training, exposure plus cognitive restructuring, exposure plus coping skills, eye movement desensitization and reprocessing (EMDR), other psychotherapies, and group format psychotherapy. Exposure refers to several closely related techniques such as prolonged exposure, direct exposure therapy, and multiple channel exposure therapy, and they are evaluated here as one category, both alone and in combination with other approaches. The category of coping skills training includes stress inoculation therapy, relaxation, biofeedback, and so on. The category of cognitive restructuring refers to psychotherapies designed to help individuals with PTSD alter their understanding of the meaning of their traumatic experiences, for example, by considering their adaptive responses to the trauma as well as the helplessness inflicted by it. The treatment modalities assessed in this chapter were individually administered with a few exceptions where psychotherapy was administered in a group format.
The majority of psychotherapy studies compared one or more active treatments to a wait-list control. Less frequently, the control was usual care (such as non-PTSD specific care) or minimum care (such as phone counseling). A smaller proportion of the psychotherapy studies compared active treatment to an active control such as a coping skills training program (e.g., relaxation) or present-centered therapy.
The committee included 52 studies of psychotherapies (reasons for exclusion are listed in the individual sections below). Of the included studies, 18 had no major limitations and thus were most informative to the committee’s conclusions regarding efficacy of a treatment modality (see evidence tables following each treatment for a summary of these studies), but such studies were considered in the context of the body of evidence for each treatment modality. Trauma types in these studies included combat (within the United States and internationally), sexual abuse, physical assault, accidental injury, motor vehicle accidents (MVAs), natural disaster, witnessing (death or genocide), being a victim of crime, and being a refugee.
When analyzing the studies by sex, population, or trauma type, the committee labeled the study as being “predominantly” one type of sex, population, or trauma if 80 percent of the study population or more was of one type of sex, population, or trauma. The committee labeled the study as “mixed” if 79 percent or less of the study population was of one type of sex, population, or trauma. Eleven studies had a predominantly male population, 25 had a female population, and 15 had a mixed (male and female) population. Ten studies were in veteran populations, 17 included victims of sexual or physical abuse, and 23 had a mixed or other trauma type.1 The committee found that in the psychotherapy literature, as in the pharmacotherapy literature, with few exceptions, when a veteran