Synergizing strengths of four trauma-focused treatments in a highly intensive integrated program for posttraumatic stress disorder: rationale and two case descriptions

Abstract

Various evidence-based trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) are available and several commonalities have been identified. Yet, these trauma-focused psychotherapies also have important differences. This raises the question whether several trauma-focused methods can be combined in one treatment format. Thus far, systematic efforts to combine multiple trauma-focused treatment methods have been limited. To describe the rationale, structure, and application of a highly intensive treatment format integrating four trauma-focused psychotherapies, illustrated by two case presentations. The study was descriptive and was not designed to evaluate clinical effectiveness. Description of a structured treatment format that integrates prolonged exposure (PE), eye movement desensitization and reprocessing therapy (EMDR), brief eclectic psychotherapy for PTSD (BEPP) and narrative exposure therapy (NET) in a highly intensive dose. Sessions were performed twice a day over the course of 1 week. This format was conceptualized in the context of a documentary series on an online ongoing education platform for therapists. A combat veteran with PTSD and a survivor of long-term physical and sexual abuse with PTSD completed the 1-week program. Their treatment courses illustrate how the components of PE, EMDR therapy, BEPP, and NET can be organized and applied within a single intensive format. In non-standardized interviews conducted for the accompanying documentary, both participants described different functions and perceived contributions of the 4 treatment approaches. The case descriptions demonstrate that the proposed integration of four trauma-focused approaches could be applied as planned in two individual treatment trajectories of patients with severe PTSD. Patients' reflections were not collected or analyzed as formal qualitative data and cannot be used to establish treatment effectiveness, safety, or general feasibility of the treatment format. Prospective studies incorporating standardized outcome assessments, systematic adverse event monitoring, and formal qualitative evaluations are required to systematically investigate the treatment program.