Talking it out

By Joel Williams

Talk therapy can lead to recovery from post-traumatic stress disorder for those who suffer from combat-related PTSD. This was the finding in the largest clinical trial to date documenting an evidence-based treatment for active-duty military personnel.

Cognitive processing therapy, a leading talk therapy used for civilians with PTSD, was found effective for nearly half of those receiving 12 sessions of the therapy in individual format over the course of six weeks. Nearly 40 percent of those receiving group therapy recovered from PTSD. The findings, published online in JAMA Psychiatry, showed significant reductions in PTSD symptoms, as well as a decrease in depression and suicidal thinking, all of which were maintained for six months.

The trial was conducted at the U.S. Army’s Fort Hood in Killeen, Texas, for the multi-institutional STRONG STAR Consortium, which is funded by the U.S. Department of Defense and based at UT Health San Antonio.

Patricia Resick, Ph.D., the developer of cognitive processing therapy and professor of psychiatry and behavioral sciences at Duke University School of Medicine, led the study comparing the two different ways of delivering the treatment. The therapy helps patients challenge distorted thoughts that perpetuate unhelpful emotions related to their trauma, such as guilt, blame and anger, and to process their natural emotions, leading to a healthier viewpoint and more control over traumatic memories.

In the clinical trial, 268 active service members diagnosed with combat-related PTSD were assigned randomly to receive cognitive processing therapy either in individual or group format. The research team found both formats were effective for many patients, but those receiving individual therapy showed significantly greater improvement.

“This is very encouraging, especially since the trial was based only on 12 sessions of therapy over six weeks,” said Dr. Resick, the paper’s first author. “People often think you have to go to therapy for years to address PTSD. But in this large-scale clinical trial, we saw such a large percentage of patients show significant improvements and even fully recover from PTSD in a matter of weeks. This makes the therapy a good option for service members who wish to stay fit for active duty and veterans seeking to reintegrate into civilian life.”

While concluding that individual cognitive processing therapy is the more effective means of delivering treatment, the research team also suggested that group therapy should remain an option when there is a shortage of available therapists.

“The results of this study provide the strongest scientific evidence to date that combat-related PTSD can be effectively treated in active-duty military personnel,” said co-author Alan Peterson, Ph.D., director of the STRONG STAR Consortium and professor in the Department of Psychiatry at UT Health San Antonio. However, he added, there still is room for improvement in order to help more service members heal from their psychological wounds.

This trial with veterans is the latest that shows added difficulty in treating combat-related PTSD as compared to PTSD in civilians.

“In the military population, much remains to be done to improve existing treatments like [cognitive processing therapy] or develop new treatments,” the researchers concluded.

They suggested additional research should focus on specific issues found in military populations that may affect PTSD treatment, including a look at the roles of substance abuse and traumatic brain injury, and assessing the potential benefits of varying treatment length according to patient needs.

“Already, the STRONG STAR Consortium is starting to address many of these issues, with additional clinical trials in progress that seek to tailor and enhance [cognitive processing therapy] for combat-related PTSD and improve its effectiveness with service members and veterans,” Dr. Peterson said.