Veterans with PTSD: Which Therapy Works Better?

PTSD is a prevalent and serious mental health problem that can occur after experiencing or witnessing a traumatic event. Effective psychotherapies for PTSD are available, but there is little information about their comparative effectiveness. This study aimed to address this gap in knowledge by comparing the effectiveness of PE (prolonged exposure) and CPT (cognitive processing therapy) for treating PTSD in veterans.

A clinical trial compared the effectiveness of the two psychotherapies for the treatment of posttraumatic stress disorder (PTSD) in veterans. The trial involved 916 veterans who were recruited from outpatient mental health clinics at 17 Department of Veterans Affairs medical centers across the US. The study found that both PE and CPT resulted in meaningful improvements in PTSD symptoms, but PE was more effective than CPT in reducing PTSD symptoms.

Participants were randomly assigned to receive either PE or CPT, delivered according to a flexible protocol of 10 to 14 sessions. The primary outcome was a change in PTSD symptom severity from before treatment to after treatment at 3- and 6-month follow-ups. Secondary outcomes included other symptoms, functioning, and quality of life.

The study found that both PE and CPT resulted in substantial improvements in PTSD symptoms, with PTSD severity improving substantially in both groups from before to after treatment. However, PE was more effective than CPT for reducing PTSD symptoms, although the difference between treatments did not reach the predetermined threshold for clinical significance. The study also found that patient preferences should be considered because both treatments resulted in meaningful improvements and did not differ in their effects on other outcomes.

It is important to note that treatment dropout was higher in the PE group than in the CPT group, with 254 participants (55.8%) dropping out of PE and 215 participants (46.6%) dropping out of CPT. Three participants in the PE group and one participant in the CPT group were withdrawn from treatment, and three participants in each treatment dropped out owing to serious adverse events.

The study highlights the importance of shared decision-making to help patients understand the evidence and select their preferred treatment for PTSD. Both PE and CPT resulted in meaningful improvements in PTSD symptoms, but PE was more effective than CPT in reducing PTSD symptoms. However, patient preferences should be considered when selecting a treatment for PTSD, as both treatments have their own advantages and disadvantages. Overall, this study provides important information for clinicians and patients in selecting a treatment for PTSD.
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