Therefore, restricting the review to studies with clinical samples takes a conservative approach, and, consistent with the aims of the review, provides an indication of whether I‐C/BT is effective for the treatment of clinically significant PTSD symptoms. It is also worth noting that people who have volunteered to be part of a trial may engage more with I‐C/BT than the general population of people with PTSD, which may have an impact on results. In support of this suggestion, completion rates for CBT in clinical settings tend to be markedly lower than those reported in randomised control trials (Hans & Hiller, 2013; Kar, 2011; Zayfert et al., 2005). McDonagh et al. (2005) found that while CBT had a positive impact on abused women’s PTSD symptoms, the dropout rate was 41.1%, while Swift and Greenberg (2014) reported dropout rates as high as 28.5% for CBT treatment groups in eight different comparison trials. Such high dropout raises concern regarding the utility of the approach, with 59% of psychologists surveyed believing that the exposure component was likely to increase patients’ wish to terminate treatment early (Zayfert et al., 2005). These findings suggest high dropout rates may be a key factor in practitioners’ decisions not to select CBT as the first‐line treatment for PTSD sufferers, opting instead for alternative approaches such as PDT.
- The two remaining studies reported that outcome assessors were not blinded to treatment and were, therefore, at high risk of detection bias (Littleton 2016; Spence 2011).
- CBT can help you realize that other people and outside situations are not responsible for your problems—but rather, it’s often your own thoughts and reactions that create these negative perspectives.
- During your early sessions, the therapist will outline the expectations related to the course of treatment.
How effective is CBT for PTSD?
- If you live with PTSD, CBT can be an effective type of therapy to help reduce the frequency of symptoms and help you develop coping skills.
- Although all were based on cognitive‐behavioural principles, the exact nature of what was included varied.
- In addition to Internet and mobile application platforms for CBT, virtual reality technology offers novel avenues to access cognitive-behavioral interventions (21).
- Trauma-focused CBT (TF-CBT) is a cognitive behavioral treatment recommended by the American Psychological Association (APA) for PTSD in kids.
There was heterogeneity across the I‐C/BT programmes, which varied in content, delivery, and guidance. Although all were based on cognitive‐behavioural principles, the exact nature of what was included varied. The extent and method by which the Internet‐based therapies were https://ecosoberhouse.com/ guided by a professional also varied. There were insufficiently clear data to perform subgroup analyses on the effect of type of therapist assistance, participant subgroups, type of recruitment, baseline symptom severity, trauma type and context, or type of device.
References to other published versions of this review
NIMH supports research at universities, medical centers, and other institutions via grants, contracts, and cooperative agreements. The author thanks the Quality of Life Research and Development Foundation for its support in this research. “Through their questions, an SFBT therapist shines a light on a person’s strengths and resources, not on their past and their problems,” Vick says. CBT primarily focuses on changing unhelpful thought and behavior patterns to help relieve PTSD symptoms.
- Dr. Rothbaum has received funding from the Wounded Warrior Project, Department of Defense, National Institute of Mental Health, Brain and Behavior Research Foundation (NARSAD), and the McCormick Foundation, and she received recent support from Transcept Pharmaceuticals.
- While different CBTs have different amounts of both exposure and cognitive interventions, they are the main components of the larger category of CBTs that have been repeatedly found to result in symptom reduction.
- Britvić, Radelić and Urlić (2006), Lampe, Barbist, Gast, Reddemann and Schüßler (2014), Monson et al. (2006), Nacasch, Fostick and Zohar (2011), Sijbrandij et al. (2007), and Gilboa‐Schechtman et al. (2010) used the PTSD Symptom Scale – Interview Version (Foa, Riggs, Dancu & Rothbaum, 1993).
- A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD.
- Download, read, and order free NIMH brochures and fact sheets about mental disorders and related topics.
Smith 2019 published data only
This is composed of core beliefs, dysfunctional assumptions, and negative automatic thoughts. Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. We acknowledge the Cochrane Common Mental Disorders Group for the support they provided during preparation of this review update. We identified 21 ongoing studies (see Characteristics of ongoing studies table).
Thus, it is not surprising that the dropout rate for PTSD treatment is high across treatment modalities. In addition, a portion of individuals do not respond adequately to PTSD treatment. Medication could potentially strengthen learning and memory, inhibit fear, and facilitate therapeutic engagement (Dunlop et al., 2012). Research is beginning to examine pharmacological agents to enhance response to trauma-focused therapies such as MDMA, D-cycloserine and the neuropeptide oxytocin (e.g., Mithoefer et al., 2011; de Kleine et al., 2012; Koch et al., 2014; Rothbaum et al., 2014). Non-pharmacological enhancement of therapy is also being explored such as rTMS (Kozel et al., 2018), exercise (Rosenbaum et al., 2015), and other cognitive training (Fonzo et al., 2017). Another potential avenue to increase engagement and reduce dropout is through use of intensive treatment programs, in which patients attend massed multiple sessions within a short period of time (e.g., one or 2 weeks) instead of weekly sessions spaced over several months.
Your healthcare professional or mental health professional will ask more questions based on your responses, symptoms and needs. You may be given questionnaires to fill out that will ask you about events you have had and your cbt interventions for substance abuse symptoms. Preparing and anticipating questions will help you make the most of your time with the healthcare professional. Post-traumatic stress disorder treatment can help you regain a sense of control over your life.
The triggers for your anxiety are identified and specific techniques are applied to reduce these sensations. One method of exposure therapy targets these triggers all at once time (flooding). The other strategy is a more gradual process of dealing with different triggers over a period of time (desensitization).
Blankenship 2013 published data only
These were added to the qualitative and quantitative analyses together with two studies that were previously awaiting classification (Engel 2015; Knaevelsrud 2015). We downgraded the evidence from high certainty by one level for serious (or by two levels for very serious) study limitations (risk of bias), indirectness of evidence, serious inconsistency, imprecision of effect estimates, or potential publication bias. We contacted investigators to verify key study characteristics, and to request missing outcome data.
Description of the intervention
