By Brad Belsher, Ph.D.
Dec. 9, 2019
U.S. Navy photo
Nearly all behavioral health providers have heard of trauma-focused treatments for PTSD. Some exalt treatments such as cognitive processing therapy (CPT) and prolonged exposure (PE) as the gold-standard treatments for PTSD, while others criticize exposure-based approaches as over-hyped. Realistically, the truth likely lies somewhere in the gray zone between the two camps. A robust body of evidence and clinical practice guidelines support trauma-focused treatments as some of the most effective psychosocial treatments for PTSD. However, not every patient may want or benefit from these treatments, and clinicians may want more options when treating PTSD.
One non-trauma focused treatment for PTSD that is receiving increased attention lately is present-centered therapy (PCT). PCT is a structured, time-limited, goal-directed therapy with homework assigned between sessions. PCT has performed surprisingly well in several clinical trials when compared to trauma-focused treatments, but these findings could not determine whether PCT was just as effective as the trauma-focused treatments. Accordingly, the Psychological Health Center of Excellence conducted a rigorous, Cochrane systematic review to evaluate just how well PCT fares against trauma-focused treatments. Our systematic review and meta-analysis included any randomized clinical trials that directly compared PCT to a first-line trauma treatment (both group and individual formats). Our primary outcomes of interest were post-treatment clinician-administered PTSD symptom severity and treatment dropout rates.
We found the following:
- PCT is an effective treatment for PTSD compared to waitlist or control conditions.
- PCT is probably not as effective as our first-line trauma treatments.
- Treatment differences between PCT and trauma-focused treatments may diminish over longer follow-up periods.
- PCT has considerably lower treatment dropout rates than trauma-focused treatments.
So what do these findings mean in the bigger picture? Perhaps most importantly, they are largely consistent with the current VA/DOD clinical practice guidelines (CPGs) in suggesting that:
1. Trauma-focused treatments, such as CPT and PE, should still be considered one of the first-line options for PTSD.
2. PCT is an effective treatment option for PTSD, and can also be considered based on the availability of trauma-focused treatments, clinician expertise in delivering PCT, and patient preferences.
Future research likely will enhance our understanding of the effectiveness of PCT, and more rigorous and sophisticated treatment designs (e.g., treatment matching) will continue to advance our approaches to treating PTSD. Fortunately, the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR) program has several research studies in the pipeline that should expand our current treatment paradigm so that we can more effectively and efficiently treat our service members and veterans.
One last caveat, Cochrane systematic reviews are laborious processes that generate lengthy, nuanced conclusions. Consequently, I have distilled just the main findings from our review in this blog. You can read about secondary outcomes we explored and other finer points in the full review on the Cochrane Library website.
Dr. Belsher is the chief of research translation and integration at the Psychological Health Center of Excellence. His primary areas of focus include deployment-related mental health, systematic review methodologies, health services research, dissemination of evidence-based mental health practice, and collaborative care.