What does the future hold for posttraumatic stress disorder (PTSD) treatments?

“We need to get further information out about those treatments that we’ve already got a strong evidence base for. We also need to develop the skills of practitioners in the delivery of these interventions,” says Professor David Forbes, Director of Phoenix Australia.

Training programs might discuss PTSD and highlight treatment options, but delivering those treatments is a complex process and training programs may not go into sufficient depth.

“Treatments involve dealing with a traumatic experience and assisting the person to confront distressing memories that they are avoiding,” says David.

“Clinicians are often nervous to encourage this for fear of making things worse, even though we know these treatments don’t do that. It takes a fair bit of skill and confidence on behalf of the clinician in knowing exactly how to engage the client and how to deliver treatment confidently and effectively.”

However, current PTSD treatments don’t work for every patient, so how can they evolve to support more people?

Prolonged exposure therapy is a key evidence-based treatment usually delivered once a week for three months. But not everybody wants treatment to take so long and a recent Phoenix Australia trial condensed the therapy to 10 sessions over 14 days.

“We found it’s as good as doing therapy over three months,” says David.

There is also a need to think about treatments that are not trauma-focused and this presents two options for innovation, says David.

One option is the development of transdiagnostic treatments — rather than dealing with the symptoms or the trauma, these treatments deal with the underlying psychological processes or mechanisms that develop and maintain the PTSD. Examples of transdiagnostic treatments include unified protocol, mindfulness and meditation.

“These treatments look at the way I might deal with my emotions, how I manage stress, the degree to which I avoid things I don’t like, and the way in which I engage in activities or not. These things maintain the PTSD or depression or anxiety or all of the above and dealing with the underlying mechanisms has the potential to address these different problems through one systematic intervention,” says David.

The second option for innovation is focusing on the medical realm, such as neuromodulation or brain stimulation treatments. In PTSD, the emotional, fear and threat protection centres in the brain are over-activated and areas of the brain involved with high levels of thought, judgement and emotion management are under-activated.

Brain stimulation methods, like transcranial magnetic stimulation and theta-burst stimulation, act on the under-activated parts of the brain. There is emerging data to suggest these non-invasive treatments are helpful for PTSD.

“But does it last? Is it a standalone treatment, or best augmented with psychological treatments? Can we use brain stimulation to activate the more sophisticated parts of processing and then do other therapies when the capacity to retain information is better?” says David.

These therapies are leading towards delivering precision medicine that suits each person.

David says technology will help deliver PTSD treatments with apps and online programs allowing people to treat themselves, or that clinicians can use to reinforce strategies learned in therapy.

“It’s a very exciting time to be working in the field of PTSD,” says David. “What we will be able to deliver to the community in terms of treatments will be much further down the track in four or five years.”