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IPT for PTSD

Exposure therapies have dominated the treatment of posttraumatic stress disorder (PTSD). Although effective, they do not benefit all patients, and many patients (and therapists) refuse to do them because of the grueling requirement to face and relive traumatic memories in order to habituate to them.  IPT offers a non-exposure-based approach to PTSD. IPT acknowledges the impact of trauma on the patient’s life, but rather than attempting to reconstruct the traumatic events, it aims to repair the damage trauma does to interpersonal trust and social functioning. Trauma can isolate patients from the social supports that protect against developing and help in recovery from PTSD.

Among the consequences of PTSD are affective numbing, interpersonal hypervigilance, and social withdrawal (1). Numbness, an avoidance particularly of negative affect, makes it hard to read one’s interpersonal environment. Thus in adapting IPT for PTSD, we devote the early part of treatment to affective reattunement: helping patients to identify their emotions and to recognize them as helpful social signals rather than as bad or dangerous. Once patients can read their feelings, they can put them to use to handle relationships better, deciding whom they can trust and whom they can’t.  IPT for PTSD tends to focus on role transitions, which are usually inherent having been traumatized (2).

Krupnick and colleagues (3) showed that group IPT reduced PTSD and depression in badly and repeatedly traumatized women relative to a waiting list control. Campanini et al. reported that adding IPT to pharmacotherapy reduced PTSD symptoms more than pharmacotherapy alone (4). Markowitz and colleagues (5) found 14 weeks of individual IPT non-inferior to Prolonged Exposure, the best tested exposure therapy, and that IPT had advantages for patients with comorbid major depression (5) or sexual trauma (6). Dropout was non-significantly lower in IPT (5): 15% versus 29%. Apparent personality disorders often resolved with treatment of PTSD (7). Patients also preferred IPT to exposure therapy (8). Gains in IPT persisted at three month follow-up (9). Further research is needed to replicate these findings, particularly for military PTSD.

References

  1. Bleiberg KL, Markowitz JC: Interpersonal psychotherapy for posttraumatic stress disorder. Am J Psychiatry 2005;162:181-183
  2. Markowitz JC: Interpersonal Psychotherapy for Posttraumatic Stress Disorder. New York: Oxford University Press, 2016
  3. Krupnick JL, Green BL, Stockton P, Miranda J, Krause E, Mete M: Group interpersonal psychotherapy for low-income women with posttraumatic stress disorder. Psychother Res 2008; 18:497-50
  4. Campanini RF, Schoedl AF, Pupo MC, Costa AC, Krupnick JL, Mello MF: Efficacy of interpersonal therapy-group format adapted to post-traumatic stress disorder: an open-label add-on trial. Depress Anxiety 2010;27:72-77
  5. Markowitz JC, Petkova E, Neria Y, Van Meter P, Zhao Y, Hembree E, Lovell K, Biyanova T, Marshall RD: Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. Am J Psychiatry 2015;172;430-440
  6. Markowitz JC, Neria Y, Lovell K, Van Meter PE, Petkova E: History of sexual trauma moderates psychotherapy outcome for posttraumatic stress disorder. Depress Anxiety 2017 Apr 4 [Epub ahead of print]
  7. Markowitz JC, Petkova E, Biyanova T, Ding K, Suh EJ, Neria Y: Exploring personality diagnosis stability following acute psychotherapy for chronic posttraumatic stress disorder. Depress Anxiety 2015;32:919-926
  8. Markowitz JC, Meehan KB, Petkova E, Zhao Y, Van Meter PE, Neria Y, Pessin H, Nazia Y: Treatment preferences of psychotherapy patients with chronic PTSD. J Clin Psychiatry 2016;77:363-370
  9. Markowitz JC, Choo T, Neria Y: Do Acute Benefits of Interpersonal Psychotherapy for Posttraumatic Stress Disorder Endure? (submitted for publication)