An Update on Psychotherapy for the Treatment of PTSD.

Most trauma survivors recover without intervention, but a minority develop chronic PTSD that requires treatment. Only two medications—sertraline and paroxetine—are FDA-approved for PTSD, with brexpiprazole-sertraline and MDMA-assisted therapy applications pending. Medication and medication-psychotherapy combinations are not recommended as first-line treatments. Instead, trauma-focused psychotherapies—prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, cognitive therapy, and trauma-focused cognitive-behavioral therapy—are the only first-line interventions. Psychedelic-assisted psychotherapy trials have shown higher response rates than other combination treatments, though they have not incorporated evidence-based PTSD psychotherapies. The review covers these state-of-the-art psychotherapies and their clinical and neurobiological effects.

Study at a glance

Abstract

Posttraumatic stress disorder (PTSD) symptoms are part of the normal response to trauma. Most trauma survivors will recover over time without intervention, but a significant minority will develop chronic PTSD, which is unlikely to remit without intervention. Currently, only two medications, sertraline and paroxetine, are approved by the U.S. Food and Drug Administration to treat PTSD, and the combination of brexpiprazole and sertraline and MDMA-assisted therapy have FDA applications pending. These medications, and the combination of pharmacotherapy and psychotherapy, are not recommended as first-line treatments in any published PTSD treatment guidelines. The only interventions recommended as first-line treatments are trauma-focused psychotherapies; the U.S. Department of Veterans Affairs/Department of Defense PTSD treatment guideline recommends prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing, and the American Psychological Association PTSD treatment guideline recommends PE, CPT, cognitive therapy, and trauma-focused cognitive-behavioral therapy. Although published clinical trials of psychedelic-assisted psychotherapy have not incorporated evidence-based PTSD psychotherapies, they have achieved greater response rates than other trials of combination treatment, and there is some enthusiasm about combining psychedelic medications with evidence-based psychotherapies. The state-of-the-art PTSD psychotherapies are briefly reviewed here, including their effects on clinical and neurobiological measures.