What is the recommended treatment for flashbacks without emotional distress, possibly related to Post-Traumatic Stress Disorder (PTSD)?

From the Guidelines

For flashbacks without emotional distress that may be related to PTSD, the recommended treatment approach focuses on psychotherapy rather than medication, with specific manualized psychotherapies such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy being preferred over pharmacotherapy. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1, these therapies are recommended as the first-line treatment for PTSD, including cases with flashbacks. The guideline suggests that these therapies can be delivered through secure video teleconferencing when validated for such use or when other options are unavailable. Some key points to consider in the treatment of flashbacks without emotional distress include:

• The use of psychotherapy to help patients process traumatic memories and reduce their intrusive nature
• The recommendation against the use of benzodiazepines, cannabis, or cannabis-derived products for PTSD treatment
• The importance of patient-centered care and shared decision making to optimize health outcomes and quality of life
• The consideration of medication options like paroxetine, sertraline, or venlafaxine if flashbacks begin causing distress or interfere with daily functioning, although this is not the primary treatment approach for flashbacks without emotional distress. Overall, the treatment of flashbacks without emotional distress should prioritize psychotherapy and patient-centered care, with medication considered only if necessary and under the guidance of a mental health professional.

From the FDA Drug Label

PTSD, as defined by DSM-III-R/IV, requires exposure to a traumatic event that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others, and a response which involves intense fear, helplessness, or horror Symptoms that occur as a result of exposure to the traumatic event include reexperiencing of the event in the form of intrusive thoughts, flashbacks or dreams, and intense psychological distress and physiological reactivity on exposure to cues to the event; A PTSD diagnosis requires that the symptoms are present for at least a month and that they cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

The recommended treatment for flashbacks without emotional distress, possibly related to Post-Traumatic Stress Disorder (PTSD), is not explicitly stated in the provided drug labels. However, Sertraline hydrochloride is indicated for the treatment of PTSD in adults.

• The efficacy of Sertraline hydrochloride in the treatment of PTSD was established in two 12-week placebo-controlled trials of adult outpatients whose diagnosis met criteria for the DSM-III-R category of PTSD 2.
• The clinical significance of flashbacks without emotional distress is unclear, and it is not known whether Sertraline hydrochloride is effective in treating this specific symptom. It is essential to note that a PTSD diagnosis requires symptoms to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. In the absence of explicit guidance, a conservative clinical decision would be to consult the drug label and consider the patient's overall clinical presentation before making a treatment decision 2.

From the Research

Treatment for Flashbacks without Emotional Distress

• The recommended treatment for flashbacks without emotional distress, possibly related to Post-Traumatic Stress Disorder (PTSD), is not explicitly stated in the provided studies. However, according to 3, selective serotonin reuptake inhibitors (SSRIs) are considered the first-line treatment for PTSD, and they may be effective in reducing flashbacks.
• Atypical antipsychotics may also be considered in PTSD where paranoia or flashbacks are prominent, as stated in 3.
• Trauma-focused cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are both widely used in the treatment of PTSD, and they tend to be equally efficacious, as shown in 4.

Flashbacks in PTSD

• Flashbacks are a common occurrence after trauma, and they are experienced with a "happening in the present" quality, as described in 5.
• Pain flashbacks are a re-experiencing of pain felt at the time of a traumatic event, and they are positively associated with the extent of pain at the time of trauma, as found in 5.
• An absence of analogue flashbacks is associated with low emotional response to traumatic film footage, as well as low trait anxiety and low current depression levels, as shown in 6.

Understanding Flashbacks

• Understanding why some individuals report an absence of flashbacks may aid preventative treatments against flashback development, as suggested in 6.
• The terms involuntary autobiographical memories, intrusive memories, and flashbacks are often used interchangeably, but they have key differences, as proposed in 7.
• Further research is needed to study intrusive memories and flashbacks in PTSD, using a variety of methods, as described in 7.