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Alan G. Kraut Headshot

Trauma Survivors Deserve Therapy That Actually Works

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The mind-boggling events of the past month -- the Boston Marathon bombings, the fertilizer plant explosion near Waco, a deadly collapse of a garment factory in Bangladesh -- will undoubtedly leave in their wake a host of survivors suffering from post-traumatic stress disorder. Many victims will get over the short-term trauma of those events, but others -- in the coming weeks and months --will begin experiencing the chronic bad dreams, flashbacks, sleep difficulties, and frightening thoughts that characterize PTSD. Those individuals will likely avoid places, events or objects that remind them of the experience.

In the United States alone, PTSD affects nearly 8 million adults in any given year, federal statistics show. Fortunately, clinical research has identified certain psychological interventions that effectively ameliorate the symptoms of PTSD. But most people struggling with the disorder don't receive those treatments.

One of the most widely-researched treatments for PTSD is prolonged exposure therapy (PE), pioneered by psychological scientist Edna Foa of the University of Pennsylvania. In PE, patients approach -- in both imaginary and real-life settings -- situations, places, and people they have been avoiding. The repeated exposure to the perceived threat disconfirms individual's expectations of experiencing harm and over time leads to a reduction in their fear.

Another approach is cognitive processing therapy (CPT), which focuses on helping the patient question and challenge the negative thoughts and feelings about the trauma.

PE, CPT and similar treatment programs are relatively short-term, and have proven effective in a variety of settings. And health economics studies suggest that providing such evidence-based treatments for PTSD result in reduced health-care costs -- partly because they are relatively short-term but also because they tend to ward off substance abuse, suicides, depression and other byproducts of trauma.

So why aren't they being commonly delivered to the people who need them?

One reason is that far too few graduate programs provide students with the training to competently provide these treatments. And many therapists, embracing therapy as more of an art than a science, view evidence-based treatments as antithetical to good treatment. A large, professional bias holds that therapy should be individualized and should focus on the underlying causes of one's problems and symptoms. But studies show scant evidence that psychodynamic therapy -- which focuses on such issues as difficult childhood relationships with parents -- effectively eases PTSD symptoms.

The U.S. mental health care system needs to change its attitude about effective therapies, given that traumatic events such as natural disasters and gun violence are pushing concerns about PTSD to the front of public consciousness. More than 286,000 Iraq and Afghanistan war veterans have sought treatment for post-traumatic stress disorder over the past decade, the U.S. Department of Veterans Affairs reports. Researchers at Harvard Medical School found that roughly one-third of residents in the path of Hurricane Katrina suffered some form of post-traumatic stress after the 2005 storm. And in the two months following last year's tragic mass shooting at Sandy Hook Elementary School in Connecticut, more than 16 percent of Newtown, Connecticut's police force had missed work because of PTSD-related issues, according to news reports.

There are plenty of ways to better disseminate proven treatments for PTSD. The federal government could demand the use of these interventions for Medicare and Medicaid reimbursements, or pay less for treatments lacking empirical support. Private medical insurers can take similar steps. State licensing boards could require training in scientifically-backed treatments in order to grant a license to practice.

In addition, governments can fund dissemination initiatives and establish treatment guidelines. The U.S. Veterans Health Administration has already begun developing its own internal and self-sustaining system of training in evidence-based treatments for PTSD. This initiative is described in detail in a commentary by Madhulika Agarwal, the VA's Deputy Undersecretary for Health for Policy and Services, and Bradley Karlin, the department's National Mental Health Director for Psychotherapy and Psychogeriatrics, in a just-published PTSD issue of the journal Psychological Science in the Public Interest.

Clinical scientists can also influence funding policies, in part by serving on committees that help the mission of government agencies (e.g., review committees of the National Institutes of Health).

Lastly, using information provided by clinical researchers, government agencies, professional organizations, and health-care systems, the media can release information to help consumers understand and seek out scientifically-supported treatments.

The personal distress and the public health burden caused by PTSD render the dissemination of efficacious and efficient interventions critical. The people of Boston, West Texas, and Newtown deserve no less.

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