What strategies can prevent post-traumatic stress disorder (PTSD) symptoms relapse?

From the Guidelines

Preventing trauma-related symptom relapse requires a comprehensive approach that combines ongoing therapy, self-care strategies, and sometimes medication, with a strong emphasis on manualized psychotherapies such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1.

Key Strategies

• Maintain regular sessions with a trauma-informed therapist even after initial symptom improvement, as this provides continued support and helps identify early warning signs of relapse.
• Establish a personalized safety plan that includes specific coping strategies like deep breathing, grounding techniques, and mindfulness practices to manage triggering situations.
• If medication has been helpful, such as SSRIs like sertraline (50-200mg daily) or paroxetine (20-50mg daily), continue as prescribed and consult with your provider before making any changes, as these medications are recommended by the guideline 1.
• Regular physical activity (30 minutes daily), adequate sleep (7-9 hours nightly), and stress management techniques strengthen resilience.
• Build a reliable support network of trusted individuals who understand your needs and can provide assistance during difficult periods.
• Monitor your symptoms using a journal or tracking app to identify patterns and triggers early.
• Avoid known triggers when possible and develop gradual exposure strategies with professional guidance when avoidance isn't feasible.

Rationale

These approaches work because they address the neurobiological impacts of trauma, helping to regulate the autonomic nervous system, strengthen prefrontal cortex functioning, and maintain healthy stress response patterns that can become dysregulated during trauma-related relapse. The guideline recommends against the use of benzodiazepines, cannabis, or cannabis-derived products 1, and instead supports the use of evidence-based psychotherapies and medications. Brief CBT, which includes elements of exposure therapy and stress inoculation training, has also been shown to be effective in preventing chronic PTSD and speeding recovery 1.

From the FDA Drug Label

Patients receiving continued sertraline treatment experienced significantly lower relapse rates over the subsequent 28 weeks compared to those receiving placebo. The efficacy of sertraline in maintaining a response in adult patients with PTSD for up to 28 weeks following 24 weeks of open-label treatment was demonstrated in a placebo-controlled trial It is generally agreed that PTSD requires several months or longer of sustained pharmacological therapy beyond response to initial treatment Systematic evaluation of sertraline has demonstrated that its efficacy in PTSD is maintained for periods of up to 28 weeks following 24 weeks of treatment at a dose of 50 to 200 mg/day

To prevent trauma-related symptoms relapse, continued treatment with sertraline is recommended, as it has been shown to significantly lower relapse rates compared to placebo 2. The duration of treatment should be for several months or longer, beyond the initial response, to maintain efficacy in PTSD 2. Dose adjustments may be needed to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment 2.

From the Research

Prevention of Trauma-Related Symptoms Relapse

To prevent trauma-related symptoms relapse, several strategies can be employed:

• Trauma-focused therapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Eye Movement Desensitization and Reprocessing (EMDR) have been shown to be effective in reducing post-traumatic symptoms 3, 4.
• Cognitive Behavioral Therapy (CBT) is also a recommended treatment for Post-Traumatic Stress Disorder (PTSD) and has been found to be effective in reducing PTSD symptoms 5, 6.
• Medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs) may be used in conjunction with trauma-focused psychotherapies, but the evidence is insufficient to determine whether they are more effective than psychotherapy alone 7.
• Avoidance of benzodiazepines or other sedative hypnotic medications is recommended, as they can exacerbate intrusive and dissociative symptoms over time 3.

Treatment Outcomes

Treatment outcomes for trauma-related symptoms can vary depending on the individual and the specific treatment approach:

• Trauma-focused CBTs have been found to be effective in reducing PTSD symptoms in individuals with ongoing threat of reexposure 5.
• EMDR has been found to be more effective than CBT in reducing post-traumatic symptoms and anxiety, but not depression 4.
• The effectiveness of CBT for PTSD in routine clinical care has been found to be comparable to efficacy studies, with large within-group effect sizes for PTSD severity at post-treatment and follow-up 6.