What You Should Know About Treatment for Posttraumatic Stress Disorder

In the May 2013 issue of Psychological Science in the Public Interest, Edna Foa and colleagues explore the challenges in disseminating evidence-based treatments for posttraumatic stress.

Here are some important facts about effective treatments for PTSD.

What Is The Impact of Using Evidence-based Treatments (EBT) for PTSD?

• Studies show that several cognitive-behavioral therapies, including prolonged exposure therapy, are highly effective as PTSD treatments. Such programs are relatively short-term, resulting in reduced costs of care.
• Health economics studies suggest that providing EBTs for PTSD result in reduced healthcare costs by thwarting substance abuse, suicides, depression, and other byproducts of trauma.
• Exposure therapy can be adapted for non-western cultures, factoring in religious tenets and societal standards.

Why Aren’t EBTs More Widely Used?

• Few therapists have been trained to deliver PE.
• Patients typically have no idea what type of treatment they should receive, and no idea what treatment their therapist will deliver.  Thus, there is a lack of consumer demand for EBTs.
• Cultural issues often create roadblocks to treatment delivery. Many devout Muslims, for example, reject PTSD treatment because it breaches the tenet of accepting one’s fate.
• Lack of resources in developing countries not only compound the impact of disasters, war, and other traumatic events, but also make basic needs such as feeding the population and ensuring clean water take priority over mental health needs.

How Can The Use of EBTs Be Expanded?

• The federal government could demand the use of EBTs 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 EBTs in order to grant a license to practice.
• Governments can fund EBT dissemination initiatives and establish treatment guidelines. The Veterans Health Administration has already taken such steps.
• Professional groups often have training requirements that could influence the extent to which professionals learn and use EBTs.
• Clinical scientists can influence funding policies by serving on committees that help the mission of government agencies (e.g., review committees for the National Institutes of Health). Researchers also can use the media to educate the public about the best treatments available.
• Using information provided by clinical researchers, government agencies, professional organizations, and healthcare systems, the media can release information to help consumers seek out scientifically supported treatments.

The report, “Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD,” is accompanied by an editorial from Bradley E. Karlin and Madhulika Agarwal of the U.S. Department of Veterans Affairs Central Office in Washington, DC.

The full report and the accompanying editorial are available free online.