This letter to The Lancet Psychiatry (journal) comes from Dr. Jonanathan Shedler. It begins:
“In a Comment published in The Lancet Psychiatry, Scott Lilienfeld and colleagues1 wrote that I encouraged psychotherapists to ignore new practice guidelines for post-traumatic stress disorder (PTSD) because they relied inordinately on randomised controlled trials (RCTs). I did not urge therapists to ignore the guidelines because they relied on RCTs; I urged them to ignore the guidelines because research studies—the same RCTs they laud—show that the recommended therapies do not work for most patients.
The only therapies considered for the guidelines were brief (eight to 12 sessions), one-size-fits-all forms of cognitive behaviour therapy, which are conducted by following step-by-step instruction manuals. Research shows that few patients who receive these treatments get well.2
The largest and arguably best RCT behind the PTSD guidelines showed that the interventions failed most patients. This RCT studied 255 female veterans with PTSD who received a so-called highly recommended form of cognitive behaviour therapy (prolonged exposure therapy) or a control treatment that did not attempt to address trauma.3
Nearly 40% of the patients who started cognitive behaviour therapy dropped out, voting with their feet about its value; 60% of the patients still had PTSD when treatment ended; and 100% of the patients were clinically depressed when treatment ended.3
At 6-month follow-up, there were no significant differences between the cognitive behaviour therapy and control groups. Results for other RCTs of brief, manual-driven cognitive behaviour therapy are even poorer: overall, approximately two-thirds of patients who receive these so-called highly recommended treatments still have PTSD after completing treatment.4 …”
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