Staff Perspective: The State of PTSD Treatment: Research is Important!

Staff Perspective: The State of PTSD Treatment: Research is Important!

Dr. Jeff Mann

In the world of treatment for Post-Traumatic Stress Disorder (PTSD) there seems to be an insatiable desire for new and novel treatments, and there is a frequent refrain that “We need effective treatments for PTSD!” One of the more recent offerings is MDMA assisted therapy for PTSD. The protocol that has been outlined by the Multidisciplinary Association for Psychedelic Studies (MAPS) includes 12 90-min therapy sessions plus three 6-8-hour medicine sessions. The medication sessions are separated by at least 21 days, and each requires the engagement of two therapists. There are three 90-minute preparation sessions prior to the first medicine session and each medicine session is followed by three 90-minute integration sessions during which the patient has an opportunity to process their experience with the therapist(s). This falls into the category of Psychedelic-Assisted Therapy for PTSD which also includes Psilocybin-Assisted Therapy. There has been a lot of attention placed on these therapies. However, MDMA assisted therapy had a recent setback when the advisory panel to the FDA “voted 9-2 that MDMA – in combination with talk therapy – is not effective for treating PTSD. And they voted 10-1 that the benefits of MDMA treatment don’t outweigh its risks.” The panel cited concerns regarding participants with history of illicit use of MDMA and other substances, difficulty of blinding (participants know when they’ve been given MDMA), risk of abuse and a vague definition of the psychotherapy used. This is in contrast to personal testimony provided by some participants that described the results of the treatment as life-changing. (Click here for more details on panel opinions and concerns).

Personal Testimony
When it comes to new and novel PTSD treatments, we often hear compelling stories from individuals that have been involved. The stories detail how dramatically the treatment has helped them and improved their quality of life. We are moved by these stories, but need to remember they are just one piece of the larger story. These individuals represent one data point. Additionally, this can be particularly challenging when we are dealing with mental health treatments. There is no blood test, imaging, or objective medical test to determine the presence or absence of a condition. So, we need well designed studies that help us understand, as much as possible, what treatments are effective. A placebo effect is a very real thing. When a subjective report from participants is the only data we have on a condition, we have to be very cautious and thoughtful about interpreting the results of the study and look at ALL of the data. The personal stories can also suggest the absence of effective treatments for PTSD; that new treatments should be approved in spite of the concerns because of a lack of effective treatments. But…

We actually DO have effective treatments!

A recent film called “Here.Is.Better.” examines the stories of four Veterans (two men and two women) who have varied backgrounds and traumatic experiences. Although these are also “personal testimony” they are stories related to treatments that have been highly researched, which have demonstrated both short-term and long-term effectiveness in treating PTSD. The treatments highlighted in the film include: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR). As a psychologist who provides regular trauma therapy, I don’t find anything magical about these treatments. They require work and dealing with difficult issues. I’ve seen it work and the results can be truly life changing. More important than my experience or the individuals in “Here.Is.Better” is the fact the research supports the effectiveness. Well designed research that looks at the whole story, picks apart the effectiveness of the treatment, compares it to other treatments, is reviewed and researched by independent peers and doesn’t shy away from examining and addressing potential problems and challenges. These treatments don't work for everyone, but they regularly demonstrate that 70-80% (or more) of those who complete the treatment no longer have a diagnosis of PTSD, as well as substantial improvements in depression, anxiety and general life functioning. If you really want to get into the data on effectiveness please sign up for one our upcoming trainings on PE or CPT.

VA/DoD CPG Recommendations
So where can we go to get a sense of the latest research? The Veterans Health Administration (VA), in collaboration with the Department of Defense (DoD) and other leading professional organizations, has been developing clinical practice guidelines (CPG) since the early 1990s. These guidelines evaluate the latest research and provide recommendations regarding what has been demonstrated through research to be the most effective treatments. Currently, the CPGs offer recommendations regarding the evidence for different treatments as “Strong for”, “Weak for”, “Neither for or against”, “Weak against” and “Strong against”. The most recent CPG for PTSD was released in 2023 (Click here to review the 2023 Provider Summary). The VERY brief summary of the evidence receiving a “Strong For” recommendation include: Individual psychotherapies over pharmacologic interventions for the treatment of PTSD and Individual, manualized trauma-focused psychotherapies for the treatment of PTSD: Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR), or Prolonged Exposure. Additionally the research on data for some treatments also received a “Strong Against” rating including: benzodiazepines for the treatment of PTSD and cannabis or cannabis derivatives for the treatment of PTSD. Evidence regarding MDMA assisted psychotherapy was rated as insufficient to provide a recommendation for or against. Please take a look at the summary to see how evidence regarding various treatments was rated.

Massed delivery
One development that I am personally excited about from recent research has been “Massed Treatment.” This refers to the delivery of a treatment like CPT or PE in a period of 1-4 weeks. For many individuals, the 3 months of weekly treatment can cause problems. Life happens, sessions are missed, work gets busy and people drop out of treatment. However, the research is starting to demonstrate that these treatments are equally effective when delivered over a shorter period of time and often have a lower dropout rate than weekly sessions. This is a modality of treatment that I am looking to include in my clinical practice.

The study of new and novel PTSD treatments like psychedelic drugs and their potential use is important and could yield amazing advances in the treatment of PTSD. But, we aren’t there yet. There remains a lot we don’t know about these treatments. Additionally, the narrative that we lack effective treatment for PTSD is inaccurate. We have good treatments that are available and we continue to learn more (through research) about how to make these treatments better and deliver them more effectively.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Jeff Mann, Psy.D. is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland.