Women Soldiers' Response to Treatment for PTSD

Psychiatric Times
By Peggy Peck
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Feb 28, 2007

WHITE RIVER JUNCTION, Vt., Feb. 28 -- For women soldiers being treated for post-traumatic stress disorder, symptoms improve when the therapy homes in on the original index event, no matter how long ago it occurred, researchers here found.

Compared with therapy that aimed at coping with PTSD symptoms in daily life, women whose therapy focused on the past traumatic events reduced symptoms by more than 70% (effect size, 0.27, P=0.03), investigators reported in the Feb. 28 issue of the Journal of the American Medical Association.

Moreover, the women who underwent "prolonged exposure" therapy were also about two-and-half times more likely to achieve total remission (15.2% versus 6.9%; odds ratio 2.43; 95% confidence interval, 1.10-5.37, P=0.01), said Paula P. Schnurr, Ph.D., of the National Center for PTSD at the VA Medical Center here, and colleagues.

The "maximum benefits of prolonged exposure are observed immediately after treatment and persist over time," she said.

But while the prolonged exposure therapy was more effective, it also had significantly higher dropout rate: 38% versus 21% (P=0.002).

The study randomized 277 women veterans and seven active duty women soldiers to either prolonged exposure or present-centered therapy. The mean age of women was 45 and roughly 31% were married.

The women were enrolled and treated from August 2002 through October 2005 at nine VA medical centers, two VA readjustment counseling centers, and one military hospital.
Both therapies were delivered according to standard protocols in 10 weekly 90-minutes sessions.

"Prolonged exposure included education about common reactions to trauma, breathing retraining; prolonged (repeated) recounting (imaginal exposure) of trauma memories during sessions; homework (listening to a recording of the recounting made during the therapy session and repeated in vivo exposure to safe situations the patient avoids because of trauma-related fear); and discussion of thoughts and feelings related to exposure exercises," they wrote.
By contrast, the present-centered therapy focused "on current life problems as manifestations of PTSD."

Sexual trauma was identified as the "worst" trauma exposure by 68.3% of the women, followed by physical assault (15.8%) and war zone exposure (5.6%). The index trauma usually occurred more than 22 years before the women were enrolled in the study.

The high rate of sexual trauma exposure tracked closely studies of PTSD in civilian women, but Dr. Schnurr pointed that 70% women in this study said their sexual trauma exposure was associated with military service.

The study was limited by the small number of active duty women included-the authors theorized that active duty soldiers might be reluctant to seek treatment because they were "worried about the stigmatizing effects of PTSD, a concern that has been expressed by soldiers serving in Iraq and Afghanistan."

Active duty soldiers, they explained, were likely to be younger than veterans and might have responded differently to the two treatments.

The study was also limited by a higher dropout rate in the prolonged exposure arm, and by the fact that the study was limited to women. But Dr. Schnurr said the findings could "with some caution" be extended to men because published studies suggested that cognitive behavioral therapy was an effective treatment for PTSD in men.

The study was funded by the VA Cooperative Studies Program and the Department of Defense. Dr. Schnurr and reported funding from the Department of Veterans Affairs. Some of her co-authors reported funding from the Department of Defense and three co-authors -- Matthew J. Friedman, M.D., Ph.D., Edna B. Foa, Ph.D., and Patricia A. Resick, Ph.D. -- published books on PTSD treatment for which they received income.