Research published in the May 2015 issue of The American Journal of Psychiatry questions the use of exposure therapy, the “gold standard” treatment for patients with PTSD. Exposure therapy attempts to lessen the power of memories, thoughts, and feelings related to the trauma through the repeated discussion of the trauma-related situations with a therapist. While prior studies have reported that it is efficacious, exposure therapy has also been called the “cruelest cure” and criticized for inducing suffering in victims of trauma.
A new study, led by Dr. John Markowitz of Columbia University, found that a gentler form of psychotherapy, where patients “focus on current interpersonal encounters rather than past trauma,” could be a good alternative to exposure therapy. The study randomly assigned unmedicated patients with PTSD to three different therapies for a 14 week period. The three treatment groups included exposure therapy, interpersonal therapy, and relaxation therapy.
The highest response rate was found in the interpersonal group (63%), compared to 47% in exposure therapy, and 38% for relaxation therapy. Both interpersonal therapy and exposure therapy produced superior improvements in quality of life and social functioning than relaxation therapy.
The drop-out rate was also higher in the prolonged exposure group than in the interpersonal cohort. In particular, patients with comorbid major depression dropped out from “prolonged exposure” nine times more than non-depressed patients treated with exposure therapy.
The researchers concluded: “Contradicting a widespread clinical belief, PTSD treatment may not require cognitive behavioral exposure to trauma reminders. Moreover, as differential therapeutics, patients with comorbid major depression may fare better in Interpersonal Psychotherapy than Prolonged Exposure.”
Markowitz, J. C., Petkova, E., Neria, Y., Van Meter, P. E., Zhao, Y., Hembree, E., … & Marshall, R. D. (2015). Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. American Journal of Psychiatry, 172(5), 430-440. (Full Text)