Post‐traumatic stress disorder: evolving conceptualization and evidence, and future research directions

Summary & key facts

This review explains how our ideas about post-traumatic stress disorder (PTSD) have changed and what we actually know now. It says PTSD can look different in different people, with problems in memory and in the sense of who you are. The paper finds that several talking therapies work well for established PTSD, that prevention efforts have mostly failed so far, and that some new approaches — including therapy combined with the drug MDMA — are showing promise. The authors also call for more research on the biology of PTSD and on how to adapt treatments for different cultures and low-resource settings.

Key facts:

• The paper traces how the official definition of PTSD has changed over time and notes that rates and kinds of responses to trauma can differ across cultures.
• Researchers report that reactions like PTSD can happen after events not previously labeled as 'traumatic', which affects how we diagnose the condition.
• Evidence supports the idea that there are several distinct forms of PTSD, including a dissociative form (where people feel disconnected from themselves) and a longer-lasting 'complex' form.
• Psychological treatments for established PTSD have the strongest evidence. Examples with good support are trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).
• Efforts to prevent PTSD right after trauma have been mostly disappointing so far, meaning prevention is still a difficult problem.
• Some newer treatments combine drugs and therapy. The review highlights MDMA-assisted psychotherapy as a promising example, but it is not presented as a finished or proven cure.
• The paper reviews biological research, including genetic studies and brain imaging, but presents these as developing areas rather than settled explanations.
• The authors call for more work on adapting treatments for low-resource settings, for different cultural contexts, and for community-based approaches.

Abstract

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

Topics

Child Abuse and Trauma Migration, Health and Trauma Posttraumatic Stress Disorder Research

Categories

Clinical Psychology Psychology Social Sciences

Tags

Artificial intelligence Clinical psychology Cognition Computer science Conceptualization Desensitization (medicine) Eye movement desensitization and reprocessing Internal medicine Medicine Neuroimaging Posttraumatic stress Psychiatry Psychological intervention Psychological trauma Psychology Psychotherapist Receptor Traumatic stress

Substances

MDMA

Conditions & symptoms

PTSD Difficulty focusing Feeling disconnected from others