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

From the Guidelines

Preventing relapse from trauma symptoms requires a comprehensive approach that prioritizes evidence-based treatments, self-care strategies, and ongoing support, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline 1. To prevent relapse, it is essential to continue prescribed treatments, such as trauma-focused cognitive behavioral therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), or medications like SSRIs (e.g., sertraline 50-200mg daily or paroxetine 20-60mg daily), which help regulate mood and anxiety. Some key points to consider:

• Develop a personalized safety plan with your therapist to identify early warning signs of relapse and specific steps to take when these occur.
• Practice regular stress management techniques, including mindfulness meditation (10-15 minutes daily), deep breathing exercises (4-7-8 method), and progressive muscle relaxation.
• Maintain healthy sleep habits by establishing a consistent sleep schedule and avoiding screens before bedtime.
• Build a strong support network of trusted individuals to reach out to when symptoms intensify.
• Avoid known triggers when possible, and develop healthy coping strategies for unavoidable triggers. The most recent and highest quality study, published in 2024, recommends the use of specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, over pharmacotherapy 1. Additionally, a 2024 review of psychological first aid as a therapeutic intervention after trauma found that it can have a positive effect on reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term 1. However, the evidence for reducing post-traumatic stress disorder/depressive symptoms is less compelling, and more research is needed to inform best practices for psychological first aid. In contrast, an older study from 2005 found that brief cognitive behavioral therapy (CBT) can speed the rate of recovery in individuals with post-traumatic stress disorder (PTSD) symptoms, but may not reduce the prevalence of chronic PTSD 1. Overall, a multi-faceted approach that combines professional treatment with self-care strategies and ongoing support is crucial for preventing relapse from trauma symptoms and improving quality of life.

From the Research

Prevention of Relapse from Trauma Symptoms

To prevent relapse from trauma symptoms, several therapies have been studied, including:

• Cognitive Behavioral Therapy (CBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Cognitive Behavior Writing Therapy (CBWT)

Comparison of Therapies

Studies have compared the efficacy of these therapies in reducing post-traumatic stress disorder (PTSD) symptoms, anxiety, and depression. The results are as follows:

• A meta-analysis of 11 studies (n = 547) found that EMDR is better than CBT in reducing post-traumatic symptoms 2
• Another meta-analysis of 8 studies found that EMDR reduced depression symptoms better than CBT in both children, adolescents, and adults 3
• A randomized controlled trial found that EMDR therapy proved to be as effective as CBT for treating panic disorder patients 4
• A multicenter randomized clinical trial found that EMDR and CBWT yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents 5
• A systematic review and meta-analysis found that EMDR was slightly superior to CBT in reducing total PTSD scores, and was better for decreased intrusion and arousal severity compared to CBT 6

Key Findings

Key findings from these studies include:

• EMDR is effective in reducing post-traumatic symptoms, anxiety, and depression
• EMDR is as effective as CBT in treating panic disorder and PTSD
• CBWT is also effective in reducing PTSD symptoms and comorbid difficulties in children and adolescents
• EMDR may be more suitable than CBT for PTSD patients with prominent intrusion or arousal symptoms 2, 3, 6