Advocates of Research-Supported Treatments for PTSD are Losing in Lots of Ways: What Are We Going to Do About It?

Abstract

Most individuals with posttraumatic stress disorder (PTSD) do not receive science-based treatment. This is a massive problem and the systems and individuals best able to address it misunderstand key components of the problem. Advocates of Research Supported Treatments (ARSTs) have substantial influence/authority in federal agencies, university settings, and medical centers and limited influence/authority with the public at large and with many providers, especially those in private practice settings. Figures such as Bessel van der Kolk and Peter Levine, who are not consistently science-based, have limited influence in government and research settings and enormous influence with the public and many individual providers. We see such figures as a main contributor to the problem. We consider four responses, (1) ARST collective action, (2) aim to reduce influence of non-ARSTs, (3) dialogue with non-ARSTs, and (4) maintain current practices. We argue for prioritizing ARST collective action. This could increase usage of high-quality PTSD treatment.

Keywords

PTSD evidence-based practice research-supported treatment collective action

Get full access to this article

View all access options for this article.

References

Bisson

J. I.

van Gelderen

Roberts

N. P.

Lewis

(2020). Non-pharmacological and non-psychological approaches to the treatment of PTSD: Results of a systematic review and meta-analyses. European Journal of Psychotraumatology, 11(1), 1795361. https://doi.org/10.1080/20008198.2020.1795361

Bledsoe

S. E.

Weissman

M. M.

Mullen

E. J.

Ponniah

Gameroff

M. J.

Verdeli

Wickramaratne

(2007). Empirically supported psychotherapy in social work training programs: Does the definition of evidence matter? Research on Social Work Practice, 17(4), 449–455. https://doi.org/10.1177/1049731506299014

Borah

E. V.

Holder

Chen

(2017). Providers’ use of evidence-based treatments for posttraumatic stress disorder: The influence of training, attitudes, and barriers in military and private treatment settings. Best Practices in Mental Health, 13(1), 34–46.

Brom

Stokar

Lawi

Nuriel-Porat

Ziv

Lerner

Ross

(2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312. https://doi.org/10.1002/jts.22189

Burgens

(2023, May 18). Want to fix your mind? Let your body talk. The New York Times Magazine. https://www.nytimes.com/2023/05/18/magazine/somatic-therapy.html.

Carr

(2023, July 31). Tell me why it hurts: How Bessel van der Kolk’s once controversial theory became the dominant way we make sense of our lives. The New York Magazine. https://nymag.com/intelligencer/article/trauma-bessel-van-der-kolk-the-body-keeps-the-score-profile.html.

Chard

K. M.

Kaysen

D. L.

Galovski

T. E.

Nixon

R. D. V.

Monson

C. M.

(2020). Cognitive processing therapy. In Forbes

Bisson

J. I.

Monson

C. M.

Berliner

(Eds.), Effective treatments for PTSD: Practice guidelines from the international society for traumatic stress studies (pp. 210–233). The Guilford Press.

Clapp

J. D.

Kemp

J. J.

Cox

K. S.

Tuerk

P. W.

(2016). Patterns of change in response to prolonged exposure: Implications for treatment outcome. Depression and Anxiety, 33(9), 807–815. https://doi.org/10.1002/da.22534

Codd

R. T. III.

(2017). Protecting the scientific lexical canon. The Behavior Therapist, 40(5), 185–191.

10.

Cook

S. C.

Schwartz

A. C.

Kaslow

N. J.

(2017). Evidence-based psychotherapy: Advantages and challenges. Neurotherapeutics, 14, 537–545. https://doi.org/10.1007/s13311-017-0549-4

11.

Council for Training in Evidence-Based Behavioral Practice. https://ebbp.org/home/council .

12.

Cox

K. S.

Wangelin

B. C.

Keller

S. M.

Lozano

B. E.

Murphy

M. M.

Maher

E. K.

Tuerk

P. W.

(2020). Emotional processing of imaginal exposures predicts symptom improvement: Therapist ratings can assess trajectory in prolonged exposure for posttraumatic stress disorder. Journal of Traumatic Stress, 33(3), 338–344. https://doi.org/10.1002/jts.22493

13.

Cox

K. S.

Wiener

Rauch

Tuerk

P. W.

Wangelin

Acierno

(2021). Individual symptom reduction and post-treatment severity: Varying levels of symptom amelioration in response to prolonged exposure for post-traumatic stress disorder. Psychological Services, 20(1), 94–106. https://doi.org/10.1037/ser0000579

14.

CSWE (2022). Educational policy and accreditation standards. Council on Social Work Education. https://www.cswe.org/getmedia/94471c42-13b8-493b-9041-b30f48533d64/2022-EPAS.pdf .

15.

Cuijpers

Veen

S. C. V.

Sijbrandij

Yoder

Cristea

I. A.

(2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165–180. https://doi.org/10.1080/16506073.2019.1703801

16.

Cummins

(2021). The Self-Help That No One Needs Right Now. The Atlantic, 18.

17.

Downey

Crummy

(2022). The impact of childhood trauma on children's wellbeing and adult behavior. European Journal of Trauma & Dissociation, 6(1), 100237. https://doi.org/10.1016/j.ejtd.2021.100237

18.

Drisko

J. W.

Grady

M. D.

(2019). Evidence-based practice in clinical social work. Springer.

19.

Duval

E. R.

Sheynin

King

A. P.

Phan

K. L.

Simon

N. M.

Martis

Rauch

S. A.

(2020). Neural function during emotion processing and modulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder. Depression and Anxiety, 37(7), 670–681. https://doi.org/10.1002/da.23022

20.

Egan

(2021, July 8). Does a writer ever get cozy on the best-seller list? Bessel van der Kolk says no. The New York Times. The New York Times. https://www.nytimes.com/2021/07/08/books/review/the-body-keeps-score-bessel-van-der-kolk.html

21.

Foa

E. B.

Kozak

M. J.

(1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. https://doi.org/10.1037/0033-2909.99.1.20

22.

Forbes

Bisson

J. I.

Monson

C. M.

Berliner

(eds.). (2020). Effective treatments for PTSD. Guilford Publications.

23.

Frank

H. E.

Becker-Haimes

E. M.

Kendall

P. C.

(2020). Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology: Science and Practice, 27(3), e12330. https://doi.org/10.1111/cpsp.12330

24.

Friedberg

R. D.

Bayar

(2017). If it works for pills, can it work for skills? Direct-to-consumer social marketing of evidence-based psychological treatments. Psychiatric Services, 68(6), 621–623. https://doi.org/10.1176/appi.ps.201600153

25.

GADE (2023). Quality Guidelines for PhD Programs. Group for the Advancement of Doctoral Education in Social Work. https://www.gadesocialwork.org/Portals/0/docs/GADE%20PhD%20Program%20Quality%20Guidelines%202023%20Revised.pdf .

26.

Grinnell

R. M.

Unrau

Y. A.

(2018). Social work research and evaluation: Foundations of evidence-based practice. Oxford University Press.

27.

Insel

T. R.

(2022). Healing: Our path from mental illness to mental health. Penguin Press.

28.

Kenchel

J. M.

Domagalski

Butler

B. J.

Loftus

E. F.

(2022). The messy landscape of eye movements and false memories. Memory, 30(6), 1–8. https://doi.org/10.1080/09658211.2020.1862234

29.

Lancaster

C. L.

Gros

D. F.

Mullarkey

M. C.

Badour

C. L.

Killeen

T. K.

Brady

K. T.

Back

S. E.

(2020). Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders? Behavioural and Cognitive Psychotherapy, 48(1), 38–53. https://doi.org/10.1017/S1352465819000304

30.

Larsen

S. E.

Stirman

S. W.

Smith

B. N.

Resick

P. A.

(2016). Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. behaviour. Research and Therapy, 77, 68–77. https://doi.org/10.1016/j.brat.2015.12.009

31.

Lee

C. W.

Cuijpers

(2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239. https://doi.org/10.1016/j.jbtep.2012.11.001

32.

Levine

P. A.

(2015). Trauma and memory: Brain and body in a search for the living past: A practical guide for understanding and working with traumatic memory. North Atlantic Books.

33.

Lilienfeld

S. O.

Ritschel

L. A.

Lynn

S. J.

Cautin

R. L.

Latzman

R. D.

(2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33(7), 883–900. https://doi.org/10.1016/j.cpr.2012.09.008

34.

McLean

C. P.

Levy

H. C.

Miller

M. L.

Tolin

D. F.

(2022). Exposure therapy for PTSD: A meta-analysis. Clinical Psychology Review, 91, 102115. https://doi.org/10.1016/j.cpr.2021.102115

35.

McNally

R. J.

(2005). Remembering trauma. Harvard University Press.

36.

Monson, C. M., Resick, P. A., & Rizvi, S. L. (2014). Posttraumatic stress disorder. Clinical handbook of psychological disorders: A step-by-step treatment manual, pp. 62–113.

37.

Mullen

E. J.

(2015, November 21). Should social work be evidence-based? OUPblog. https://blog.oup.com/2015/11/social-work-evidence-based/.

38.

Okpych

N. J.

J. L.

(2014). A historical analysis of evidence-based practice in social work: The unfinished journey toward an empirically grounded profession. Social Service Review, 88(1), 3–58. https://doi.org/10.1086/674969

39.

Payne

Levine

P. A.

Crane-Godreau

M. A.

(2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 93, 1–18. https://doi.org/10.3389/fpsyg.2015.00093

40.

Rauch

Foa

(2006). Emotional Processing Theory (EPT) and Exposure Therapy for PTSD. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 36(2), 61–65. https://doi.org/10.1007/s10879-006-9008-y

41.

Riggs

D. S.

Tate

Chrestman

Foa

E. B.

(2020). Prolonged exposure. In Forbes

Bisson

J. I.

Monson

C. M.

,, & Berliner

(Eds.), Effective treatments for PTSD: Practice guidelines from the international society for traumatic stress studies (pp. 188–209). The Guilford Press.

42.

Rubin

Babbie

(2017). Research methods for social. Work. Cengage Learning.

43.

Sakaluk

J. K.

Williams

A. J.

Kilshaw

R. E.

Rhyner

K. T.

(2019). Evaluating the evidential value of empirically supported psychological treatments (ESTs): A meta-scientific review. Journal of Abnormal Psychology, 128(6), 500–509. https://doi.org/10.1037/abn0000421

44.

Sripada

R. K.

Bohnert

K. M.

Ganoczy

Pfeiffer

P. N.

(2018). Documentation of evidence-based psychotherapy and care quality for PTSD in the department of veterans affairs. Administration and Policy in Mental Health and Mental Health Services Research, 45(3), 353–361. https://doi.org/10.1007/s10488-017-0828-8

45.

Taylor

McLean

Korner

Stratton

Glozier

(2020). Mindfulness and yoga for psychological trauma: Systematic review and meta-analysis. Journal of Trauma & Dissociation, 21(5), 536–573. https://doi.org/10.1080/15299732.2020.1760167

46.

Thyer

B. A.

(1995). Promoting an empiricist agenda within the human services: An ethical and humanistic imperative. Journal of Behavior Therapy and Experimental Psychiatry, 26(2), 93–98. https://doi.org/10.1016/0005-7916(95)00010-W

47.

Thyer

B. A.

(2002). Evidence-based practice and clinical social work. BMJ Mental Health, 5(1), 6–7. https://doi.org/10.1136/ebmh.5.1.6

48.

Thyer

B. A.

Pignotti

(2011). Evidence-based practices do not exist. Clinical Social Work Journal, 39, 328–333. https://doi.org/10.1007/s10615-011-0358-x

49.

VA/DoD (2018). VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Clinician Summary. https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf.

50.

van der Kolk

(2014). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin UK.

51.

van der Kolk Laura

B. A.

West

Rhodes

Emerson

Suvak

Spinazzola

(2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of Clinical Psychiatry, 75(6), 22573. https://doi.org/10.1136/ebmh.5.1.6

52.

Wike

T. L.

Bledsoe

S. E.

Manuel

J. I.

Despard

Johnson

L. V.

Bellamy

J. L.

Killian-Farrell

(2014). Evidence-based practice in social work: Challenges and opportunities for clinicians and organizations. Clinical Social Work Journal, 42, 161–170. https://doi.org/10.1007/s10615-014-0492-3

53.

Wike

T. L.

Grady

Massey

Bledsoe

S. E.

Bellamy

J. L.

Stim

Putzu

(2019). Newly educated MSW social workers’ use of evidence-based practice and evidence-supported interventions: Results from an online survey. Journal of Social Work Education, 55(3), 504–518. https://doi.org/10.1080/10437797.2019.1600444

54.

Wolitzky-Taylor

Zimmermann

Arch

J. J.

De Guzman

Lagomasino

(2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9–17. https://doi.org/10.1016/j.brat.2015.06.010

55.

Zaccari

Sherman

A. D.

Febres-Cordero

Higgins

Kelly

(2022). Findings from a pilot study of trauma center trauma-sensitive yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women veterans. Complementary Therapies in Medicine, 70, 102850. https://doi.org/10.1016/j.ctim.2022.102850