What type of clients with post-traumatic stress disorder (PTSD) symptoms would benefit from booster sessions versus a full course of therapy?

From the Guidelines

Clients experiencing trauma symptom flares who have previously completed trauma-focused therapy with good results but are now experiencing temporary setbacks are the most likely to benefit from booster sessions rather than full course therapy. These individuals have developed effective coping skills, understand their trauma responses, and need brief reinforcement rather than comprehensive treatment. They often have specific triggers or stressors causing the flare-up, maintain overall functioning despite symptoms, and demonstrate good insight into their condition 1. In contrast, full course therapy is more suitable for clients whose symptoms have significantly worsened, who have experienced new traumas, whose functioning is severely impaired, or who never fully responded to previous treatment. The decision between booster sessions and full therapy should be based on symptom severity, functional impairment, time since previous treatment, and the client's own preference.

Key Considerations

• Booster sessions typically involve 1-5 sessions focused on specific skills reinforcement, which can help maintain therapeutic gains without requiring complete retreatment 1.
• Full course therapy may require 8-16 sessions of evidence-based trauma treatments like Prolonged Exposure or Cognitive Processing Therapy, and is recommended for those with more severe symptoms or significant functional impairment 1.
• The most recent guidelines recommend the use of specific manualized psychotherapies, such as prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy, over pharmacotherapy for the treatment of posttraumatic stress disorder (PTSD) 1.

Client Characteristics

• Clients who have developed effective coping skills and understand their trauma responses are more likely to benefit from booster sessions.
• Those with specific triggers or stressors causing the flare-up, who maintain overall functioning despite symptoms, and demonstrate good insight into their condition are also good candidates for booster sessions.
• In contrast, clients with significantly worsened symptoms, new traumas, severe functional impairment, or those who never fully responded to previous treatment are more likely to require full course therapy.

Treatment Approach

• The treatment approach should be based on symptom severity, functional impairment, time since previous treatment, and the client's own preference 1.
• Booster sessions can be an effective way to provide brief reinforcement and maintain therapeutic gains, while full course therapy is necessary for those with more severe symptoms or significant functional impairment.

From the FDA Drug Label

Patients meeting DSM-III-R criteria for PTSD who had responded during a 24-week open trial on sertraline 50 to 200 mg/day (n=96) were randomized to continuation of sertraline or to substitution of placebo for up to 28 weeks of observation for relapse Patients receiving continued sertraline treatment experienced significantly lower relapse rates over the subsequent 28 weeks compared to those receiving placebo.

Booster Sessions vs Full Course Therapy:

• The provided information does not directly answer the question of what type of clients would benefit from booster sessions versus full course therapy for trauma symptoms flare.
• However, it can be inferred that clients who have responded to initial treatment with sertraline may benefit from continued treatment to prevent relapse, but the specific details of booster sessions are not provided.
• Key Considerations:
  • Clients with a history of trauma and PTSD may require ongoing treatment to manage symptoms.
  • The decision to use booster sessions or full course therapy should be based on individual client needs and response to treatment.
  • More research is needed to determine the most effective treatment approach for trauma symptoms flare 2

From the Research

Client Characteristics for Booster Sessions vs Full Course Therapy

• Clients who have previously completed a full course of trauma-focused therapy and are experiencing a flare-up of symptoms may benefit from booster sessions 3, 4.
• Booster sessions may be suitable for clients who have a stable support network and are able to manage their symptoms with minimal intervention 3.
• Full course therapy may be more beneficial for clients who are experiencing severe symptoms, have a history of complex trauma, or are at risk of reexposure to trauma 5, 4.
• Clients who are experiencing ongoing threat of reexposure to trauma may require adapted treatment approaches that prioritize establishing relative safety and differentiating between realistic threat and generalized fear responses 4.

Treatment Considerations

• Trauma-focused cognitive-behavioral therapies (CBT) are recommended as first-line treatments for posttraumatic stress disorder (PTSD) 6, 5.
• Mindfulness-based treatments may be effective in reducing PTSD symptoms and improving emotional regulation 6.
• Medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) may be used as an adjunct to trauma-focused therapy or as a second-line treatment for PTSD 7, 5.
• The choice of treatment should be based on the individual client's needs and circumstances, and may involve a combination of psychotherapy and medication 7, 5.