Lead/Presenter: Paula Schnurr, National Center for PTSD
All Authors: Schnurr PP (National Center for PTSD), Lang AJ, Center of Excellence for Stress and Mental Health Lunney CA, National Center for PTSD
The VA/DoD PTSD Practice Guideline recommends trauma-focused therapy as the initial treatment approach for PTSD. Three non-trauma-focused alternatives, including Present-Centered Therapy (PCT), were suggested as second-line treatment. We evaluated another non-trauma-focused treatment, Acceptance and Commitment Therapy (ACT), which is disseminated in VA's national evidence-based psychotherapy program as a treatment for depression but is also used for PTSD. Our objective was to evaluate the benefits of ACT for PTSD by performing secondary analysis of an RCT that examined the effectiveness of ACT for post-deployment distress in a transdiagnostic sample of OEF/OIF Veterans. The primary study found modest improvements in outcomes but no difference between ACT and PCT. In this study we examined whether ACT led to greater improvements than PCT in symptoms, functioning, quality of life, engagement, and satisfaction among Veterans with PTSD.
Participants were recruited from 5 VA Medical Centers and randomized to 12 sessions of ACT or PCT. Although inclusion required only current anxiety or depressive disorder and impairment, 82% (N = 131) of participants had PTSD. On average, participants were male, white, non-Hispanic, and in their mid-30s, with some college education. Roughly half were married or cohabitating, and 40% were employed. Measures included the PTSD Checklist, PHQ-9, Brief Symptom Inventory, Sheehan Disability Scale, AUDIT, and measures of anger, insomnia, functioning, quality of life, and satisfaction. Analyses followed the intention-to-treat principle using hierarchical linear models.
Participants improved modestly on all measures except physical functioning. ACT outperformed PCT only on avoidance symptoms of PTSD and insomnia. Dropout and satisfaction were comparable in both treatments, and satisfaction was high overall.
The greater improvement in avoidance is consistent with the focus in ACT on decreasing experiential avoidance. The greater improvement in insomnia is important because sleep disturbance is a common residual symptom following even successful PTSD treatment. The overall findings make it difficult to recommend ACT over other evidence-based treatments, and only a non-inferiority study could establish its comparability to PCT.
VA has invested substantial resources in promoting access to evidence-based psychotherapy. Although some Veterans with PTSD prefer non-trauma-focused treatments, our findings can help VA promote evidence based alternatives that lead to optimal improvement.