Why New Psychotherapies for Posttraumatic Stress Disorder?

Abstract

Psychodynamic therapy seeks to reengage normal mechanisms by addressing what is unconscious and, in tolerable doses, making it conscious. This is accomplished by exploring the psychological meaning of a traumatic event. It may include sifting and sorting through wishes, fantasies, fears and defenses stirred up by the event [4] . Transference and countertransference, and the therapist– patient relationship are crucial factors in this approach. Although varying in length, psychodynamic therapy is usually of longer duration than CBT. Unfortunately, only few empirical investigations with randomized designs and validated outcome measures have been reported [4, 13] , so there is currently no suffi cient evidence indicating that psychodynamic therapy is effective in reducing PTSD symptomatology. Brief eclectic psychotherapy (BEP) has been proposed by Gersons et al. [14] as a fully manualized, multimodal treatment approach that combines educational, cognitive-behavioral and psychodynamic elements. It comprises fi ve essentials: (1) psychoeducation; (2) imaginal exposure; (3) writing assignments and mementos; (4) the domain of meaning and integration, and (5) a farewell ritual. BEP proved to be effective in reducing PTSD symptoms in police offi cers suffering from chronic PTSD, as compared with a wait-list control group. In addition, the improvement demonstrated for PTSD symptoms progressed further in all outcome measures, including reThe effi cacy of psychotherapeutic and pharmacotherapeutic approaches in the treatment of posttraumatic stress disorder (PTSD) can be regarded as empirically demonstrated [1–5] . Overall, effect sizes seem to be higher for psychotherapy as compared with medication [6] . Psychotherapy for PTSD includes the following approaches: Cognitive-behavioral therapy (CBT) uses a variety of techniques such as exposure, cognitive processing and restructuring, stress inoculation training, assertiveness training and relaxation techniques. CBT is usually offered as a time-limited psychotherapy, averaging approximately 8–12 sessions, with meetings once or twice weekly. Many well-controlled trials with a mixed variety of trauma survivors have demonstrated that CBT is effective in treating PTSD [4, 7–11] . More specifi cally, exposure therapy currently is seen as the treatment modality with the strongest evidence for its effi cacy [4] . Eye movement desensitization and reprocessing (EMDR) is a technique in which the patient, under the guidance of a therapist, carries out horizontal eye movements while he/she recalls the traumatic scenes. Although the clinical effi cacy of this approach has been well documented, EMDR still remains controversial. A meta-analysis revealed that EMDR is similarly effective in comparison to other exposure therapies, but that eye movements in particular have no incremental therapeutic effect [12] .