IPT May Help Patients Recover Without Exposure to Reminders of Past Trauma
Feb 16, 2005
For years, the "gold standard" treatment for patients struggling with posttraumatic stress disorder (PTSD) has involved exposure to reminders of the triggering traumatic event.
Now, findings from a small pilot study by Weill Cornell Medical College researchers may offer patients a new alternative to that often painful process.
"While these findings need to be replicated in a larger, controlled trial,this is the first study we're aware of in which a non-exposure therapy showed good results for PTSD," said co-researcher Dr. John C. Markowitz, Clinical Professor of Psychiatry at Weill Cornell Medical College and Attending Psychiatrist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
The findings were published in the January issue of the American Journal of Psychiatry.
In PTSD, "the patient's sense of control over their world is compromised by some severe, traumatic life-event," explained study lead author and co-researcher Dr. Kathryn L. Bleiberg, an Instructor of Psychology in the Department of Psychiatry at Weill Cornell and Professional Associate at NewYork-Presbyterian/Weill Cornell. Patients typically experience recurrent nightmares, ongoing anxiety, difficulty in relating to others, and a pattern of avoidance of reminders of the past trauma.
"The good news is that PTSD is treatable," Dr. Markowitz said. "Medications work to some degree, and then there are exposure-based therapies, where patients are confronted with reminders of the trauma that triggered the syndrome."
Of course, revisiting dreadful events such as serious accident or sexual abuse can be painful, and might even keep some PTSD patients from seeking therapy, the researchers said.
As Dr. Bleiberg explained, "PTSD patients didn't have a choice about being traumatized. But patients should at least have some choice in the type of treatment they can pursue to help them recover."
In their study, she and Dr. Markowitz examined the effectiveness against PTSD of interpersonal psychotherapy (IPT), a form of talk therapy that focuses "not on the past trauma, but on dysfunctional relationships in the here-and-now," Dr. Bleiberg said.
IPT has long shown efficacy in helping people struggling with depression, Dr. Markowitz explained. "In PTSD, too, marriages can suffer, patients can feel uncomfortable around co-workers. With IPT, we focus on rebuilding those relationships. As people gain confidence in those areas, they tend to feel a lot better," he said.
The Weill Cornell team tested IPT in 14 volunteers suffering from PTSD linked to events such as childhood sexual abuse, adult rape or mugging, or direct experience of the World Trade Center collapse. Subjects were asked to attend 14 sessions over a period of 14 weeks.
"Our initial results in this pilot study have been very good," Dr. Markowitz said. "We only had one – very late – dropout, and by the end of therapy, 12 of the 14 participants no longer met the diagnostic criteria for PTSD."
A few patients were emboldened to go a step further, he said.
"Although we didn't encourage them to do so, some patents spontaneously would tell us things like 'Oh, I just arranged an airplane trip,' after avoiding airplanes for a year," Dr. Markowitz noted. "It's possible IPT helped them gain the confidence to expose themselves to triggers they sought to avoid before."
Both researchers stressed that these findings are very preliminary, so the efficacy of IPT in larger or more varied groups cannot be confirmed at this time. They also note that, for most, exposure therapy remains a highly effective and desirable treatment option.
More research is needed, Dr. Bleiberg said, adding that "we're currently seeking funding for a larger, controlled trial that would compare IPT against medication."
In the meantime, however, she remains heartened by these early findings.
"It's just nice to know that an alternative therapy might be out there for patients who don't want to have to focus on the trauma that affected them so badly to begin with," she said.