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Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence
Several case studies and series, uncontrolled trials, and RCTs have been conducted on various psychotherapies not included in the classes outlined above. Several other studies were excluded, and the reasons are briefly described here. Three trials were excluded because they were not randomized (or only partially randomized) (Ragsdale et al., 199620) or did not include a comparison or control group (Forbes et al., 2003;21 Zayfert et al., 200522). Many trials included participants not formally diagnosed with PTSD, or only part of the sample was diagnosed so were excluded (Classen et al., 2001; Igreja et al., 2004;23 Krakow et al., 2000, 2001;24 Lange et al., 2001, 2003;25 Solomon et al., 1992;26 Zatzick et al., 200427). In one study, PTSD was not the primary study outcome, and the study did not include an overall PTSD outcome measure (Ouimette et al., 199728). The committee also identified two program reviews that were not included in this review (Hammarberg and Silver, 1994;29 Johnson et al., 199630). See Table 4-8 for a summary of included studies.
The committee noted that any psychotherapy can be administered in a group format, and was aware that group formats are commonly used in
Trial examined short-term specialized inpatient treatment for war-related PTSD (adventure-based counseling and psychodrama).
This was a pilot study using imagery rehearsal as the treatment.
Assessed rates of exposure therapy (ET) and completed CBT for PTSD in a clinical setting and looked at predictors of completion. Illustrated therapeutic challenges in real-world clinical practice (as opposed to in the context of a study).
Trial used a testimony method intervention in rural community survivors of war; case and noncase group; “case” group randomly divided into testimony method or control.
Patients had PTSD symptoms coupled with clear criterion A trauma link(s). Treatment was sleep-imagery rehearsal.
Patients had mild to severe posttraumatic stress (not PTSD diagnosis). Treatment was Interapy or Internet therapy, vs. a wait-list control condition.
This was a cohort study where some patients had combat stress reaction, some PTSD. It compared veterans who participated in the Koach program vs. veterans who did not. Koach used behavior therapy (flooding) with a focus on functioning in a military-type setting that exposed veterans to anxiety-provoking stimuli.
Mixed diagnosis—PTSD symptomatology (but not actual PTSD) and/or depression. Subjects were trauma patients receiving medical care immediately after the trauma, and although some were acutely stressed, diagnosis of PTSD was not made until the 3-month follow-up.
Impact on PTSD symptoms not assessed, and main treatment was for substance abuse (substance abuse and psychosocial outcomes examined 1 year after VA inpatient substance abuse treatment).
Treatment involved multiple modalities.
Program evaluation of a three-phase inpatient program.