What alternative treatments are available for a 36-year-old female with post-traumatic stress disorder (PTSD) and generalized anxiety disorder, with a history of psychogenic non-epileptic seizures, who prefers not to use medications?

From the Guidelines

For a 36-year-old female with PTSD, generalized anxiety disorder, and a history of psychogenic non-epileptic seizures who prefers non-medication approaches, a phase-based treatment approach starting with stabilization is recommended, as outlined in the Expert Consensus Treatment Guidelines for Complex PTSD in Adults 1. This approach is crucial given her complex presentation, including a history of psychogenic non-epileptic seizures, which suggests significant self-regulation problems and emotional dysregulation. The stabilization phase aims to improve emotional, social, and psychological competencies before proceeding to trauma-focused interventions. Key components of this initial phase may include emotion regulation skills training, which has been utilized to address the perceived need for stabilization in individuals with complex PTSD 1.

Some evidence-based treatments that can be part of this approach include:

• Trauma-focused psychotherapies like Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE), and Eye Movement Desensitization and Reprocessing (EMDR), which are typically introduced after the stabilization phase.
• Cognitive Behavioral Therapy (CBT) for addressing both PTSD and anxiety symptoms by modifying unhelpful thought patterns.
• Mindfulness-based interventions such as Mindfulness-Based Stress Reduction (MBSR) to reduce anxiety symptoms.
• Somatic therapies, including Somatic Experiencing, which can be particularly beneficial for addressing the physical manifestations of trauma.
• Regular physical exercise, proper sleep hygiene, and stress management techniques like deep breathing and progressive muscle relaxation to complement formal therapies.

These approaches work by addressing the neurobiological impacts of trauma, helping to regulate the autonomic nervous system, process traumatic memories, and develop healthier coping mechanisms. Given the complexity of her condition, a comprehensive treatment plan combining several of these approaches under the guidance of experienced mental health professionals in trauma treatment is ideal. The recent guidelines and research, such as those discussed in the critical analysis of treatment guidelines for complex PTSD in adults 1, support the effectiveness of a phase-based treatment approach for individuals with complex trauma presentations.

From the Research

Alternative Treatments for PTSD and Generalized Anxiety Disorder

The patient's preference for non-medication treatments can be addressed through various alternative therapies. Some of these alternatives include:

• Mindfulness-Based Stress Reduction (MBSR) 2, which has shown promise in reducing PTSD symptoms
• Eye Movement Desensitization and Reprocessing (EMDR) 3, a therapy that has been found to be effective in reducing PTSD symptoms and improving remission rates
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) 3, 4, 5, a conjoint parent-child treatment that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress
• Cognitive Behavioral Therapy (CBT) 6, which has been found to be efficacious and effective in the treatment of anxiety disorders, including generalized anxiety disorder
• Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) 4, which are recommended as first-line treatments for PTSD

Considerations for Treatment

When considering alternative treatments, it is essential to take into account the patient's specific needs and circumstances. For example:

• The patient's history of psychogenic non-epileptic seizures should be considered when selecting a treatment approach
• The patient's preference for non-medication treatments should be respected and alternative therapies should be explored
• The patient's symptoms of generalized anxiety disorder should be addressed in conjunction with their PTSD symptoms

Available Evidence

The available evidence suggests that alternative treatments such as MBSR, EMDR, TF-CBT, CBT, PE, and CPT can be effective in reducing PTSD symptoms and improving remission rates 2, 3, 4, 6, 5. However, it is crucial to consult with a qualified healthcare professional to determine the best course of treatment for the patient's specific needs.