individuals or groups who have anxiety, schizophrenia, addiction, and depression. Hospitalized patients are often the most likely candidates for animal-assisted therapy, but AAT can also help people in personal homes, schools, community centers, nursing homes, or rehabilitation centers. “Interaction with the  animals... decrease[s] blood pressure and to have a calming effect on individuals with dissociative disorder.”[65] AAT can also reduce anger and stress. AAT is often overlooked or not considered within PTSD patients treatment options.

Present centered therapy[]

Present centered therapy (PCT) is a non-trauma-focused, evidence-based psychotherapy (EBP) for PTSD. According to VA/DOD PTSD treatment guidelines (2015), it is currently a second-line recommended treatment (i.e., “weak-for”) for PTSD. [66][67]

Other interpersonal psychotherapy approaches[]

Other approaches, in particular involving social supports,[68][69] may also be important. An open trial of interpersonal psychotherapy[70] reported high rates of remission from PTSD symptoms without using exposure.[71] A current, NIMH-funded trial in New York City is now (and into 2013) comparing interpersonal psychotherapy, prolonged exposure therapy, and relaxation therapy.[72][full citation needed][73][74]

Multicultural perspectives[]

Trauma is ingrained in culture, and different cultures receive and treat trauma in different ways.[75] Some cultures treat trauma with ancient practices such as praying or ritual.[75]

The term “historical trauma” (HT) gained currency in the clinical and health science literatures in the first two decades of the 21st century.[76] It is defined as the psychological injury and ongoing presence of stressors resulting from historical events that occurred several generations ago. Native Americans, African Americans, Holocaust survivors, and Irish people are some examples.

In the case of Native Americans, many therapists use "a return to indigenous traditional practices" as a form of treatment for HT.[77] The principle is quite different to prevailing forms of cognitive-behavioral therapy, since the goal is not “adaptation” or cognitive restructuring of the individual to the prevailing cultural norm, “but rather spiritual transformations and accompanying shifts in collective identity, purpose, and meaning making.”[77]

HT is often overlooked due to mental health professionals working under the impression that it is equivalent to PTSD. This can lead to a misunderstanding of HT, due to an exclusive focus on the individual, rather than historical causes and events.

Researchers at the Stress-response Syndromes Lab at the University of Zurich, Switzerland, use the historical contributions of the Swiss psychologist Carl Gustav Jung to develop culturally sensitive treatments like symbolism and different myth stories to treat PTSD. Jung’s psychology asserts that “the fundamental ‘language’ of the psyche is not words, but images...studying the trinity of myths, metaphors, and archetypes enhances clinical interventions and psychotherapy.”[78]

A combination of Western psychotherapy and Japanese culture is helpful when using psychotherapy as an effective treatment in Japan.[79] "After the Kobe-Awaji earthquake in 1995...Japanese psychologists became acutely aware of the need to receive specialized training in the treatment of posttraumatic stress disorder (PTSD) as well as crisis intervention."[79] Psychotherapy is a recent practice used in Japan in which some practices of western psychotherapy are “modified to suit the Japanese client population” and forms to create a sense of cultural integration.[79] The  two main methods of treatment practices Japanese psychotherapists work with are nonverbal tasks and parallel therapy.

Recommendations[]

A number of major health bodies have developed lists of treatment recommendations. These include:

References[]

  1. ^ "What Is PTSD?". www.psychiatry.org. Retrieved 2020-12-06.
  2. ^ Jump up to: a b Lowery-Gionta EG, May MD, Taylor RM, Bergman EM, Etuma MT, Jeong IH, et al. (September 2019). "Modeling trauma to develop treatments for posttraumatic stress". Translational Issues in Psychological Science. 5 (3): 243–275. doi:10.1037/tps0000199.
  3. ^ Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, Andrade LH, et al. (March 2017). "Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys". JAMA Psychiatry. 74 (3): 270–281. doi:10.1001/jamapsychiatry.2016.3783. hdl:10230/32386. PMC 5441566. PMID 28055082.
  4. ^ "How Common is PTSD in Adults? - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 2020-12-06.
  5. ^ Jump up to: a b c d Abdallah CG, Averill LA, Akiki TJ, Raza M, Averill CL, Gomaa H, et al. (January 2019). "The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder". Annual Review of Pharmacology and Toxicology. 59 (1): 171–189. doi:10.1146/annurev-pharmtox-010818-021701. PMC 6326888. PMID 30216745.
  6. ^ "Medications".
  7. ^ Giller EL, ed. (1990). Biological Assessment and Treatment of Posttraumatic Stress Disorder. Washington DC: American Psychiatric Press, Inc.
  8. ^ "Clinician's Guide to Medications for PTSD". U.S. Department of Veterans Affairs. 2009.
  9. ^ Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, et al. (November 2004). "Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder". The American Journal of Psychiatry. 161 (11 Suppl): 3–31. doi:10.1176/appi.books.9780890423363.52257. ISBN 0-89042-336-9. PMID 15617511.
  10. ^ Raskind MA, Peskind ER, Chow B, Harris C, Davis-Karim A, Holmes HA, et al. (February 2018). "Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans". The New England Journal of Medicine. 378 (6): 507–517. doi:10.1056/NEJMoa1507598. PMID 29414272.
  11. ^ Griffin GD, Charron D, Al-Daccak R (November 2014). "Post-traumatic stress disorder: revisiting adrenergics, glucocorticoids, immune system effects and homeostasis". Clinical & Translational Immunology. 3 (11): e27. doi:10.1038/cti.2014.26. PMC 4255796. PMID 25505957.
  12. ^ Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, et al. (December 2019). "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". The Lancet. Psychiatry. 6 (12): 995–1010. doi:10.1016/S2215-0366(19)30401-8. PMC 6949116. PMID 31672337.
  13. ^ O'Neil ME, Nugent SM, Morasco BJ, Freeman M, Low A, Kondo K, et al. (September 2017). "Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review". Annals of Internal Medicine. 167 (5): 332–340. doi:10.7326/M17-0477. PMID 28806794.
  14. ^ Betthauser K, Pilz J, Vollmer LE (August 2015). "Use and effects of cannabinoids in military veterans with posttraumatic stress disorder". American Journal of Health-System Pharmacy (Review). 72 (15): 1279–84. doi:10.2146/ajhp140523. PMID 26195653.
  15. ^ "Long-term Nabilone Use: A Review of the Clinical Effectiveness and Safety". CADTH Rapid Response Reports. Oct 2015. PMID 26561692.
  16. ^ Gregg K (2016-07-13). "Raimondo signs law allowing marijuana for treatment of PTSD". Providence Journal. Archived from the original on 16 August 2016. Retrieved 18 August 2016.
  17. ^ "Breakthrough Therapy". Food and Drug Administration. 4 January 2018.
  18. ^ Wan, William (26 August 2017). "Ecstasy could be 'breakthrough' therapy for soldiers, others suffering from PTSD". Washington Post. ISSN 0190-8286. Retrieved 28 March 2021.
  19. ^ Mithoefer MC, Feduccia AA, Jerome L, Mithoefer A, Wagner M, Walsh Z, et al. (September 2019). "MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials". Psychopharmacology. 236 (9): 2735–2745. doi:10.1007/s00213-019-05249-5. PMC 6695343. PMID 31065731.
  20. ^ Jerome L, Feduccia AA, Wang JB, Hamilton S, Yazar-Klosinski B, Emerson A, et al. (August 2020). "Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: a longitudinal pooled analysis of six phase 2 trials". Psychopharmacology. 237 (8): 2485–2497. doi:10.1007/s00213-020-05548-2. PMC 7351848. PMID 32500209.
  21. ^ Jain S, Greenbaum MA, Rosen C (February 2012). "Concordance between psychotropic prescribing for veterans with PTSD and clinical practice guidelines". Psychiatric Services. 63 (2): 154–60. doi:10.1176/appi.ps.201100199. PMID 22302333.
  22. ^ Auxéméry Y (October 2012). "[Posttraumatic stress disorder (PTSD) as a consequence of the interaction between an individual genetic susceptibility, a traumatogenic event and a social context]". L'Encephale (in French). 38 (5): 373–80. doi:10.1016/j.encep.2011.12.003. PMID 23062450.
  23. ^ Kapfhammer HP (December 2008). "[Therapeutic possibilities after traumatic experiences]". Psychiatria Danubina. 20 (4): 532–45. PMID 19011595.
  24. ^ Reist, C (2005). Post-traumatic Stress Disorder. Compendia, Build ID: F000005, published by Epocrates.com
  25. ^ Maxmen JS, Ward NG (2002). Psychotropic drugs: fast facts (3rd ed.). New York: W. W. Norton. p. 349. ISBN 978-0-393-70301-6.
  26. ^ Jump up to: a b Guina J, Rossetter SR, DeRHODES BJ, Nahhas RW, Welton RS (July 2015). "Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis". Journal of Psychiatric Practice. 21 (4): 281–303. doi:10.1097/pra.0000000000000091. PMID 26164054. S2CID 24968844.
  27. ^ Jump up to: a b Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, Figueira I (March 2009). "Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 33 (2): 169–80. doi:10.1016/j.pnpbp.2008.12.004. PMC 2720612. PMID 19141307.
  28. ^ Martényi F (March 2005). "[Three paradigms in the treatment of posttraumatic stress disorder]". Neuropsychopharmacologia Hungarica. 7 (1): 11–21. PMID 16167463.
  29. ^ Haagen JF, Smid GE, Knipscheer JW, Kleber RJ (August 2015). "The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis". Clinical Psychology Review. 40: 184–94. doi:10.1016/j.cpr.2015.06.008. PMID 26164548.
  30. ^ Jump up to: a b Veterans Affairs and Department of Defense clinical practice guideline for management of post-traumatic stress. VA/DoD. 2010.
  31. ^ Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, Zohar J, et al. (2008). "World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision". The World Journal of Biological Psychiatry. 9 (4): 248–312. doi:10.1080/15622970802465807. PMID 18949648.
  32. ^ "What Is Exposure Therapy?".
  33. ^ Rizzo AA, Rothbaum BO, Graap K. Virtual reality applications for combat-related posttraumatic stress disorder. In: Figley CR, Nash WP, editors. Combat stress injury: Theory, research and management. New York: Routledge; 2007. pp. 420–425
  34. ^ Jump up to: a b "Cognitive Behavioral Therapy (CBT) for Treatment of PTSD". American Psychological Association.
  35. ^ Jump up to: a b Forman-Hoffman V, Middleton JC, Feltner C, Gaynes BN, Weber RP, Bann C, et al. (May 2018). "Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update". AHRQ Comparative Effectiveness Review. Rockville (MD): Agency for Healthcare Research and Quality (US). doi:10.23970/ahrqepccer207. PMID 30204376.
  36. ^ Ehlers A, Clark DM (April 2000). "A cognitive model of posttraumatic stress disorder". Behaviour Research and Therapy. 38 (4): 319–45. doi:10.1016/S0005-7967(99)00123-0. PMID 10761279.
  37. ^ Ehlers A, Wild J (2015). "Cognitive Therapy for PTSD: Updating Memories and Meanings of Trauma". In Schnyder U, Cloitre M (eds.). Evidence Based Treatments for Trauma-Related Psychological Disorders. Cham: Springer International Publishing. pp. 161–187. doi:10.1007/978-3-319-07109-1_9. ISBN 978-3-319-07108-4.
  38. ^ "Cognitive Therapy (CT)". American Psychological Association.
  39. ^ Jump up to: a b "Narrative Exposure Therapy (NET)". American Psychological Association.
  40. ^ Jump up to: a b c d Sharpless BA, Barber JP (February 2011). "A Clinician's Guide to PTSD Treatments for Returning Veterans". Professional Psychology, Research and Practice. 42 (1): 8–15. doi:10.1037/a0022351. PMC 3070301. PMID 21475611.
  41. ^ Niles BL, Mori DL, Polizzi C, Pless Kaiser A, Weinstein ES, Gershkovich M, Wang C (September 2018). "A systematic review of randomized trials of mind-body interventions for PTSD". Journal of Clinical Psychology. 74 (9): 1485–1508. doi:10.1002/jclp.22634. PMC 6508087. PMID 29745422.
  42. ^ "APA Dictionary of Psychology". dictionary.apa.org. Retrieved 2020-09-06.
  43. ^ Foa EB (December 2011). "Prolonged exposure therapy: past, present, and future". Depression and Anxiety. 28 (12): 1043–7. doi:10.1002/da.20907. PMID 22134957. S2CID 28115857.
  44. ^ Rupp C, Doebler P, Ehring T, Vossbeck-Elsebusch AN (May 2017). "Emotional Processing Theory Put to Test: A Meta-Analysis on the Association Between Process and Outcome Measures in Exposure Therapy". Clinical Psychology & Psychotherapy. 24 (3): 697–711. doi:10.1002/cpp.2039. PMID 27561691.
  45. ^ Courtois CA, Sonis J, Brown LS, Cook J, Fairbank JA, Friedman M, Schulz P (2017). "Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults" (PDF). Washington, D.C.: American Psychological Association.
  46. ^ Schnyder U (2015). Evidence Based Treatments for Trauma-Related Psychological Disorders. Springer International Publishing Switzerland. ISBN 978-3-319-07109-1.
  47. ^ "Cognitive Processing Therapy (CPT)".
  48. ^ Jump up to: a b Stickgold R (January 2002). "EMDR: a putative neurobiological mechanism of action". Journal of Clinical Psychology. 58 (1): 61–75. CiteSeerX 10.1.1.124.5340. doi:10.1002/jclp.1129. PMID 11748597.
  49. ^ "Eye Movement Desensitization and Reprocessing (EMDR) Therapy".
  50. ^ Jump up to: a b c d e f Evidence-based Psychological Interventions in the Treatment of Mental Disorders. Australian Psychological Society. 2018.
  51. ^ "Information". Traumabehandeling. March 31, 2017.
  52. ^ "Brief Eclectic Psychotherapy (BEP)". American Psychological Association.
  53. ^ Kleim B, Grey N, Wild J, Nussbeck FW, Stott R, Hackmann A, et al. (June 2013). "Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder". Journal of Consulting and Clinical Psychology. 81 (3): 383–93. doi:10.1037/a0031290. PMC 3665307. PMID 23276122.
  54. ^ Forbes D, Creamer M, Bisson JI, Cohen JA, Crow BE, Foa EB, et al. (October 2010). "A guide to guidelines for the treatment of PTSD and related conditions". Journal of Traumatic Stress. 23 (5): 537–52. doi:10.1002/jts.20565. PMID 20839310.
  55. ^ "PsycNET". psycnet.apa.org.
  56. ^ Pacheco, D (January 8, 2021). "How post-traumatic stress disorder affects sleep". Sleep Foundation.
  57. ^ Rolle, N (May 2020). "Sleep hygiene" (PDF). American Occupational Therapy Association.
  58. ^ Jump up to: a b "Role of occupational therapy with post-traumatic stress disorder" (PDF). American Occupational Therapy Association. 2015.
  59. ^ Jump up to: a b Marcinko DE, Hetico HR (2016-01-06). Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical PlannersTM. CRC Press. ISBN 9781498725996.
  60. ^ Jump up to: a b Coulter ID, Willis EM (June 2004). "The rise and rise of complementary and alternative medicine: a sociological perspective". The Medical Journal of Australia. 180 (11): 587–9. doi:10.5694/j.1326-5377.2004.tb06099.x. PMID 15174992. S2CID 15983789.
  61. ^ Gallegos AM, Crean HF, Pigeon WR, Heffner KL (December 2017). "Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials". Clinical Psychology Review. 58: 115–124. doi:10.1016/j.cpr.2017.10.004. PMC 5939561. PMID 29100863.
  62. ^ Jump up to: a b Barrera TL, Mott JM, Hofstein RF, Teng EJ (February 2013). "A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder". Clinical Psychology Review. PubMed. 33 (1): 24–32. doi:10.1016/j.cpr.2012.09.005. PMID 23123568.
  63. ^ Kingsley G (2007). "Contemporary group treatment of combat-related posttraumatic stress disorder". The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. 35 (1): 51–69. doi:10.1521/jaap.2007.35.1.51. PMID 17480188. ProQuest 198124994.
  64. ^ Rozynko V Dondershine HE (1991). "Trauma focus group therapy for Vietnam veterans with PTSD". Psychotherapy: Theory, Research, Practice, Training. 28 (1): 157–161. doi:10.1037/0033-3204.28.1.157.
  65. ^ Jump up to: a b Wynn GH (August 2015). "Complementary and alternative medicine approaches in the treatment of PTSD". Current Psychiatry Reports. 17 (8): 600. doi:10.1007/s11920-015-0600-2. PMID 26073362. S2CID 40832398.
  66. ^ Frost et al. 2014 ITSDD
  67. ^ Belsher BE, Beech E, Evatt D, Smolenski DJ, Shea MT, Otto JL, et al. (November 2019). "Present-centered therapy (PCT) for post-traumatic stress disorder (PTSD) in adults". The Cochrane Database of Systematic Reviews. 2019 (11). doi:10.1002/14651858.CD012898.pub2. PMC 6863089. PMID 31742672.
  68. ^ Brewin CR, Andrews B, Valentine JD (October 2000). "Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults". Journal of Consulting and Clinical Psychology. 68 (5): 748–66. doi:10.1037/0022-006X.68.5.748. PMID 11068961.
  69. ^ Ozer EJ, Best SR, Lipsey TL, Weiss DS (January 2003). "Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis". Psychological Bulletin. 129 (1): 52–73. doi:10.1037/0033-2909.129.1.52. PMID 12555794.
  70. ^ Weissman MM, Markowitz JC, Klerman GL (2007). Clinician's Quick Guide to Interpersonal Psychotherapy. New York: Oxford University Press.[page needed]
  71. ^ Bleiberg KL, Markowitz JC (January 2005). "A pilot study of interpersonal psychotherapy for posttraumatic stress disorder". The American Journal of Psychiatry. 162 (1): 181–3. doi:10.1176/appi.ajp.162.1.181. PMID 15625219.
  72. ^ "Trauma and PTSD Program – Columbia University Department of Psychiatry". Columbiatrauma.org. Archived from the original on 2014-02-01. Retrieved 2014-01-29.[full citation needed]
  73. ^ Markowitz JC, Milrod B, Bleiberg K, Marshall RD (March 2009). "Interpersonal factors in understanding and treating posttraumatic stress disorder". Journal of Psychiatric Practice. 15 (2): 133–40. doi:10.1097/01.pra.0000348366.34419.28. PMC 2852131. PMID 19339847.
  74. ^ Markowitz JC (October 2010). "IPT and PTSD". Depression and Anxiety. 27 (10): 879–81. doi:10.1002/da.20752. PMC 3683871. PMID 20886608.
  75. ^ Jump up to: a b Wilson J (2002). "The Lens of Culture: Theoretical and Conceptual Perspectives in the Assessment of Psychological Trauma and PTSD". The Lens of Culture. WHO Publication. pp. 3–30.
  76. ^ Gone, J. P.; Hartmann, W. E.; Pomerville, A.; Wendt, D. C.; Klem, S. H.; Burrage, R. L. (2019). "The Impact of Historical Trauma on Health Outcomes for Indigenous Populations in the USA and Canada: A Systematic Review". The American Psychologist. 74 (1): 20–35. doi:10.1037/amp0000338. PMID 30652897. S2CID 58570971.
  77. ^ Jump up to: a b Gone JP (October 2013). "Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment". Transcultural Psychiatry. 50 (5): 683–706. doi:10.1177/1363461513487669. PMID 23715822. S2CID 198988285.
  78. ^ Maercker A, Heim E (Summer 2016). "A New Approach to Culturally Sensitive PTSD Research in Zurich – Inspired by Contributions from Cal Gustav Jung". International Psychology Bulletin. 20 (3): 67–71.
  79. ^ Jump up to: a b c Iwakabe S (2008). "Psychotherapy Integration in Japan". Journal of Psychotherapy Integration. 18 (1): 103–125. doi:10.1037/1053-0479.18.1.103.
  80. ^ "PTSD Treatments". American Psychological Association.
  81. ^ "Treatment Essentials - PTSD: National Center for PTSD".
  82. ^ "Recommendations | Post-traumatic stress disorder | Guidance | NICE".
  83. ^ "Australian PTSD Guidelines".
Retrieved from ""