Treatments of Posttraumatic Stress Disorder in Civilian Populations

Abstract

Purpose of Review

Posttraumatic stress disorder is a chronic, heterogeneous disorder for which a multitude of psychotherapies, pharmaceuticals, and immerging treatment programs are available. Majority of efficacy studies focus on Caucasian male military populations, which may be a reason why not all patients respond to treatment with long-term positive outcomes. Additionally, effects of treatment on symptom clusters have been neglected. This work reviews treatment of PTSD and its symptom clusters exclusively in civilian populations, which have been historically under-examined in the literature.

Recent Findings

Exposure therapy stands at the forefront of successful PTSD treatment and offers a more cost-effective solution to pharmacotherapy; however, refugees and patients with comorbid depression may not experience such strong benefits. For exposure therapy and other forms of psychotherapy, non-inferiority studies point to promise of internet-delivered and telemedicine-based methods for reaching populations that may not have access to in-person care.

SSRIs are the most widely used pharmaceutical treatment for PTSD; moderate initial benefits are observed yet long-term retention and outcomes may be enhanced by adjunct treatment. Again, refugees are a group that experiences lesser benefit. Research has begun to explore efficacy of treatments for individual symptom clusters, with hyperarousal benefiting most from currently available modalities. Avoidance, intrusion, negative thoughts and beliefs, and dissociation are symptoms requiring more research for focused interventions.

Summary

Treatment of PTSD has evolved to (1) include equivalent proportions of men and women, along with focused female-exclusive cohorts; (2) explore novel methods of treatment online and in various cultural contexts; and (3) less focus on medication as evidenced by current clinical trials. In addition to further efficacy and safety studies in more diverse ethnic populations, work is needed to examine what therapies are best for targeting specific symptom clusters of PTSD. This research will drive precision treatment, and such research is beginning to point towards underlying mechanisms of pathology and change.

This is a preview of subscription content, log in to check access.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress. 2013;26(5):537–47. https://doi.org/10.1002/jts.21848.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  3. 3.

    Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, et al. An evidence map of the women veterans’ health research literature (2008–2015). J Gen Intern Med. 2017;32(12):1359–76. https://doi.org/10.1007/s11606-017-4152-5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Women, Trauma, and PTSD. n.d. Retrieved July 23, 2018, from https://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp.

  5. 5.

    • Search of: Recruiting, Not yet recruiting, Active, not recruiting, Enrolling by invitation Studies | Interventional Studies | PTSD | United States - List Results - ClinicalTrials.gov. n.d. Retrieved July 17, 2018, from https://clinicaltrials.gov/ct2/results?cond=PTSD&cntry=US&recrs=b&recrs=a&recrs=f&recrs=d&age_v=&gndr=&type=Intr&rslt=&Search=Apply. Findings from ongoing trials may lead to new directions in psychiatric care. Two themes stood out from reviewing the registry: new methods of delivery through telemedicine and online resources; primary focus on pharmacotherapy and alternative therapy, with pharmacotherapy being used mainly to facilitate exposure therapy and in fewer studies than we have previous seen.

  6. 6.

    Acarturk C, Konuk E, Cetinkaya M, Senay I, Sijbrandij M, Gulen B, et al. The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial. Psychol Med. 2016;46(12):2583–93. https://doi.org/10.1017/S0033291716001070.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Alghamdi M, Hunt N, Thomas S. The effectiveness of narrative exposure therapy with traumatised firefighters in Saudi Arabia: a randomized controlled study. Behav Res Ther. 2015;66:64–71. https://doi.org/10.1016/j.brat.2015.01.008.

    Article  PubMed  Google Scholar 

  8. 8.

    Anderson ML, Najavits LM. Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation? Rehabil Psychol. 2014;59(3):349–53. https://doi.org/10.1037/a0036869.

    Article  PubMed  Google Scholar 

  9. 9.

    Blasio PD, Camisasca E, Caravita SCS, Ionio C, Milani L, Valtolina GG. The effects of expressive writing on postpartum depression and posttraumatic stress symptomS. Psychol Rep. 2015;117(3):856–82. https://doi.org/10.2466/02.13.PR0.117c29z3.

    Article  PubMed  Google Scholar 

  10. 10.

    Bomyea J, Stein MB, Lang AJ. Interference control training for PTSD: a randomized controlled trial of a novel computer-based intervention. J Anxiety Disord. 2015;34:33–42. https://doi.org/10.1016/j.janxdis.2015.05.010.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Brom D, Stokar Y, Lawi C, Nuriel-Porat V, Ziv Y, Lerner K, et al. Somatic experiencing for posttraumatic stress disorder: a randomized controlled outcome study. J Trauma Stress. 2017;30(3):304–12. https://doi.org/10.1002/jts.22189.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    • Buhmann CB, Nordentoft M, Ekstroem M, Carlsson J, Mortensen EL. The effect of flexible cognitive-behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial. Br J Psychiatry J Ment Sci. 2016;208(3):252–9. https://doi.org/10.1192/bjp.bp.114.150961 Traditionally effective treatments CBT and sertraline may not be effective for refugee populations. This was the largest refugee cohort identified and one of the longest studies. More research in this group is required to identify successful treatment strategies.

    Article  Google Scholar 

  13. 13.

    Difede J, Cukor J, Wyka K, Olden M, Hoffman H, Lee FS, et al. D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial. Neuropsychopharmacology. 2014;39(5):1052–8. https://doi.org/10.1038/npp.2013.317.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    • Ehlers A, Hackmann A, Grey N, Wild J, Liness S, Albert I, et al. A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. Am J Psychiatry. 2014;171(3):294–304. https://doi.org/10.1176/appi.ajp.2013.13040552 Demonstrated non-inferiority of intensive cognitive therapy to standard 3-month care, which may lead to better retention and reduced costs for patients.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Esala JJ, Taing S. Testimony therapy with ritual: a pilot randomized controlled trial. J Trauma Stress. 2017;30(1):94–8. https://doi.org/10.1002/jts.22163.

    Article  PubMed  Google Scholar 

  16. 16.

    Feder A, Parides MK, Murrough JW, Perez AM, Morgan JE, Saxena S, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(6):681–8. https://doi.org/10.1001/jamapsychiatry.2014.62.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Fetzner MG, Asmundson GJG. Aerobic exercise reduces symptoms of posttraumatic stress disorder: a randomized controlled trial. Cogn Behav Ther. 2015;44(4):301–13. https://doi.org/10.1080/16506073.2014.916745.

    Article  PubMed  Google Scholar 

  18. 18.

    Galano MM, Grogan-Kaylor AC, Stein SF, Clark HM, Graham-Bermann SA. Posttraumatic stress disorder in Latina women: examining the efficacy of the moms’ empowerment program. Psychol Trauma Theory Res Pract Policy. 2017;9(3):344–51. https://doi.org/10.1037/tra0000218.

    Article  Google Scholar 

  19. 19.

    Ghafoori B, Fisher D, Korosteleva O, Hong M. A randomized, controlled pilot study of a single-session psychoeducation treatment for urban, culturally diverse, trauma-exposed adults. J Nerv Ment Dis. 2016;204(6):421–30. https://doi.org/10.1097/NMD.0000000000000512.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Hien DA, Levin FR, Ruglass LM, Lopez-Castro T, Papini S, Hu MC, Cohen LR, Herron A. Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial. J Consult Clin Psychol. 2015;83(2):359–369. https://doi.org/10.1037/a0038718.

  21. 21.

    Hijazi AM, Lumley MA, Ziadni MS, Haddad L, Rapport LJ, Arnetz BB. Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: a preliminary randomized clinical trial. J Trauma Stress. 2014;27(3):314–22. https://doi.org/10.1002/jts.21922.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Horesh D, Qian M, Freedman S, Shalev A. Differential effect of exposure-based therapy and cognitive therapy on post-traumatic stress disorder symptom clusters: a randomized controlled trial. Psychol Psychother. 2017;90(2):235–43. https://doi.org/10.1111/papt.12103.

    Article  PubMed  Google Scholar 

  23. 23.

    Johnson DM, Johnson NL, Perez SK, Palmieri PA, Zlotnick C. Comparison of adding treatment of PTSD during and after shelter stay to standard care in residents of battered women’s shelters: results of a randomized clinical trial. J Trauma Stress. 2016;29(4):365–73. https://doi.org/10.1002/jts.22117.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Kasckow J, Morse J, Begley A, Anderson S, Bensasi S, Thomas S, et al. Treatment of post traumatic stress disorder symptoms in emotionally distressed individuals. Psychiatry Res. 2014;220(1–2):370–5. https://doi.org/10.1016/j.psychres.2014.06.043.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Kelly A, Garland EL. Trauma-informed mindfulness-based stress reduction for female survivors of interpersonal violence: results from a stage I RCT. J Clin Psychol. 2016;72(4):311–28. https://doi.org/10.1002/jclp.22273.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Kwako LE, George DT, Schwandt ML, Spagnolo PA, Momenan R, Hommer DW, et al. The neurokinin-1 receptor antagonist aprepitant in co-morbid alcohol dependence and posttraumatic stress disorder: a human experimental study. Psychopharmacology. 2015;232(1):295–304. https://doi.org/10.1007/s00213-014-3665-4.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Langkaas TF, Hoffart A, Øktedalen T, Ulvenes PG, Hembree EA, Smucker M. Exposure and non-fear emotions: a randomized controlled study of exposure-based and rescripting-based imagery in PTSD treatment. Behav Res Ther. 2017;97:33–42. https://doi.org/10.1016/j.brat.2017.06.007.

    Article  PubMed  Google Scholar 

  28. 28.

    Lewis CE, Farewell D, Groves V, Kitchiner NJ, Roberts NP, Vick T, et al. Internet-based guided self-help for posttraumatic stress disorder (PTSD): randomized controlled trial. Depress Anxiety. 2017;34(6):555–65. https://doi.org/10.1002/da.22645.

    Article  PubMed  Google Scholar 

  29. 29.

    Li W, Ma Y-B, Yang Q, Li B-L, Meng Q-G, Zhang Y. Effect and safety of sertraline for treat posttraumatic stress disorder: a multicenter randomised controlled study. Int J Psychiatry Clin Pract. 2017;21(2):151–5. https://doi.org/10.1080/13651501.2017.1291838.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    • Littleton H, Grills AE, Kline KD, Schoemann AM, Dodd JC. The From Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD. J Anxiety Disord. 2016;43:41–51. https://doi.org/10.1016/j.janxdis.2016.07.010 Success of internet-delivered care with long-term benefit to patients.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Markowitz JC, Petkova E, Neria Y, Van Meter PE, Zhao Y, Hembree E, et al. Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. Am J Psychiatry. 2015;172(5):430–40. https://doi.org/10.1176/appi.ajp.2014.14070908.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Maxwell K, Callahan JL, Holtz P, Janis BM, Gerber MM, Connor DR. Comparative study of group treatments for posttraumatic stress disorder. Psychotherapy (Chicago). 2016;53(4):433–45. https://doi.org/10.1037/pst0000032.

    Article  Google Scholar 

  33. 33.

    Meredith LS, Eisenman DP, Han B, Green BL, Kaltman S, Wong EC, et al. Impact of collaborative care for underserved patients with PTSD in primary care: a randomized controlled trial. J Gen Intern Med. 2016;31(5):509–17. https://doi.org/10.1007/s11606-016-3588-3.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Mitchell KS, Dick AM, DiMartino DM, Smith BN, Niles B, Koenen KC, Street A. A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. J Trauma Stress. 2014;27(2):121–128. https://doi.org/10.1002/jts.21903.

  35. 35.

    Morath J, Gola H, Sommershof A, Hamuni G, Kolassa S, Catani C, et al. The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD: evidence from a randomized controlled trial. J Psychiatr Res. 2014;54:1–10. https://doi.org/10.1016/j.jpsychires.2014.03.016.

    Article  PubMed  Google Scholar 

  36. 36.

    Mueser KT, Gottlieb JD, Xie H, Lu W, Yanos PT, Rosenberg SD, et al. Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. Br J Psychiatry J Ment Sci. 2015;206(6):501–8. https://doi.org/10.1192/bjp.bp.114.147926.

    Article  Google Scholar 

  37. 37.

    Nieminen K, Berg I, Frankenstein K, Viita L, Larsson K, Persson U, et al. Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial. Cogn Behav Ther. 2016;45(4):287–306. https://doi.org/10.1080/16506073.2016.1169626.

    Article  PubMed  Google Scholar 

  38. 38.

    Olden M, Wyka K, Cukor J, Peskin M, Altemus M, Lee FS, et al. Pilot study of a telehealth-delivered medication-augmented exposure therapy protocol for PTSD. J Nerv Ment Dis. 2017;205(2):154–60. https://doi.org/10.1097/NMD.0000000000000563.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    • Popiel A, Zawadzki B, Pragłowska E, Teichman Y. Prolonged exposure, paroxetine and the combination in the treatment of PTSD following a motor vehicle accident. A randomized clinical trial - The “TRAKT” study. J Behav Ther Exp Psychiatry. 2015;48:17–26. https://doi.org/10.1016/j.jbtep.2015.01.002 The largest study of exposure therapy; the most common treatment for PTSD is in this review. PE has higher rates of remission than pharmacotherapy, and with lower rates of refusal to treatment than paroxetine.

    Article  PubMed  Google Scholar 

  40. 40.

    Powers MB, Medina JL, Burns S, Kauffman BY, Monfils M, Asmundson GJG, et al. Exercise augmentation of exposure therapy for PTSD: rationale and pilot efficacy data. Cogn Behav Ther. 2015;44(4):314–27. https://doi.org/10.1080/16506073.2015.1012740.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Resick PA, Suvak MK, Wells SY. The impact of childhood abuse among women with assault-related PTSD receiving short-term cognitive-behavioral therapy. J Trauma Stress. 2014;27(5):558–67. https://doi.org/10.1002/jts.21951.

    Article  PubMed  Google Scholar 

  42. 42.

    Rosaura Polak A, Witteveen AB, Denys D, Olff M. Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study. Appl Psychophysiol Biofeedback. 2015;40(1):25–31. https://doi.org/10.1007/s10484-015-9268-y.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial. Acta Psychiatr Scand. 2015;131(5):350–9. https://doi.org/10.1111/acps.12371.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Sack M, Zehl S, Otti A, Lahmann C, Henningsen P, Kruse J, et al. A comparison of dual attention, eye movements, and exposure only during eye movement desensitization and reprocessing for posttraumatic stress disorder: results from a randomized clinical trial. Psychother Psychosom. 2016;85(6):357–65. https://doi.org/10.1159/000447671.

    Article  PubMed  Google Scholar 

  45. 45.

    Schneier FR, Campeas R, Carcamo J, Glass A, Lewis-Fernandez R, Neria Y, et al. Combined mirtazapine and SSRI treatment of PTSD: a placebo-controlled trial. Depress Anxiety. 2015;32(8):570–9. https://doi.org/10.1002/da.22384.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Schubert SJ, Lee CW, de Araujo G, Butler SR, Taylor G, Drummond PD. The effectiveness of eye movement desensitization and reprocessing therapy to treat symptoms following trauma in Timor Leste. J Trauma Stress. 2016;29(2):141–8. https://doi.org/10.1002/jts.22084.

    Article  PubMed  Google Scholar 

  47. 47.

    Sonne C, Carlsson J, Bech P, Elklit A, Mortensen EL. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study. BMC Psychiatry. 2016;16(1):383. https://doi.org/10.1186/s12888-016-1081-5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Spence J, Titov N, Johnston L, Jones MP, Dear BF, Solley K. Internet-based trauma-focused cognitive behavioural therapy for PTSD with and without exposure components: a randomised controlled trial. J Affect Disord. 2014;162:73–80. https://doi.org/10.1016/j.jad.2014.03.009.

    Article  PubMed  Google Scholar 

  49. 49.

    Ter Heide FJJ, Mooren TM, van de Schoot R, de Jongh A, Kleber RJ. Eye movement desensitisation and reprocessing therapy v. stabilisation as usual for refugees: randomised controlled trial. Br J Psychiatry J Ment Sci. 2016;209(4):311–8. https://doi.org/10.1192/bjp.bp.115.167775.

    Article  Google Scholar 

  50. 50.

    van den Berg DPG, de Bont PAJM, van der Vleugel BM, de Roos C, de Jongh A, Van Minnen A, et al. Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72(3):259–67. https://doi.org/10.1001/jamapsychiatry.2014.2637.

    Article  PubMed  Google Scholar 

  51. 51.

    van der Kolk BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, et al. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. 2014;75(6):e559–65. https://doi.org/10.4088/JCP.13m08561.

    Article  PubMed  Google Scholar 

  52. 52.

    van der Kolk BA, Hodgdon H, Gapen M, Musicaro R, Suvak MK, Hamlin E, et al. A randomized controlled study of neurofeedback for chronic PTSD. PLoS One. 2016;11(12):e0166752. https://doi.org/10.1371/journal.pone.0166752.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Wolff N, Huening J, Shi J, Frueh BC, Hoover DR, McHugo G. Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men. J Anxiety Disord. 2015;30:66–80. https://doi.org/10.1016/j.janxdis.2014.10.009.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Wu KK, Li FW, Cho VW. A randomized controlled trial of the effectiveness of brief-CBT for patients with symptoms of posttraumatic stress following a motor vehicle crash. Behav Cogn Psychother. 2014;42(1):31–47. https://doi.org/10.1017/S1352465812000859.

    Article  PubMed  Google Scholar 

  55. 55.

    Zatzick D, O'Connor SS, Russo J, Wang J, Bush N, Love J, Peterson R, Ingraham L, Darnell D, Whiteside L, Van Eaton E. Technology-enhanced stepped collaborative care targeting posttraumatic stress disorder and comorbidity after injury: a randomized controlled trial. J Trauma Stress. 2015;28(5):391–400. https://doi.org/10.1002/jts.22041.

  56. 56.

    Zang Y, Hunt N, Cox T. Adapting narrative exposure therapy for Chinese earthquake survivors: a pilot randomised controlled feasibility study. BMC Psychiatry. 2014;3(14):262–263. https://doi.org/10.1186/s12888-014-0262-3.

  57. 57.

    Zoellner LA, Telch M, Foa EB, Farach FJ, McLean CP, Gallop R, et al. Enhancing extinction learning in posttraumatic stress disorder with brief daily imaginal exposure and methylene blue: a randomized controlled trial. J Clin Psychiatry. 2017;78(7):e782–9. https://doi.org/10.4088/JCP.16m10936.

    Article  PubMed  Google Scholar 

  58. 58.

    Cognitive Behavioral Therapy (CBT) for Treatment of PTSD. n.d. Retrieved July 17, 2018, from http://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy.aspx.

  59. 59.

    Cognitive Processing Therapy (CPT). n.d. Retrieved July 17, 2018, from http://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy.aspx.

  60. 60.

    Zhang Y, Feng B, Xie J-P, Xu F-Z, Chen J. Clinical study on treatment of the earthquake-caused post-traumatic stress disorder by cognitive-behavior therapy and acupoint stimulation. J Tradit Chin Med = Chung I Tsa Chih Ying Wen Pan. 2011;31(1):60–3.

    PubMed  Google Scholar 

  61. 61.

    Raes F, Williams JMG, Hermans D. Reducing cognitive vulnerability to depression: a preliminary investigation of MEmory specificity training (MEST) in inpatients with depressive symptomatology. J Behav Ther Exp Psychiatry. 2009;40(1):24–38. https://doi.org/10.1016/j.jbtep.2008.03.001.

    Article  PubMed  Google Scholar 

  62. 62.

    EMDR Institute. Retrieved July, 2018, from http://www.emdr.com/

  63. 63.

    Najavits LM. Seeking safety: a treatment manual for PTSD and substance abuse. New York: Guilford Press; 2002.

    Google Scholar 

  64. 64.

    Hien DA, Levin FR, Ruglass LM, López-Castro T, Papini S, Hu M-C, et al. Combining seeking safety with sertraline for PTSD and alcohol use disorders: a randomized controlled trial. J Consult Clin Psychol. 2015;83(2):359–69. https://doi.org/10.1037/a0038719.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults: (501872017-001). [Data set]. American Psychological Association. 2017. https://doi.org/10.1037/e501872017-001.

  66. 66.

    Asnis GM, Kohn SR, Henderson M, Brown NL. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs. 2004;64(4):383–404.

    CAS  Article  Google Scholar 

  67. 67.

    Zatzick D, Jurkovich G, Rivara FP, Russo J, Wagner A, Wang J, et al. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg. 2013;257(3):390–9. https://doi.org/10.1097/SLA.0b013e31826bc313.

    Article  PubMed  PubMed Central  Google Scholar 

  68. 68.

    Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, et al. Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuro-Psychopharmacol Biol Psychiatry. 2009;33(2):169–80. https://doi.org/10.1016/j.pnpbp.2008.12.004.

    CAS  Article  Google Scholar 

  69. 69.

    Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) | National Heart, Lung, and Blood Institute (NHLBI). n.d. Retrieved July 17, 2018, from https://www.nhlbi.nih.gov/science/antihypertensive-and-lipid-lowering-treatment-prevent-heart-attack-trial-allhat.

  70. 70.

    Nestler EJ, Hyman SE, Holtzman DM, Malenka RC. Reinforcement and addictive disorders. In Molecular Neuropharmacology: A Foundation for Clinical Neuroscience. 3rd ed. New York: McGraw-Hill Education; 2015. Retrieved from https://neurology.mhmedical.com/content.aspx?aid=1105916764

    Google Scholar 

  71. 71.

    Mitchell KS, Dick AM, DiMartino DM, Smith BN, Niles B, Koenen KC, et al. A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. J Trauma Stress. 2014;27(2):121–8. https://doi.org/10.1002/jts.21903.

    Article  PubMed  Google Scholar 

  72. 72.

    Le QA, Doctor JN, Zoellner LA, Feeny NC. Cost-effectiveness of prolonged exposure therapy versus pharmacotherapy and treatment choice in posttraumatic stress disorder (the optimizing PTSD treatment trial): a doubly randomized preference trial. The Journal of Clinical Psychiatry. 2014;75(3):222–30. https://doi.org/10.4088/JCP.13m08719.

    Article  PubMed  Google Scholar 

  73. 73.

    Dale LP, Carroll LE, Galen GC, Schein R, Bliss A, Mattison AM, et al. Yoga practice may buffer the deleterious effects of abuse on women’s self-concept and dysfunctional coping. J Aggress Maltreat Trauma. 2011;20(1):90–102. https://doi.org/10.1080/10926771.2011.538005.

    Article  Google Scholar 

  74. 74.

    Van Der Kolk BA. Trauma and memory. Psychiatry Clin Neurosci. 1998;52:S52–64. https://doi.org/10.1046/j.1440-1819.1998.0520s5S97.x.

    Article  Google Scholar 

  75. 75.

    • Michopoulos V, Powers A, Gillespie CF, Ressler KJ, Jovanovic T. Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond. Neuropsychopharmacology. 2017;42(1):254–70. https://doi.org/10.1038/npp.2016.146 The relationship between inflammation and symptom severity is a new target both for treatment and as use for predicting development of trauma-related disorders shortly following a trauma. Somatically engaging interventions may be well-suited to address inflammation.

    CAS  Article  PubMed  Google Scholar 

  76. 76.

    Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2013;26(3):299–309.

    Article  Google Scholar 

  77. 77.

    Dai W, Kaminga AC, Tan H, Wang J, Lai Z, Wu X, et al. Comorbidity of post-traumatic stress disorder and anxiety in flood survivors. Medicine. 2017;96(36). https://doi.org/10.1097/md.0000000000007994.

Download references

Acknowledgments

The editors would like to thank Dr. Jennifer Severe for taking the time to review this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Lana Ruvolo Grasser.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Grasser, L.R., Javanbakht, A. Treatments of Posttraumatic Stress Disorder in Civilian Populations. Curr Psychiatry Rep 21, 11 (2019). https://doi.org/10.1007/s11920-019-0994-3

Download citation

Keywords

  • PTSD
  • Psychotherapy
  • Pharmacotherapy
  • Precision medicine
  • Trauma
  • Alternative therapy