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A new study published in Frontiers in Psychology examines five forms of PTSD treatment and provides an overview of the patient types who prefer each. For example, the results suggest that cognitive behavioral therapy (CBT) and prolonged exposure therapy are the two most preferred forms of treatment overall, but that older patients prefer psychodynamic treatments.
“Psychotherapies for the treatment of PTSD can be divided into two categories: trauma-focused interventions and non-trauma-focused interventions,” say the researchers, led by psychologists Meike MÃ¼ller-Engelmann and Laura Schwartzkopff of the University. Goethe from Frankfurt, Germany. âThe first group includes treatment approaches that directly address the traumatic event (eg, desensitization and reprocessing of eye movements, exposure therapy, and cognitive behavioral therapy), while treatment approaches not Trauma-focused efforts seek to treat the symptoms of PTSD without directly focusing on the traumatic event (eg, stabilization therapy).
The researchers recruited 104 traumatized German adults to participate in an online survey measuring their preferences for five forms of PTSD treatment, described by the researchers below:
1. Exposure therapy
âThis treatment is based on the assumption that post-traumatic stress disorder is essentially maintained by avoiding thoughts, feelings and memories related to the trauma. During this treatment, symptoms should be reduced by directly addressing (confronting) memories of the traumatic experience. First, you and your therapist determine why this procedure is helpful in reducing your symptoms. Once you are stabilized enough to get involved in this process, confronting the traumatic memories takes place in several stages.
Advantages : âThe effectiveness of this treatment has been proven by scientific studies. Overall, this treatment is very effective and has lasting positive effects. You will have the experience of being able to deal with memories and being able to process the traumatic experience.
Disadvantages: âTreatment can be very stressful as it requires dealing with memories and situations that you have previously avoided. Before a significant reduction in stress occurs, a temporary increase in load may occur.
2. Eye movement desensitization (EMDR)
âThis treatment takes its name from right-left eye movements which, like any back-and-forth movement, can have a calming and integrating effect. This effect can also be achieved by alternating keys (right-left), for example of the hands, or by listening to bilateral music (with sounds alternating between the right ear and the left ear). For example, your therapist asks you to follow the movements of his finger with your eyes while thinking of the worst moment of trauma. A stop signal is agreed upon, with which the exercise can be interrupted at any time. In a typical EMDR session, the therapist asks you first to think about the worst time you can remember, a stressful thought about yourself, as well as a corresponding positive thought (for example, “Today I can defend myself “). Once attention has been directed to feelings and bodily sensations, space is created for new inner images, thoughts, feelings and bodily sensations that can spontaneously emerge. The past experience can thus be lived and placed in a new context. Each session ends with a deepening of positive thoughts, eg âToday I can defend myselfâ and a deepening of positive body feeling. “
Advantages : âThe effectiveness of this treatment has been proven by scientific studies. This treatment is generally very effective and has lasting positive effects for most people. This treatment does not require dealing with all the details of the traumatic experience.
Disadvantages: âWhether special eye movements or even mutual stimulation are necessary for the therapeutic effect is a controversial question. Treatment may cause a mild headache or nausea.
3. Cognitive Behavioral Therapy (CBT)
âIn this treatment, you will analyze, with the help of the therapist, the stressful thoughts related to the trauma. People who have been traumatized often suffer from distorted and distressing views, eg “I am responsible for the rape / attack”, “I am not safe” and “My life is destroyed forever”. These thoughts lead to feelings of guilt, shame, fear, etc. During treatment, you will learn to recognize and challenge these beliefs and find more balanced and appropriate beliefs. At first you will receive substantial support from the therapist, but over the course of treatment you will gradually become an expert on your own issues. This procedure generally leads to a reduction in feelings of stress and therefore symptoms of post-traumatic stress disorder.
Advantages: âThe effectiveness of this treatment has been proven by scientific studies. This treatment is generally very effective and has lasting positive effects. Although the traumatic experience is discussed in the treatment, the goal is not a direct and repeated confrontation with the details of the trauma. Through the treatment, you will learn tools that will allow you to become your own long-term therapist.
Disadvantages: âIt takes considerable effort to recognize and change distorted beliefs. This requires regular independent written homework between sessions. Often, contested beliefs are understood rationally, but it takes a long time for the new thoughts to feel right. Cognitive procedures are linked to a certain amount of stress as traumatic experiences must be discussed to understand and change distorted thoughts.
âOften this treatment does not directly address the traumatic experience but rather aims to stabilize your psychological state. The aim is to make the load bearable. This is achieved, for example, by working with your therapist on techniques for dealing with high tension, stress, and overwhelming feelings. Concretely, this can involve learning calming gestures that help you distract yourself. It is also important to learn to recognize stress at an early stage and to actively manage it. In addition, fantastic trips or relaxation exercises can be used. For example, one exercise is the âsafe placeâ exercise, in which you imagine a place where you feel safe and which you can return to in your imagination when you are under a lot of pressure. Another exercise is âthinking stopâ, which is used to control recurring unpleasant thoughts. “
Advantages: âPure stabilizing therapy involves very little stress, as there is no direct confrontation with traumatic experiences. This can make it easier to get involved in the treatment.
Disadvantages: âIn the treatment, the traumatic experience is not treated directly. According to studies, treatments that consist exclusively of stabilization have low efficacy and do not allow long-term cure.
5. Psychodynamic therapy
âThe goal of psychodynamic trauma therapy is to identify and treat the unconscious effects of the trauma on the patient. For example, it is determined how the trauma changed the patient’s personal values ââand what meanings are attributed to the experiences. It is assumed that the trauma is such an overwhelming experience that it could not be dealt with in the moment. In therapy, the treatment conditions are found. Together with the patient, the therapist tries to understand to what extent current situations trigger trauma-related stress reactions, even if the traumatic event is a thing of the past. Therapy will not primarily focus on symptoms, but will be primarily concerned with establishing insight, which involves recognizing a connection between today’s burden and traumatic experiences. Here, the therapeutic relationship is of the utmost importance, which means that the feelings and behaviors that emerge within this relationship reflect issues in the patient’s daily life that can be addressed as part of the therapeutic relationship. Therefore, the therapist treats the patient with respect and support. Usually, such therapies take a long time.
Advantages : âPsychodynamic therapies are widespread and do not require a detailed focus on traumatic memories. “
Disadvantages: âThe therapy is long lasting. Currently, there is a lack of studies demonstrating the effectiveness of this treatment.
Participants read information about the five treatments for PTSD and were asked what type of treatment they would like to take and why. The researchers found that about 30% of participants preferred prolonged exposure therapy or cognitive behavioral therapy, 20% of participants preferred eye movement desensitization and retreatment therapy or psychodynamic therapy, and only a fraction of the participants. participants (
Researchers see this as evidence that people who have experienced traumatic events prefer to engage in psychotherapies that challenge them to deal with the traumatic event rather than ignore it or resort to distraction techniques. In addition, people’s preferences for trauma-focused interventions are based on the belief that these types of treatments are more effective. For example, when researchers asked participants why they chose the PTSD treatment option they chose, many cited a belief in the perceived treatment mechanism (for example, “Dealing with trauma seems important to me. â) As well as a belief in the effectiveness of the treatment. (“This treatment is scientifically valid”) as the most important reason.
The authors found little evidence to suggest that patient preferences for PTSD treatments were based on an individual’s psychological and / or demographic profile.
“We did not find any individual differences, such as demographic and clinical factors, to be associated with treatment preference, except for age: people who preferred psychodynamic psychotherapy were significantly older than patients. who preferred CBT, “say the researchers.
Overall, this research underscores the importance of educating patients about the different treatments available for PTSD.
âBased on our study, which indicates that patients with PTSD differ in their treatment preferences, comprehensive patient education and preference assessments can improve the care of PTSD patients,â the researchers say. âOf course, it should be borne in mind that clinical facilities cannot cover and offer all treatment options for PTSD. However, taking into account patient preferences can increase treatment adherence and hence treatment outcome and completion.
An interview with psychologists Meike MÃ¼ller-Engelmann and Laura Schwartzkopff discussing their new research on PTSD is available here.