Will booster sessions or a full course of treatment be beneficial for a patient experiencing a mild post-traumatic stress disorder (PTSD) symptom flare after 3 years of remission?

From the Guidelines

For a patient experiencing a mild flare of trauma symptoms after 3 years of remission, booster sessions are likely sufficient rather than a full course of treatment. I recommend starting with 2-4 booster sessions of the previously effective therapy (such as Cognitive Processing Therapy or Prolonged Exposure if those were used initially) [ 1 ]. These sessions should focus on reviewing and reinforcing previously learned coping skills, identifying current triggers, and addressing any new stressors that may have contributed to the symptom recurrence. The use of brief Cognitive Behavioral Therapy (CBT) has been shown to be effective in speeding up the rate of recovery in patients with PTSD [ 1 ].

Key Considerations

• The patient's previous period of successful remission suggests that they have already developed effective coping strategies that likely just need reinforcement rather than complete relearning.
• Booster sessions are often effective because they help patients quickly reactivate skills they've already learned but may have stopped practicing regularly [ 1 ].
• If symptoms don't improve after 4 booster sessions, then transitioning to a full course of treatment would be appropriate, considering other evidence-based treatments such as trauma-focused CBT [ 1 ].

Treatment Approach

• Start with 2-4 booster sessions, focusing on reviewing and reinforcing previously learned coping skills.
• Identify current triggers and address any new stressors that may have contributed to the symptom recurrence.
• Consider the use of trauma-focused CBT as an alternative if booster sessions are not effective [ 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. 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

Booster sessions may help in maintaining the response to treatment in patients with PTSD who have responded to initial treatment with sertraline.

• The decision to use booster sessions or full course treatment should be based on the individual patient's needs and response to treatment.
• Periodic reassessment is necessary to determine the need for continued treatment.
• The dose of sertraline needed for maintenance treatment may be different from the dose needed to achieve an initial response 2, 2, 2

From the Research

Treatment Options for Mild Trauma Symptom Flare

• The provided studies do not directly address the question of whether booster sessions or a full course of treatment would be more effective for a patient with mild trauma symptoms after 3 years of remission 3, 4, 5, 6, 7.
• However, the studies suggest that cognitive-behavioral therapy (CBT) can be an effective treatment for various mental health conditions, including posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and anxiety disorders 3, 4, 5, 6, 7.
• The combination of CBT and selective serotonin reuptake inhibitors (SSRIs) may produce greater improvement than either treatment alone, especially in children and adolescents with internalizing disorders 5, 6.
• The response to combined treatment can vary across disorders and patient characteristics, with younger patients and those with milder symptoms tend to respond faster to treatment 6.
• Booster sessions may be beneficial in maintaining treatment gains and preventing symptom relapse, but the optimal duration and frequency of booster sessions are not well established 4.

Considerations for Treatment

• The decision to use booster sessions or a full course of treatment should be based on the individual patient's needs and circumstances, taking into account the severity of symptoms, treatment history, and patient preferences 3, 4, 5, 6, 7.
• CBT and SSRIs can have different mechanisms of action, and their combination may be more effective for some patients than either treatment alone 5, 6, 7.
• The treatment approach should be tailored to the individual patient's needs, with a focus on reducing psychological distress, family interference, and avoidance, which are central symptom domains in anxiety disorders 7.