Psychotherapies for Chronic Posttraumatic Stress Disorder (PTSD)
This randomized, controlled trial funded by the National Institute of Mental Health compares three different psychotherapy treatments for patients with chronic PTSD. A total of 165 patients will be assigned to prolonged exposure (PE), interpersonal psychotherapy (IPT), or relaxation therapy and treated over the course of 14 weeks. Independent evaluators blinded to study treatment condition will evaluate treatment response. Responders to treatment will be assessed three months later. Non-responders to treatment will be offered up to three months of alternative treatment at New York State Psychiatric Institute.
There is no cost to participate in the study aside from transportation to and from sessions and the need to complete assessment interviews and self-report instruments. All ratings and treatment are kept confidential.
Potential subjects receive initial screening over the phone by oral consent. Those who seem likely candidates then come in for a face-to-face evaluation, which requires written informed consent. An experienced psychiatrist takes a history, does a CAPS rating, and gets a urine toxicology screen. Reliably trained independent evaluators then do a SCID, SCID-II, and other ratings. Dr. Markowitz then meets with eligible candidates to obtain a separate informed written consent for the study.
Patients are randomly assigned to receive prolonged exposure (10 90-minute sessions over 14 weeks), interpersonal psychotherapy (14 50-minute sessions), or relaxation (nine 90-minute and one 30-minute session). Patients also need to fill out self-reports and come in for periodic evaluations, mainly at weeks seven and 14. We ask responders to come in for a further three-month evaluation, for which we offer $50 for the final independent evaluation and $25 for a final reflective function evaluation.
- Age 18-65
- Primary diagnosis of DSM-IV PTSD, chronic
- CAPS score >50 for at least 3 months
- Willingness and ability to give informed consent
- Diagnosis of schizophrenia, bipolar disorder, other psychotic disorders
- Primary diagnosis of major depressive disorder or major depression, melancholic subtype
- If patient meets criteria for both PTSD and MDD, absence of prominent criterion B (reexperiencing) and criterion C (numbing/avoidance) symptoms
- Psychiatric disorder due to a general medical condition
- Current substance abuse or dependence
- Acute suicide or homicide risk
- Unstable or life-threatening medical condition
- Primary diagnosis of borderline or antisocial personality disorder
- At least partial benefit from current treatment regimen
- Unwillingness to discontinue current ineffective psycho- or pharmacotherapy
- Inability to speak or read English