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Emerging Interventions for PTSD: Hype or Hope?

January 12, 2016

New research puts the evidence behind novel interventions for the treatment of PTSD in the spotlight, and results show that despite their popularity, less than a third can be considered as currently promising alternatives to established treatments.
 
Despite several evidence-based therapies for PTSD outlined clearly in the recent guidelines,1 there are barriers that prevent many individuals from engaging in successful treatment. Long delays in treatment seeking, and high drop-out and non-response rates are commonplace amongst individuals with PTSD.2 The very nature of the disorder itself may make it resistant to conventional methods of psychotherapy- for example, a key feature of PTSD is avoidance of the traumatic stimuli, and all evidence-based treatments contain some degree of engaging with the traumatic memory.3 Similarly, while PTSD has a strong physiological component, evidence-based treatments have a largely psychological approach to recovery.
 
The volume of emerging interventions for PTSD is partially symptomatic of how challenging the disorder is to treat. As a result, the variety of treatment options on offer range from Ayurvedic to Zinc. Yet a common theme underlies their appeal in that they offer modalities of treatment that are novel compared to traditional treatment for PTSD, and involve a broad range of approaches for dealing with the psychological consequences of trauma. Many emerging interventions, including acupuncture, yoga, meditation and experiential therapies such as animal-assisted or outdoor therapy, shift the emphasis of the treatment away from an internal focus of the individual’s traumatic experiences and instead are grounded in interactions with the environment. Other emerging interventions such as ‘power therapies’ claim to offer much faster therapeutic outcomes to the lengthy and costly process that can be involved in traditional psychotherapy. The appeal of emerging interventions is reflected in their popularity: up to 40% of individuals report using such interventions to treat PTSD, and Government bodies are regularly lobbied to provide support for emerging interventions.3
 
Emerging interventions might be popular and appealing, but do they work? A comprehensive review recently published in Journal of Traumatic Stress investigated the evidence behind 15 of the popular emerging interventions for adults with PTSD. In this context, emerging means popular and novel treatments that are not currently recommended by current guidelines for the treatment of PTSD (see image/table that has list of emerging interventions).
 
The review found just 19 studies had investigated the efficacy of these interventions, and many interventions had no empirical evidence at all. The small pool of evidence was further hindered by overall low quality of published studies. But the results also contained hope: after being rigorously assessed against multiple measures of study quality, the studies investigating four treatments showed significant promise.
 
Acupuncture, Emotional Freedom Technique, mantram-based meditation and yoga might seem more different then alike, but there are significant similarities: they are theoretically grounded in mind-body philosophies; they do not directly address cognitions or emotions; and they do not involve talking therapy. They also are all likely to affect somatic aspects of PTSD. For example, both yoga and mantra-based meditation teach relaxation skills, whereas Emotional Freedom Technique and acupuncture both involve the manipulation of purported “meridians” which may reduce physiological arousal. Critically, the therapeutic mechanisms via which many emerging interventions can improve PTSD symptoms remain speculative.
 
Where do we go from here? Clinicians should continue to use evidence-based treatments as first-line options against PTSD until the efficacy of emerging interventions can be established through high quality trials. One feasible role for emerging interventions may be as complementary or preparatory treatment for current evidence-based treatments. Of course, relevant bodies need to fund high quality research trials to test these interventions, yet responsibility also lies with researchers developing interventions to hypothesise and systematically assess the putative mechanisms by which clinical change should occur. Urgently, we must do more to ensure that the hope or hype of emerging interventions become real solutions to such a devastating disorder.
 

Author Biography

staff-our-people-olivia-metcalf.jpg
Olivia Metcalf, PhD
has a background in cognitive and experimental psychology and currently works as a research fellow at Phoenix Australia - Centre for Posttraumatic Mental Health, University of Melbourne. Her recent work involves educating mental health professionals about the unique experiences of military and veteran populations and synthesising best-practice research for the treatment of mental health conditions resulting from trauma.

 

Reference Article


Metcalf, O., Varker, T., Forbes, D., Phelps, A., Dell, L., DiBattista, A., . . . O'Donnell, M. (2016). Efficacy of Fifteen Emerging Interventions for the Treatment of Posttraumatic Stress Disorder: A Systematic Review. Journal of Traumatic Stress, n/a-n/a. doi: 10.1002/jts.22070
 

References Cited


Australian Centre for Posttraumatic Mental Health. (2013). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne, Victoria: ACPMH.

Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry: Interpersonal and Biological Processes, 71(2), 134-168. doi: 10.1521/psyc.2008.71.2.134

Hoge, C. W. (2011). Interventions for war-related posttraumatic stress disorder: Meeting veterans where they are. JAMA, 306(5), 549-551.

Libby, D. J., Pilver, C. E., & Desai, R. (2013). Complementary and alternative medicine use among individuals with posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), 277

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), e559-e565.