Intensive cognitive-behavioral treatment of PTSD: An overview of massed outpatient treatment programs

Abstract

Cognitive-behavioral treatment usually lasts several months with sessions being delivered on a weekly basis. However, despite its status as highly effective first-line treatment for PTSD, given the relatively low remission, high dropout, and low accessibility of cognitive-behavioral treatment, there is room for improvement. Empirical work suggests that optimizing cognitive-behavioral treatment dose might enhance PTSD treatment outcome. This has sparked different groups to explore the efficacy of intensified programs for adults where the treatment sessions are massed. In this chapter, the literature on outpatient PTSD programs delivered in such an intensive format is reviewed to investigate whether the findings support the anticipated benefits while considering potential risks. The reviewed studies showed that PTSD symptoms can indeed be substantially reduced (medium to large effect sizes) in a relatively short period (within one to three weeks). Although treatment response was not superior to that of programs offering weekly sessions, symptom reduction occurred faster while the results also suggest that massed intensive cognitive-behavioral treatment may prevent patients from dropping out. There are no reports of symptom exacerbation or adverse events indicating that the treatments are safe and well tolerated. While not improving treatment response as such, the fast response and low dropout suggest that massed cognitive-behavioral treatment is making trauma-focused treatment more accessible. Future research is needed that compares the effectiveness and long-term effects of weekly based versus intensive cognitive-behavioral treatment for PTSD in controlled studies.