It is becoming increasingly difficult to ignore the fact that post-traumatic stress disorder (PTSD) is a complicated mental health disease, which requires appropriate care, counseling, and psychotherapeutic interventions. A choice of an appropriate approach is extremely vital, as inadequate treatment can harm the state of a patient, thereby, making a further treatment more complicated and even impossible in some instances. That is why verification of treatment credibility is a constant concern of mental health practitioners. Research-based approval of particular treatment is the most suitable way to check their reliability on practice. As a result, a categorization of treatments in accordance with extents of its research-supported empirical evidence is a general framework applied to a choice of treatment of post-traumatic stress disorder. The following paper suggests that this approach is the most effective way of preserving patients from adverse treatment outcomes and provides a detailed account of the related PTSD treatments in terms of this subject.
Well-Established and Probably Efficacious Treatments
Concerning definition and difference between well-established and probably efficacious treatments, these aspects should be recognized as follows. A well-established treatment is based on designs and concepts suggested by numerous studies, which were objectively verified by independent investigators (Society of Clinical Psychology, 2016). Such treatments rely on an undeniable expertise of recent studies, which have proved their validity and empirical efficacy, and practitioners consider adoption of these treatments for a regular practice. As for probably efficacious treatments, they build upon several empirical studies, supported by practitioners (Society of Clinical Psychology, 2016). These treatments, however, still need a better research and approval by independent verification. It is worth saying that probably efficacious studies do not necessarily mean that they imply certain harms to patients. They may address specific cases; meanwhile their application to a standard incidence of mental health disorders can be redundant or hardly adjustable for a particular patient.
Speaking about these treatments in the context of post-traumatic stress disorder, five well-established treatments should be indicated: prolonged exposure, present-centered therapy, cognitive processing therapy (CPT), seeking safety, and eye movement decentralization and reprocessing (EMDR) (Society of Clinical Psychology, 2016). A single probably efficacious treatment is stress inoculation therapy, meanwhile psychological debriefing does not have any research support and is recognized as potentially dangerous treatment (Society of Clinical Psychology, 2016). On a large scale, practitioners are expected to combine these treatments with a choice of one prevailing approach. That is why differentiation between well-established and probably efficacious treatments is vital. Reliance on a certain treatment should be rationalized, and empirically-driven findings are the best support for a chosen treatment. Furthermore, such allocation of treatment credibility indicates particular instances of using an appropriate approach. A brief description and understanding of each treatment in terms of a practical context is also important, so that each treatment should be given an account.
Prolonged Exposure Therapy
Prolonged exposure is a manualized treatment protocol that should be conducted weekly with 90 minutes durability. The treatment is comprised of the following components. The first element is a psychoeducation concerning the most prominent reactions to trauma (Tuerk et al., 2011). Also, this step includes rationalizing for treatment and accumulation of details related to a patient and his/her incidence of PTSD. The second component is a self-assessment of anxiety throughout application of subjective units of distress (Tuerk et al., 2011). The third stage suggests that a patient should be exposed to in vivo situations that were avoided because of a distress (Tuerk et al., 2011). The fourth step is a repeated and prolonged exposure of a patient to memories and associations related to the trauma (Tuerk et al., 2011). This process implies an exposure of a patient to situations that will potentially cause fear but within measures of his/her personal sensation of safety. Treatment sessions are usually audio-taped in order to identify the further direction for a patient exposure. The related study involved 65 participants of both genders and various ethnicities (Black, White, and Hispanic) to test the treatment. As a result, 66% of participants met treatment complements after application of the aforementioned steps of the treatment. The study reports about successful results of testing, as prolonged exposure proved to be applicable to cases of PTSD.
This treatment is particularly focused on present feelings and cognitive state of a patient in order to retrieve target elements of exposure. Nonetheless, the method is not limited to that approach. Present-centered therapy includes basic psychological considerations of altering maladaptive behavioral patterns via educating a patient to cope with adverse effects of trauma and adopt problem-solving strategies that can address his/her current life issues (Frost, Laska, & Wampold, 2014). This treatment is peculiar with its methodology, as long as it does not involve a patient’s exposure and restructuring techniques practiced with other treatments (Frost, Laska, & Wampold, 2014). Thus, each treatment session is unique, as well as it requires assignment of specific problem-solving models (Frost, Laska, & Wampold, 2014). In spite of its extremely flexible methodology, the treatment is often practiced and proved to be effective even in the most severe cases of post-traumatic stress disorder. The study included 5 random clinical trials of PTSD cases of different severity. As a result, 3 trials demonstrated superior effectiveness of present-centered therapy, meanwhile 2 other trials occurred to be cases beyond complete treatment of PTSD. Thus, present-centered therapy managed to address all treatable cases, and can be commonly practiced.
Cognitive Processing Therapy
This type of treatment promotes a concept that PTSD is not a recoverable disorder but an effect of a victim’s beliefs and emotions triggered by a traumatic event. In other words, a patient’s cognition is affected by outcomes of traumatic events, and he/she interprets the reality throughout that prism. Avoidance of natural recovery triggers is increasingly frequent in cases of PTSD, so that cognitive processing therapy refers to these processes (Mott, Elwood, & Houle 2012). Usually, treatment protocol involves from 12 to 17 sessions, with a standard durability of 50 minutes once or twice a week (Mott, Elwood, & Houle 2012). The individual treatment consists of four phases. The first stage is education of a patient regarding PTSD symptoms and potential approaches to their treatment. The second step is acknowledgment of a patient about his/her feelings and post-traumatic experiences (Mott, Elwood, & Houle 2012). The third phase is a provision of a patient with specific lessons and trainings for adaptability (Mott, Elwood, & Houle 2012). Eventually, the fourth step is assistance in recognition of changes and adoption of healthy beliefs in the future life. The related research on cognitive processing therapy involved 50 participants of a randomized, controlled, repeated-measures, and semi-crossover study. As a result of hierarchical linear modeling analyses, 58% of the participants have been revealed to recover prior to the 12th session of the treatment protocol. The study, however, concluded that patients benefit from the therapy to various extents, but additional treatment significantly improves their state.
This treatment is particularly used for addressing PTSD accompanied with substance abuse, so that many theoreticians tend to regard it as a treatment devoted to such cases only. Seeking safety is an evidence-based practice, which addresses a patient’s state throughout identification of potential safety circumstances (Najavits, 2015). A patient with PTSD experiences a feeling that trauma event will occur again and, therefore, changes his/her behaviors in a way that causes psycho-cognitive disruptions (Najavits, 2015). Seeking safety is a manualized treatment that orients a patient towards prospects of life that are safe (Najavits, 2015). This is the main reason why practitioners refer to this treatment in cases of PTSD with substance abuse or sexual harassment incidents. The treatment provides education of a patient with regard to coping skills and problem-solving strategies, so that a patient starts feeling safe and, thus, recovers. The author admits that this therapy has been tested in more than 20 pilot trials, controlled studies, dissemination researches, and multisite studies (Najavits, 2015). The final guideline has been published in 2002, so that it is well-developed and effective treatment nowadays.
Eye Movement Desensitization and Reprocessing
Concerning this treatment, EMDR is an integrative psychotherapy that is oriented towards all aspects of human memory: images, cognition, emotions, senses, and selected modes of regular functioning. Provision of removal of these negative senses and reprocessing of them facilitates a patient’s recovery after a traumatic event and establishes numerous clinical factors when a patient is not ready for a proactive psychotherapeutic treatment (Russell, Lipke, & Figley, 2011). EMDR consists of eight phases, which are the following. The first one is acquisition of a patient’s history of trauma incidence. The second step is a preparation of a patient for the further intervention (Russell, Lipke, & Figley, 2011). The third step is assessment of a patient's state and his/her capability to undergo the treatment (Russell, Lipke, & Figley, 2011). The fourth step is a factual desensitization and reprocessing of traumatic memories. Then, the fifth phase is installation: a patient should attempt to acquire new adaptive behaviors (Russell, Lipke, & Figley, 2011). The sixth stage is a body scan, as a patient boosts his/her senses to understand whether any physical pain is associated with a trauma (Russell, Lipke, & Figley, 2011). The seventh phase is closure, and a mental health professional provides a patient with concluding remarks and advice for the future (Russell, Lipke, & Figley, 2011). Eventually, the eighth phase requires from a patient to reevaluate a memory related to trauma and express his/her new attitude. The article does not provide its own research data but refers to the other studies, which prove that almost 77% of participants managed to recover and had no PTSD symptoms in the future (Russell, Lipke, & Figley, 2011). The article also discussed various speculations about methodology of these studies. However, the central conclusion of this debate is that effectiveness of EMDR is beyond collection of data, and each case should be supported by practical evidence.
Stress Inoculation Therapy
This treatment is recognized as probably efficacious, and its primary methodology is application of various coping skill learning and patient education about independent relaxation throughout breath, relaxing muscles, and problem-solving strategies (Hensel-Dittmann et al., 2011). A treatment implies avoidance of focusing on past traumatic experiences and orients a patient towards present and future life (Hensel-Dittmann et al., 2011). As a consequence, cognitive restructuring is also practiced in terms of this treatment, as it relies on addressing natural means of post-stress recovery. The related study included 28 participants, who were mainly asylum seekers, who had to leave their countries because of suffering organized violence. Standardized clinic interviews were conducted after 4, 6, and 12 months of treatment, and socio-demographic as well as clinical characteristics were considered. The results suggest that 64% of patients managed to fully recover, meanwhile the rest needed moderate additional treatment on average (Hensel-Dittmann et al., 2011). The treatment proved its efficacy even in such severe PTSD cases as experiencing strong organized violence.
Taking into account all findings related to the outlined treatments, it should be noted that cognitive processing therapy can be the most effective one in addressing actual trauma of a patient. First of all, CPT facilitates natural recovery processes, which is the most harmless and relapse-free approach. Second, adjustment of a patient’s cognition towards healthy perceptions and adequate reciprocity with an objective reality is the best way to deploy adaptive skills at their fullest potential. In such a way, this treatment is regarded as the most efficient. Cognitive processing therapy addresses distinct circumstances of a patient’s trauma, so that this treatment is the most flexible. Henceforth, processing of actual trauma is increasingly pivotal and cognitive processing is capable of such treatment. Beyond a doubt, some alternative means of cognitive restructuring can be applied, but they need approval and justification from the perspective of an empirical validity.
On the other hand, use of specific treatments with a modest research support is possible in peculiar cases when a chosen treatment is evidently congruent with a patient’s case and conditions allow to approach a patient. Relying heavily on treatments, which are described as potentially harmful and unverified, is not recommended, though. It is informative to note that making generalizations concerning PTSD treatments can be inadequate sometimes owing to the fact that each patient has suffered from a trauma under unique circumstances with many individual specifics of cognition. Therefore, application of the same treatment to various patients may result in entirely different outcomes. Practitioners can be less strict about a choice of treatment, but this choice should refer to their feeling of responsibility for positive outcomes rather than general statements about a selection of a particular treatment. Overall, mental health professionals should both utilize evidence accumulated from a patient’s presentation and best practices related to the treatment approaches of PTSD.
It is appropriate to make a general comment on the fact that a choice of a certain treatment still should be determined with an accurate understanding of a patient’s case. Thus, cognitive processing therapy has been selected as the most prominent, since it provides a better flexibility. At any rate, application of other treatments is also possible in case a patient’s presentation is congruent with a chosen approach. Concerning research-supported evidence, it is the primary way of sorting credible treatments as well as guidelines for practitioners. Verification of empirical validity may place some biases on other treatments that can be potentially effective, but the original purpose of treatment validation is the ethical concern, as long as barely practiced and studied treatments can result in adverse consequences for a patient, who is the most valuable stakeholder in that regard.