Brief Eclectic Psychotherapy for PTSD

Abstract

To the Editor: Trauma-focused cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing are empirically supported treatments for posttraumatic stress disorder (PTSD).1 However, dropout rates from CBT studies are usually around 20%; up to 58% of patients who completed CBT are still diagnosed with PTSD at posttreatment assessment. Furthermore, only 32%–66% of patients achieve good end-state functioning. Therefore, there is a need for further development in the field.2 Brief eclectic psychotherapy (BEP), a fully manualized, 16-session multimodal treatment approach, differs from trauma-focused CBT in that (1) the aim of exposure is catharsis rather than habituation/extinction; (2) the use of mementos and a farewell ritual, usually applied in grief work, is added; and (3) psychodynamic elements such as reflecting on the connection between early life experiences and the processing of adult trauma, or the implicit use of transference phenomena, are introduced in the domain of meaning and integration. BEP has proved to be effective in reducing PTSD symptoms in police officers3 and survivors of interpersonal violence, accidents, and disasters.4 In a single photon emission computed tomography study, BEP was shown to modulate the functioning of specific PTSD-related sites in the prefrontal cortex,5 while magnetic resonance imaging scans did not detect any treatment-related changes in hippocampal volumes.6 BEP responders showed reduced heart rate responsivity to trauma scripts7 and an increase in cortisol and dehydroepiandrosterone levels.8 These promising results deserve augmentation by an independent research group. Therefore, we conducted a randomized, controlled trial of BEP vs a “minimal attention” control group in a sample of patients suffering from chronic PTSD who had experienced a variety of traumatic events.