February 26, 2013 - A few weeks ago an article in the Scientific American Twitter stream caught my eye. EMDR (Eye Movement Desensitization and Reprocessing) once again debuted as a “promising new treatment” for PTSD. EMDR, which has been repeatedly called “promising” over the last two decades, works only about as well for PTSD as other psychological treatment modalities with which it competes, primarily cognitive behavioral therapy (CBT) and exposure therapy. These so-called trauma focused treatments (TFT) all garner similar results. TFT have large effects in clinical trials, with two important caveats: 1) the enthusiasm of their various advocates bias the study results towards the treatment the researchers prefer; and, 2) they are effective for a significant number of carefully selected PTSD patients. The sad truth, however, is that current short-term treatments are not the solution for most patients with PTSD. Trial criteria often exclude those with comorbid disorders, multiple traumas, complex PTSD, and suicidal ideation, among others. Even when they are included, comorbid patients drop out of treatment studies at a much higher rate than those with simple PTSD, a problem that has implications for clinical practice.
The large majority of those with PTSD also have other psychological disorders (commonly, substance abuse, depression, and anxiety disorders) and many of these patients have complex PTSD, which is both harder to treat, and more prone to relapse (see Fig. 1). Those who suffer from both PTSD and substance abuse (64%-84% of veterans, for example) often perceive the disorders as “functionally correlated.” Similarly, depression and PTSD are mutually reinforcing; each compounds the symptoms of the other. Both substance abuse and depression are notoriously difficult to treat, and harder to treat when comorbid with PTSD. Multiple studies document the long-term failure of PTSD treatment, but there are fewer on the effectiveness of therapies in treating comorbid PTSD in civilian populations. Existing studies challenge the assumption that PTSD treatments effective for simple PTSD, are also effective for combined PTSD and substance abuse, or PTSD and depression. read more>>>