Treatment
The chronic and sometimes devastating psychologic and interpersonal sequelae of
post-traumatic stress disorder (PTSD) necessitates timely and effective
treatment of people with this syndrome.[1,2] The avoidant responses associated
with PTSD often delay or prevent these individuals from seeking professional
assistance. While no specific therapies for PTSD in the
cancer setting have been developed, treatment modalities used with other people with PTSD can help alleviate distress in cancer patients and survivors.[3,4]
Most
clinicians recommend using a multimodal approach, choosing components
to meet the specific needs of each patient and taking into account any
concurrent psychiatric disorders such as depression or substance abuse. Multiple modalities are frequently considered in a
crisis intervention approach to facilitating adjustment of cancer patients.
The crisis intervention model comprises a broad range of therapies that can be
helpful in the treatment of PTSD. The goals of this model are to reduce
symptoms and restore patients to their usual levels of functioning. In this
model, the therapist often takes an active, directive stance with the patient,
focusing on resolving concrete problems, teaching specific coping skills, and
providing a safe and supportive environment.[5]
Cognitive-behavioral techniques have proven especially helpful within the
crisis intervention setting. Some of these methods include helping the patient
to understand symptoms, teaching effective coping strategies and stress
management techniques (such as relaxation training), restructuring cognitions,
and providing exposure to opportunities for systematic desensitization of
symptoms.[6] In a single case study, a 10-session cognitive-behavioral intervention for a male cancer patient 3 years post–bone marrow transplant with PTSD was found to be effective. This study used a combination of cognitive coping strategies, relaxation procedures, relapse prevention, and generalization techniques; benefits were found to be maintained at a 6-month follow-up.[7] Behaviorally oriented approaches to sexual therapy may also be
useful when the avoidance manifested by patients is decreased
sexual activity and avoidance of intimate situations.
Support groups also appear to benefit people who experience post-traumatic symptoms. In the group setting, such patients can receive emotional
support and encounter others with similar experiences and symptoms, thereby
validating their own experiences and learning a variety of coping and management strategies.
For patients with particularly distressing or severe symptoms,
psychopharmacology may provide an additional means of treatment. Several
classes of medications have been used in the treatment of individuals with
PTSD.[8,9] For example, tricyclic and monoamine oxidase-inhibitor antidepressants
are commonly used, particularly when the symptoms of PTSD are accompanied by
depression. Serotonin-reuptake inhibitors such as fluoxetine are effective
in reducing the hyperarousal and intrusive symptoms of PTSD.[1] Antianxiety
medications may help reduce overall arousal and anxiety symptoms.
Infrequently, antipsychotic medications may reduce severe intrusive flashbacks.
References
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Davidson JR, Foa EB: Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV. J Abnorm Psychol 100 (3): 346-55, 1991.
[PUBMED Abstract]
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Alter CL, Pelcovitz D, Axelrod A, et al.: Identification of PTSD in cancer survivors. Psychosomatics 37 (2): 137-43, 1996 Mar-Apr.
[PUBMED Abstract]
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Foa EB: Psychosocial treatment of posttraumatic stress disorder. J Clin Psychiatry 61 (Suppl 5): 43-8; discussion 49-51, 2000.
[PUBMED Abstract]
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Adshead G: Psychological therapies for post-traumatic stress disorder. Br J Psychiatry 177: 144-8, 2000.
[PUBMED Abstract]
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Perry S, Difede J, Musngi G, et al.: Predictors of posttraumatic stress disorder after burn injury. Am J Psychiatry 149 (7): 931-5, 1992.
[PUBMED Abstract]
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Mikulincer M, Solomon Z: Attributional style and combat-related posttraumatic stress disorder. J Abnorm Psychol 97 (3): 308-13, 1988.
[PUBMED Abstract]
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DuHamel KN, Ostroff JS, Bovbjerg DH, et al.: Trauma-focused intervention after bone marrow transplantation: A case study. Behav Ther 31 (1): 175-86, 2000.
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Marmar CR, Neylan TC, Schoenfeld FB: New directions in the pharmacotherapy of posttraumatic stress disorder. Psychiatr Q 73 (4): 259-70, 2002 Winter.
[PUBMED Abstract]
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Davidson JR: Pharmacotherapy of posttraumatic stress disorder: treatment options, long-term follow-up, and predictors of outcome. J Clin Psychiatry 61 (Suppl 5): 52-6; discussion 57-9, 2000.
[PUBMED Abstract]
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