Interpersonal Therapy Found as Effective as Exposure Therapy for PTSD – Findings Suggest a New Avenue for Treatment
New York, NY (March 25, 2015) -- A head-to-head comparison of exposure therapy and interpersonal psychotherapy (IPT) for post-traumatic stress disorder (PTSD) found that IPT, a talk therapy that focuses on feelings and relationships rather than on the trauma a patient suffered, was as effective as exposure therapy. The study, published in the American Journal of Psychiatry online in March 2015, is the first to compare the two treatments.
Exposure therapy, a type of cognitive-behavioral therapy (CBT), is considered the gold standard in PTSD treatment. It requires that patients—in a controlled setting—confront their fears gradually over time, to reduce their anxiety. Because of the nature of the treatment, many patients have difficulty with it.
“There are effective treatments for PTSD, mostly psychotherapies, and almost entirely psychotherapy focusing on exposing patients to frightening reminders of their traumas,” said John Markowitz, MD, professor of clinical psychiatry at Columbia University Medical Center and research psychiatrist at the New York State Psychiatric Institute. “The cognitive behavioral approach works, has the most evidence to support it, and has dominated both research and clinical treatment. But it’s not perfect: Exposure-based treatment doesn’t benefit everyone, and it asks patients to do what they’re most afraid of doing.”
Dr. Markowitz and his colleagues recruited 110 non-medicated patients with chronic PTSD and randomized them to receive one of three treatments over 14 weeks: prolonged exposure, IPT, or relaxation therapy. While the researchers found little difference between the exposure therapy and IPT groups in PTSD outcome, IPT had advantages for the half of patients who also had major depression.
“The results suggest a whole new avenue of treatment for individuals with chronic PTSD,” said Dr. Markowitz. “They also raise a range of research questions: Instead of the fear-extinction circuit underlying exposure-based treatment, might some disruption in attachment explain why IPT works?”
He added, “We’d like to replicate the results before claiming any long-term consequences. But if the findings hold, a range of psychotherapists who don’t practice CBT, and a range of patients who either don’t respond to CBT or refuse it, might benefit from this approach.”
The co-authors, all from Columbia University Medical Center and the New York State Psychiatric Institute, are Eva Petkova, PhD; Yuval Neria, PhD; Page Van Meter, PhD; Yihong Zhao, PhD; Elizabeth Hembree, PhD; Karina Lovell, PhD; Tatyana Biyanova, PhD; and Randall Marshall, MD.
The study was funded by NIMH grant R01 MH079078 (Dr. Markowitz).
Dr.Markowitz receives research funding from NIMH; royalties from American Psychiatric Publishing, Basic Books, and Oxford University Press; and an editorial stipend from Elsevier Press. Dr. Hembree receives royalties from Oxford University Press. Dr. Marshall is an employee of Retrophin and has been an employee of Alkermes.
Columbia University Department of Psychiatry and New York State Psychiatric Institute (Columbia Psychiatry/NYSPI)
New York State Psychiatric Institute (founded in 1896) and the Columbia University Department of Psychiatry have been closely affiliated since 1925. Their co-location in a New York State facility on the NewYork-Presbyterian/Columbia University Medical Center campus provides the setting for a rich and productive collaborative relationship among scientists and physicians in a variety of disciplines. Columbia Psychiatry/NYSPI are ranked among the best departments and psychiatric research facilities in the nation and have contributed greatly to the understanding of and current treatment for psychiatric disorders. The Department and Institute are home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders and childhood psychiatric disorders. Their combined expertise provides state of the art clinical care for patients, and training for the next generation of psychiatrists and psychiatric researchers.
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