Exposure Therapy Tops Cognitive Restructuring in Preventing PTSD
A recent study published in the June issue of the Archives of General Psychiatry found that prolonged-exposure therapy is more successful in treating individuals who have suffered a traumatic event than cognitive restructuring. According to the study, six months after the traumatic event only 37% of patients who received prolonged-exposure therapy developed PTSD. Conversely, 63% of those that were treated with cognitive restructuring developed PTSD. This is the first study that has compared the two types of therapies. Prolonged-exposure therapy helps the individual to confront the traumatic event and as such some feel that it elicits a certain amount of distress. However, Dr. Richard A. Bryant and colleagues conducting the study said, “Despite some concerns that patients may not be able to manage the distress elicited by [prolonged-exposure therapy], there was no difference in dropout rates.” The following is an excerpt of a article from Medpage Today that reviews the study:
In prolonged-exposure therapy, patients are encouraged to relive the traumatic event over and over. They may describe it verbally in detail in sessions with a therapist and do daily homework assignments that force patients to go over the event in their minds.
Dr. Bryant and colleagues said many clinicians have resisted using exposure therapy because they worry the distress it creates may drive patients away from therapy altogether.
Cognitive restructuring involves identifying unhealthy thoughts and emotional responses to the trauma and tries to modify them by having patients apply rational analysis. The unhealthy thoughts typically revolve around guilt about behavior during the trauma and excessive worry about future harm and their reactions to the stress.
The researchers recruited 90 patients who had been involved in motor vehicle accidents or non-sexual assaults and who met criteria for acute stress disorder — 30 patients were assigned to prolonged-exposure therapy, 30 to cognitive restructuring, and 30 were assigned to a wait list. Patients on the wait list were reassessed six weeks later and then offered unspecified active treatment.