From the Guidelines
For a patient experiencing a resurgence of mild, tolerable PTSD symptoms after three years of remission, I strongly recommend initiating a treatment plan with specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, as these have been shown to be effective in managing PTSD symptoms. According to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1, these therapies are preferred over pharmacotherapy for the treatment of PTSD.
Key Components of the Treatment Plan
- Initiate 8-12 weekly sessions of prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy to address the re-emerging symptoms
- Implement daily mindfulness meditation starting with 5-10 minutes and gradually increasing to 20 minutes to help manage symptoms and reduce anxiety
- Teach grounding techniques like the 5-4-3-2-1 method for immediate symptom management
- Encourage regular physical activity of 30 minutes, 3-5 times weekly, to help reduce anxiety and improve mood
Medication Consideration
Medication, such as paroxetine, sertraline, or venlafaxine, may be considered if symptoms worsen, but it is not initially indicated given the mild nature of symptoms, and the guideline recommends against the use of benzodiazepines, cannabis, or cannabis-derived products 1.
Delivery of Therapy
The treatment plan can be delivered through secure video teleconferencing if validated for use or when other options are unavailable, as recommended by the guideline 1. This approach prioritizes the patient's previous successful recovery experience and targets the neurobiological aspects of PTSD, addressing both the heightened amygdala activity and reduced prefrontal cortex regulation that typically occur during symptom recurrence.
From the Research
Therapy Treatment Plan for Patient with Resurgence of Trauma Symptoms
The patient has been in remission from PTSD for 3 years and is now experiencing a resurgence of mild and tolerable trauma symptoms. Based on the available evidence, the following therapy treatment plan can be considered:
- Trauma-focused cognitive behavioral therapy (TF-CBT): This therapy has been shown to be effective in reducing PTSD symptoms and improving remission rates 2, 3, 4. TF-CBT can help the patient process their traumatic experiences and develop coping skills to manage their symptoms.
- Eye movement desensitization and reprocessing (EMDR): EMDR has been found to be effective in reducing PTSD symptoms and improving remission rates 2, 3. EMDR can help the patient reprocess their traumatic memories and reduce their distress.
- Memory specificity training: This training has been shown to augment the effects of TF-CBT in reducing PTSD severity 5. Memory specificity training can help the patient recall specific positive memories and improve their cognitive functioning.
- Combined therapy: Combining psychotherapy with medication may be considered, although the evidence is insufficient to determine whether combined therapy is superior to monotherapy 6.
Considerations for Treatment
When developing a treatment plan, the following considerations should be taken into account:
- Drop-out rates: Patients treated with psychotherapy may be more likely to drop out of treatment 6.
- Trauma type and severity: The type and severity of the traumatic experience may affect treatment outcomes and drop-out rates 6.
- Comorbidities: The patient's comorbidities, such as depression or substance use disorders, should be considered and treated concurrently 4.
- Medication: Medication, such as selective serotonin reuptake inhibitors, may be considered for patients who have residual symptoms after psychotherapy or are unable or unwilling to access psychotherapy 4.