CBT for PTSD Cognitive-Behavioral Therapy

CBT for PTSD

Cognitive-Behavioral Therapy as a Treatment for Post Traumatic Stress Disorder: Evidence from Recent Studies

Post-Traumatic Stress Disorder (PTSD) is an all-too-common diagnosis typified by ongoing stress, emotional and psychological disturbances, and quality of life deterioration experienced as the result of a traumatic event, series of events, or life situation but extending beyond the scope of this event or period. Soldiers who have been involved in or witnessed combat, victims of abuse, and many other individuals are at great risk for developing PTSD, which not only greatly diminishes quality of life but which can also greatly affect a person's ability to care for themselves and to remain a productive member of society. Many treatments have been developed for and/or applied to cases of PTSD, with varying degrees of success in addressing both specific symptoms and the underlying causes of the disorder. The following pages present an analysis of research from the past decade into the efficacy of cognitive-behavioral therapy (CBT) as a treatment for PTSD, yielding insight not only into the actual treatment of and prognosis for PTSD, but also into certain issues that exist in the research itself.

Current Research Findings and Gaps

An extensive study involving more than two hundred subjects was conducted by Cohen et al. (2004), in which children with abuse-related PTSD were given treatment either with child-centered therapy or with trauma-focused CBT (a specialized form of traditional cognitive-behavioral therapy) and assessed for the ongoing severity and emergence of their PTSD symptoms. The authors report that children in the TF-CBT group fared far better than their counterparts in the child-centered therapy group, with improvements in all areas that were greater than improvements seen in children in the child-centered therapy group to a statistically significant degree (Cohen et al., 2004). While this is certainly encouraging, the description the authors provide of child-centered therapy make it clear that this is not a trauma-focused therapeutic model and is concerned primarily with the parent-child relationship rather than with directly addressing past events or current behaviors and emotional issues (Cohen et al., 2004). There is also the possibility of overstating CBT's benefits in this case when the authors mention improvements in self-reported levels of depression and other factors in the parents of the subjects in the TF-CBT group, which is not something baseline levels were established for and which is unreliable for numerous other reasons (Cohen et al., 2004). While this study does suggest CBT is an effective treatment for PTSD, its relative or comparative efficacy cannot truly be established through this research. It is also made clear through a series of internal references that the primary authors of this paper and conductors of this research have spent a great deal of time investigating CBT in relation to PTSD, and while this is to be expected it also points to the potential for bias which given the open design of the study, where researchers knew which children were in which treatment group and might thus have observed different results (Cohen et al., 2004).

Hinton et al. (2004) affirm the general finding that CBT is an effective treatment for PTSD, however, and indeed the shortcomings found in Cohen et al.'s (2004) research does not diminish the validity of this basic conclusion. Working with a small cohort of twelve Vietnamese refugees all suffering from severe and treatment-resistant PTSD, these researchers were able to achieve significant improvements as measured by reductions in symptom expression, sensitivity to anxiety and toe certain stimuli, depression, and headache and other pains that had been culturally associated with PTSD (Hinton et al., 2004). Internally, this research ahs far fewer potential problems than does Coehn et al.'s (2004) study; the use of highly objective and often redundant instruments for measuring PTSD expression and their reduction over the course of treatment makes the findings far more valid and generalizable than those of the previous study, and these researchers also staggered the onset of treatment for their subjects, which enabled a reliable tracking of improvements over time and yielded fairly consistent and positive results (Hinton et al., 2004). At the same time, the size of the study's population of subjects and the unique cultural and experiential elements of this study make it more difficult to assess the efficacy of CBT in the broader treatment of PTSD -- that is, amongst larger populations that are of a more diverse background. Again, there is support for the general conclusion seen in a large sample of published research that PTSD is effectively treated by CBT, but there are significant limitations to this particular research study. The authors are careful to note the limitations and broader implications of their study, and in this they make their results more certain and their potential for bias at least somewhat reduced, and again the number of instruments used to measure and analyze the results of the CBT intervention are very reassuring.

Not all research as compelling supports the use of CBT for the treatment of PTSD, however, or at least not for the treatment of all PTSD symptoms. Research conducted by Zayfert and DeViva (2004) found that even after the remission or resolution of PTSD most symptoms, insomnia was a persistent experience for forty-eight percent of subjects treated with CBT. Patients that had experienced PTSD as the result of a trauma that took place in a sleep context were at greater risk for what the researchers termed "residual insomnia," however this effect was not limited to such patients but was in fact observable regardless of specific PTSD backgrounds (Zayfert & DeViva, 2004). It must be acknowledged that this study's population consisted of only twenty-seven individuals and thus could not be considered exhaustive or comprehensive, however the diversity of the subjects included does suggest that this might be a broadly applicable result, and the high percentage of residual insomnia sufferers also provides a compelling argument towards a certain failing in the use of CBT treatment of PTSD (Zayfert & DeViva, 2004). In addition, the fact that these researchers did not observe subjects during their treatment or diagnosis with PTSD but only after they were no longer diagnosable with the disorder limits the validity of their findings to some degree. CBT is still tangentially supported as a primary treatment for PTSD in this research, as all of the subjects in this research received CBT treatment which effectively alleviated them of most of their symptoms, yet the residual insomnia clearly requires a different approach.