CBT for PTSD in the Real World: The Glass Is Still Mostly Empty

Evidence-based treatments for post-traumatic stress disorder (PTSD), typically tested in narrowly defined groups without other comorbidities, have shown beneficial but limited effects. Treatment effects on nonsymptomatic domains of function (e.g., relationships) have been infrequently examined. In two randomized, controlled trials, researchers have now examined the effectiveness of tailored cognitive-behavioral therapy (CBT) in two population groups — individuals with PTSD and comorbid substance dependence, and individuals whose PTSD had presumably worsened their intimate relationships.

Mills and colleagues compared standard substance-dependence treatment alone or added to prolonged exposure in 103 patients with severe substance dependence (early onset; 80% with drug injection use histories) and severe PTSD (Clinician-Administered PTSD Scale [CAPS] score, 90). Intervention recipients had greater CAPS reductions than controls at 9 months (but not earlier); PTSD rates were statistically similar (56% and 79%). The groups showed similarly decreased substance dependence rates (9-month rates, 45% and 56%), similarly limited rates of abstinence (18% and 27%), and similar levels of anxiety and depression symptoms.

Monson and colleagues randomized 40 couples with one partner who had modestly severe PTSD (CAPS score, 71) to couples-oriented CBT treatment for PTSD or to a waiting list. Treatment was associated with greater reductions in CAPS scores at posttreatment (median, 16 weeks) than the waiting list (–35.4 vs. –12.2 points) and four times greater improvement in patient-reported relationship satisfaction.