Study Shows One-on-One PTSD Therapy Works Better Than Group Sessions

Active-duty service members who sustain combat-related PTSD get better faster by receiving cognitive processing therapy individually, as opposed to in a group, a new study shows.

The study, published in the November issue of JAMA Psychiatry, showed significant improvement regardless of the method in which the patient received the therapy.1 But those who got it one on one showed twice as much improvement as those who received the therapy in a group.

Cognitive processing therapy teaches a person to look at their trauma differently. Therapists do this through “Socratic questioning.” The philosopher Socrates believed that people who know themselves best (how they react to certain thoughts, feelings and triggers) are most likely to find happiness in life. He also proclaimed to know nothing.

Such a worldview allows a person to look at events, even traumatic ones, with an open mind, and from different angles. Those fresh ways of looking at things can be liberating to a person living with PTSD, particularly when they get hung up on “stuck points.” For people with PTSD, a common stuck point is “I can’t trust anyone.” A good therapist will ask questions that help someone get to the “why” behind that, and then help them learn how to trust people again based on their answers. It also helps them better understand the context in which the trauma occurred, which can become blurry.

A good therapist will ask questions that help someone get to the “why” behind that, and then help them learn how to trust people again based on their answers.

The study, led by Patricia Resick of Duke University Medical Center, enrolled 268 active-duty personnel seeking treatment for PTSD at Fort Hood, Texas. All had been deployed near Iraq or Afghanistan. All but 24 were men, and the average age was 33.

In the study, participants were randomized to receive either group or individual CPT twice weekly for six weeks. Both groups received the therapy during the same period. All participants had co-occurring disorders such as depression or alcohol abuse. Those with suicidal or homicidal intent were excluded from the study.

Therapy Did Not Work for Half of Study Participants

Although CPT significantly helped half of all those enrolled regardless of whether they received it in groups or one on one, the other half continued to have significant PTSD-related symptoms. Most continued to suffer from depression as well, although symptoms improved.

As to why those in individual therapy fared better than those in groups, the authors surmised it may have been because those receiving individual therapy got more one-on-one attention and could reschedule missed sessions.

The study did not talk about the stigma of having PTSD and the “suck it up” or “be tough” mentality that is entrenched in the military environment. In a recent interview with Foundations Recovery Network, Miss USA Deshauna Barber, an active-duty service member, explained these issues and talked about how she plans to use her Miss USA platform to advance the national conversation about them.

Post-traumatic stress disorder among soldiers has become a national crisis, with the U.S. having been at war for many years now. Suicide rates in the military, both among active-duty service members and veterans, have skyrocketed and attracted national attention.

But anyone who experiences severe trauma can develop PTSD, which can be a debilitating illness that leaves many people unable to work or even leave their homes.

More Research Needed on PTSD Co-occurring with Substance Abuse

People with PTSD live with fear, anger, rage, crippling anxiety and an inability to trust others or function socially.

People with PTSD commonly turn to drugs or alcohol to numb these feelings, but end up feeling worse. For many people with PTSD, drinking alcohol is like throwing gasoline on a fire.

People with PTSD commonly turn to drugs or alcohol to numb these feelings, but end up feeling worse. For many people with PTSD, drinking alcohol is like throwing gasoline on a fire.

Such was the story of Robert H., who has been sober 17 years. But even after becoming sober and recovering from depression, things still weren’t right.

“I became angry all the time,” he writes on the Heroes in Recovery website.2 “I was then diagnosed with PTSD. I had unknowingly been self-medicating myself since I got out of the Army. So, I then went through 15 weeks of cognitive therapy sessions. That ended this past month. I have been mentally screwed up for 45 years. But through all this, I never drank or relapsed.”

Adds Robert: “I now have 17 years sober thanks to my 12-Step program. And my wife and I are still together. Amazing.”

Meanwhile, Resick and colleagues say there is much more work to be done in terms of determining how to best treat service members with PTSD. “Future research should focus on specific issues found in military populations that may affect PTSD treatment,” they wrote. “Areas inviting study include the roles of comorbidities such as concurrent depression, substance abuse, traumatic brain injury, and sleep disorders; the potential effect of moral injury (an event that conflicts with deeply held morals and beliefs; read more in this exclusive Foundations Recovery Network interview with two Iraq veterans) resulting from combat trauma; and high rates of witnessing or dealing with the aftermath of deaths of others, including gruesome deaths of friends.”


Sources
1. Resick, P. et al. (2016, Nov. 23). “Effect of Group vs Individual Cognitive Processing Therapy in Active-Duty Military Seeking Treatment for Posttraumatic Stress Disorder: A Randomized Clinical Trial.” JAMA Psychiatry. Retrieved Dec. 8, 2016, from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2587076
2. Robert H. (2015, Dec. 3). 17 years sober. Heroes in Recovery. Retrieved Dec. 8, 2016, from https://heroesinrecovery.com/stories/17-years-sober/

Leave a Comment