When people with post-traumatic stress disorder (PTSD) choose their own treatment — be it medication or counseling — they respond better, a new study finds.
The study included 200 adult patients, including military veterans and survivors of sexual assault, seen at outpatient clinics in Seattle and Cleveland.
They were asked if they preferred treatment with the antidepressant sertraline (Zoloft) or 10 weeks of prolonged exposure counseling therapy.
In this type of counseling, patients are encouraged to talk about what happened to them, taught coping strategies, and explore their thoughts and feelings by revisiting the memory and reminders of the trauma that triggered their PTSD.
The patients were then assigned to either a group in which they received their preferred treatment or to a group in which they were randomly selected to receive either medication or counseling.
Two years after their last session, 70 percent of the patients who received counseling were free of PTSD, compared with 55 percent of those who started and remained on medication through the two years of follow-up.
Treatment preference made a significant difference. The researchers found that 74 percent of those who wanted and received counseling were PTSD-free, compared with 37 percent of those who wanted counseling but received medication instead.
Receiving their choice of treatment appeared to affect patients’ commitment. Nearly 75 percent of those who received their preferred therapy completed their full treatment program, while more than half of those who did not receive their preferred therapy completed the course of treatment.
The study was published recently in the American Journal of Psychiatry.
“In any form of health care, when receiving a recommendation from a provider, patients may or may not be given a choice of approaches to address their problems,” said study author Lori Zoellner, director of the University of Washington’s Center for Anxiety and Traumatic Stress.
“This research suggests that prolonged exposure and sertraline are both good, evidence-based options for PTSD treatment — and that providing information to make an informed choice enhances long-term outcomes,” Zoellner said in a university news release.
The findings show the importance of tailoring PTSD treatment to the patient, said study co-author Norah Feeny, a psychology professor at Case Western Reserve University in Cleveland.
The study “showed that we’ve got two effective, very different interventions for chronic PTSD and associated difficulties,” she said.
“Given this, and the fact that getting a treatment you prefer confers significant benefit, we are now able to move toward better personalized treatment for those suffering after trauma. These findings have significant public health impact and should inform practice,” Feeny concluded.