In Brief

Reliving trauma: Pluses and minuses

(This article was first printed in the February, 2004 issue of the Harvard Mental Health Letter. For more information or to order, please go to http://health.harvard.edu/mental.)

A Veterans Administration study suggests that psychotherapy groups in which patients relive their traumatic experiences may not be a wise choice of treatment for post-traumatic stress disorder (PTSD). The study subjects were 325 Vietnam veterans with chronic PTSD — as well as other psychiatric symptoms including depression, alcoholism, and drug addiction. They were assigned at random to receive either “trauma-focused” or “present-centered” group psychotherapy in groups of six, weekly for seven months, then monthly for another five months.

In the trauma-focused therapy, patients were guided through the reliving of traumatic memories in group sessions and asked to listen repeatedly to audiotapes of those sessions. The treatment also included cognitive restructuring and relapse prevention. The present-centered treatment concentrated on education about the symptoms, their causes, and how they were related to personal problems.

In both types of therapy, about 40% of the men showed a significant but modest improvement in symptoms, physical health, and overall quality of life after seven months and after a year. For men who completed the whole course of treatment, the two approaches were about equally effective. Trauma-focused therapy even had slightly more effect on some of the symptoms, especially avoidance and emotional numbing.

But the dropout rate in trauma-focused therapy was considerably higher (27% versus 18%). The authors conclude that therapeutic reliving of the trauma is not cost-effective for these men; it involves too much wasted effort. That could change if we learn how to help patients remain in treatment, or how to tell which patients would benefit from this type of therapy.

Schnurr PP, et al. “Randomized Trial of Trauma-Focused Group Therapy for Posttraumatic Stress Disorder: Results from a Department of Veterans Affairs Cooperative Study,” Archives of General Psychiatry (May 2003): Vol. 60, No. 5, pp. 481–89.