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Current Treatment Options in Psychiatry

, Volume 6, Issue 3, pp 179–187 | Cite as

Brief Novel Therapies for PTSD—Treatment of PTSD in Primary Care

  • Ashley L. Fedynich
  • Jeffrey A. CigrangEmail author
  • Sheila A. M. Rauch
PTSD (S Creech and L Sippel, Section Editors)
  • 43 Downloads
Part of the following topical collections:
  1. Topical Collection on PTSD

Abstract

Purpose

The prevalence of posttraumatic stress disorder (PTSD) among patients in primary care clinics is higher than that of the general population and many people prefer to get mental health care in primary care, creating a unique opportunity to identify and treat the disorder. Current treatment guidelines recommend psychotherapy as a first-line treatment for PTSD; however, there is a limited amount of research examining effective psychotherapy treatment protocols for PTSD within primary care. This review aims to examine the existing literature for the treatment of PTSD in primary care and discuss ongoing dissemination efforts for primary care mental health providers.

Recent findings

Prolonged Exposure for Primary Care (PE-PC) has adapted the traditional PE model for use in primary care. We conducted the first randomized controlled trial examining the effectiveness of a PTSD treatment protocol for primary care (PE-PC) among active duty service members with PTSD which demonstrated significant decreases in PTSD symptomology compared with a control group. Service members receiving PE-PC showed significantly larger reductions in self-reported PTSD symptoms in PE-PC compared with minimal attention control and were more likely to no longer meet diagnostic criteria for PTSD following the four-session intervention.

Summary

While there is limited research examining the treatment of PTSD within primary care, PE-PC has demonstrated efficacy. This intervention provides a proven effective PTSD treatment option for primary care that promises to expand access to patients who are likely to never follow through to complete care in another setting (such as specialty mental health). Additional clinical trials are underway to replicate and expand results. Implementation and dissemination efforts are ongoing and under empirical examination as well within DoD, VA, and civilian primary care settings.

Keywords

Posttraumatic stress disorder Primary care Brief therapy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ashley L. Fedynich, Jeffrey A. Cigrang, and Sheila A. M. Rauch 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.

References and Recommended Reading

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

  1. 1.
    Calhoun PS, Bosworth HB, Grambow SC, Dudley TK, Beckham JC. Medical service utilization by veterans seeking help for posttraumatic stress disorder. Am J Psychiatr. 2002;159(12):2081–6.  https://doi.org/10.1176/appi.ajp.159.12.2081.CrossRefPubMedGoogle Scholar
  2. 2.
    Kimberling R, Calhoun KS. Somatic symptoms, social support, and treatment seeking among sexual assault victims. J Consult Clin Psychol. 1994;62(2):333–40.  https://doi.org/10.1037//0022-006X.62.2.333.CrossRefGoogle Scholar
  3. 3.
    Schnurr PP, Friedman MJ, Sengupta A, Jankowski M, Holmes T. PTSD and utilization of medical treatment services among male Vietnam veterans. J Nerv Ment Dis. 2000;188(8):496–504.  https://doi.org/10.1097/00005053-200008000-00004.CrossRefPubMedGoogle Scholar
  4. 4.
    Bohnert KM, Sripada RK, Mach J, McCarthy JF. Same-day integrated mental helath care and PTSD diagnosis and treatment among VHA primary care patients with positive PTSD screens. Psychiatr Serv. 2016;67(1):94–100.  https://doi.org/10.1176/appi.ps.201500035.CrossRefPubMedGoogle Scholar
  5. 5.
    Han B, Wong EC, Mao Z, Meredith LS, Cassells A, Tobin JN. Validation of a brief PTSD screener for underserved patients in federally qualified health centers. Gen Hosp Psychiatry. 2016;38:84–8.  https://doi.org/10.1016/J.GENHOSPPSYCH.2015.07.009.CrossRefPubMedGoogle Scholar
  6. 6.
    Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults. Psychological Bulletin. 2003;129(1):52–73.  https://doi.org/10.1037/a0027649.
  7. 7.
    Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Mental health treatment received by primary care patients with posttraumatic stress disorder. J Clin Psychiatry. 2003;64:1230–6.  https://doi.org/10.4088/JCP.v64n1014.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    VA/DoD. Clinical practice guideline for management of post-traumatic stress. 2010. Retrieved from https://www.healthquality.va.gov/guidelines/MH/ptsd/cpgPTSDFULL201011612c.pdf Accessed January 13, 2019
  9. 9.
    VA/DoD. Clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. 2017. Retrieved from: https://www.healthquality.va.gov/guidelined/mh/ptsd. Accessed January 13, 2019
  10. 10.
    American Psychological Association. Clinical practice guideline for the treatment of PTSD. 2017. Retrieved from https://www.apa.org/ptsd-guideline/ptsd.pdf Accessed January 13, 2019
  11. 11.
    International Society for Traumatic Stress Studies. Posttraumatic stress disorder prevention and treatment guidelines: methodology and recommendations. 2019. Retrieved from http://www.istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL-March-19-2019.pdf.aspx. Accessed January 13, 2019
  12. 12.
    Greene T, Neria T, Gross R. Prevalence, detection and correlates of PTSD in the primary care setting: a systematic review. J Clin Psychol Med Settings. 2016;23(2):160–80.  https://doi.org/10.1007/s10880-016-9449-8.CrossRefPubMedGoogle Scholar
  13. 13.
    Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC. Association of post-traumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatr. 2007;164:150–3.  https://doi.org/10.1176/appi.ajp.164.1.150.CrossRefPubMedGoogle Scholar
  14. 14.
    Possemato K. The current state of intervention research for posttraumatic stress disorder within the primary care setting. J Clin Psychol Med Settings. 2011;18:268–80.  https://doi.org/10.1007/s10880-011-9237-4.CrossRefPubMedGoogle Scholar
  15. 15.
    Sayer NA, Friedemann-Sanchez G, Spoont M, Murdoch M, Parker LE, Chiros C, et al. A qualitative study of determinates of PTSD treatment initiation in veterans. Psychiatry. 2009;72:238–55.  https://doi.org/10.1521/psyc.2009.72.3.238.
  16. 16.
    National Institute for Health and Care Excellence. Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care (NICE clinical guideline 26). London: Gaskell; 2005.Google Scholar
  17. 17.
    Hoffman V, Middleton JC, Feltner C, Gaynes BN, Weber RP, Bann C, et al. Psychological and pharmacological treatments for adults with posttraumatic stress disorder: A systematic review update. AHRQ Publication No. 18-EHC011-EF. PCORI Publication No. 2018-SR-01. Rockville: Agency for Healthcare Research and Quality; 2018.Google Scholar
  18. 18.
    •• Cigrang JA, Rauch SAM, Mintz J, Mitchell JA, Najera E, Litz BT, et al. Moving effective treatment for posttraumatic stress disorder to primary care: a randomized controlled trial with active duty military. Fam Syst Health. 2017;35(4):450–62.  https://doi.org/10.1037/FSH0000315 First randomized controlled trial examining the effectiveness of Prolonged Exposure for Primary Care.
  19. 19.
    Hunter CL, Goodie JL, Oordt MS, Dobmeyer AC. Integrative behavioral health in primary care: step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association; 2014.Google Scholar
  20. 20.
    • Corso KA, Bryan CJ, Morrow CE, Appolonio KK, Dodendorf DM, Baker MT. Managing posttraumatic stress disorder symptoms in active-duty military personnel in primary care settings. J Ment Health Couns. 2009;31(2):119–37.  https://doi.org/10.17744/mehc.31.2.1m2238t85rv38041 Review of findings from two brief writing interventions for PTSD in primary care.
  21. 21.
    • Harmon AL, Goldstein ESR, Shiner B, Watts BV. Preliminary findings for a brief posttraumatic stress intervention in primary mental health care. Psychol Serv. 2014;11(3):295–9.  https://doi.org/10.1037/a0035846 Review of findings from a brief trauma treatment for PTSD in primary care.
  22. 22.
    Schnurr PP, Friedman MJ, Oxman TE, Dietrich AJ, Smith MW, Shiner B, et al. RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial. J Gen Med. 2012;28(1):32–40.  https://doi.org/10.1007/s11606-012-2166-6.CrossRefGoogle Scholar
  23. 23.
    Oxman TE, Dietrich AJ, Williams JW, Kroenke K. A three-component model for reengineering systems for the treatment of depression in primary care. Psychosomatics: Journal of Consultation and Liaison. 2002;43(6):441–50.  https://doi.org/10.1176/appi.psy.43.6.441.
  24. 24.
    Dietrich AJ, Oxman TE, Williams JW, Schulberg HC, Bruce ML, Lee PW, et al. Re-engineering systems for the treatment of depression in primary care: cluster randomized controlled trial. Br Med J. 2004;329(7466):618–22.  https://doi.org/10.1136/bmj.38219.481250.55.CrossRefGoogle Scholar
  25. 25.
    •• Cigrang JA, Rauch SAM, Avila LL, Bryan CJ, Goode JL, Hryshko-Mullen A, et al. Treatment of active duty military with PTSD in primary care: early findings. Psychol Serv. 2011;8(2):104–13.  https://doi.org/10.1037/a0022740 Preliminary results from the pilot study of Prolonged Exposure for Primary Care.
  26. 26.
    Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6:459–73.  https://doi.org/10.1007/BF00974317.CrossRefGoogle Scholar
  27. 27.
    •• Cigrang JA, Rauch SAM, Mintz J, Brundige A, Avila LL, Bryan CJ, et al. Treatment of active duty military with PTSD in primary care: A follow-up report. J Anxiety Disord. 2015;36:110–4.  https://doi.org/10.1016/J.JANXDIS.2015.10.003 Follow-up results from the Prolonged Exposure for Primary Care pilot study including 1-month and 6-month follow-ups.
  28. 28.
    Cahill SP, Foa EB. Psychological theories of PTSD. In: Friedman MJ, Keane TM, Resick PA, editors. Handbook of PTSD; science and practice. New York: Guilford Press; 2007.Google Scholar
  29. 29.
    Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized clinical trial. J Am Med Assoc. 2007;297:820–30.  https://doi.org/10.1001/jama.297.8.820.CrossRefGoogle Scholar
  30. 30.
    Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences. New York: Oxford University Press; 2007.Google Scholar
  31. 31.
    Sloan DM, Marx BP, Lee DJ, Resick PA. A brief exposure-based treatment vs. cognitive processing therapy for posttraumatic stress disorder: a randomized noninferiority clinical trial. JAMA Psychiatry. 2018;75(3):233–9.  https://doi.org/10.1001/jamapsychiatry.2017.4249.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Resick PA, Monson CM, Chard KM. Cognitive processing therapy for PTSD: a comprehensive manual. New York: The Guilford Press; 2016.Google Scholar
  33. 33.
    Gillock KL, Zayfert C, Hegel MT, Ferguson RJ. Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization. Gen Hosp Psychiatry. 2005;27:392–9.  https://doi.org/10.1016/J.GENHOSPPSYCH.2005.06.004.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ashley L. Fedynich
    • 1
  • Jeffrey A. Cigrang
    • 1
    Email author
  • Sheila A. M. Rauch
    • 2
    • 3
  1. 1.Wright State UniversityDaytonUSA
  2. 2.Emory University School of MedicineAtlantaUSA
  3. 3.Atlanta VA Medical CenterAtlantaUSA

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