Recovery Rates in the Treatment of PTSD
The PHQ-9 and GAD-7 are sensitive and reliable measures or tests for Depression and Anxiety respectively. They are used in IAPT services across NHS England to compare outcomes of CBT in the primary care. As such, they are Efficacy’s benchmark to measure our services. In IAPT the target for recovery is 50%.
We recently reviewed a trauma-focussed CBT service for a ‘blue light’ occupational health service. This was treating employees all diagnosed with post-traumatic stress disorder (PTSD). For those discharged the results are phenomenal.
Recovery Rates on Depression and Anxiety Scores
The chart below shows that for the 42 PTSD discharges to date, the average depressive score (PHQ-9) was 15, suggesting that employees were in the high end of 'moderate’ depression. At 12 on the anxiety test (GAD-7) suggests they are also in the 'moderate' range for an identifiable anxiety disorder.
After an average of 10.8 sessions, the group almost reached our recovery score, set at 5 – scoring 5.1 on depression (PHQ-9) and 5.2 on anxiety (GAD-7). Before we move on it is worth noting that NHS England defines a higher score for recovery; these employees would have been defined as recovered from depression scoring ‘10’ on the PHQ-9 and ‘8’ on the GAD-7. Meaning we would have done better with an NHS recovery comparison on anxiety and depression. However, they were referred for PTSD treatment, so how did they get on?
What are the PTSD recovery rates?
While PHQ-9 and GAD-7 are reliable tests of depression and anxiety, they are not always sensitive enough to measure recovery in specific disorders, like PTSD. Improving the employee’s depression and anxiety scores, I would expect that PTSD measure to improve. The Impact of Events Scale-revised (IES-r) is frequently used in PTSD research and by IAPT to measure PTSD recovery.
This chart shows an average IES-r score of 52.6 at assessment. The IES-r is not a test of severity but has a cut-off point for a “probable diagnosis” of PTSD at 33. On discharge, our group of 42 scored 16.0 – suggesting a clear recovery of PTSD.
An average has a range. What is remarkable about these discharge scores is that all 42 were below the 33-cut-off point – indicating 100% achieved recovery. This is an outstanding result, superior to any randomised controlled trial's (RCT) outcome data on the treatment of PTSD, or NHS service.
Why are our recovery results on PTSD so good?
It is sufficient to say that we know we are treating PTSD; from occupational health, our patients have been assessed by Efficacy Psychiatrists or HCPC Psychologists to confirm if patients meet the diagnostic criteria for PTSD.
As CBT therapists, from our behavioural therapy history, we know PTSD is perfectly treatable, published in RCTs. Our data on these 42 employees is not comparable to an RCT as it is set in the real world – with no control over variables. So, could it be that our variables are efficacious:
- We only provide CBT by BABCP accredited CBT therapists
- Our triage is designed to ensure people are ‘therapy ready.’
- All were employed, and while everyone returned to work (all but one that retired) half were on sick leave at commencing trauma-focussed CBT – having the real motivation to engage in treatment.
- To prevent therapeutic drift, we tightly govern every treatment cycle at regular intervals to ensure patients are receiving disorder-specific formulated CBT
- We adapt interventions to a changing presentation while firmly remaining in the principle of evidence-based therapy
- We encourage and support co-current treatments
- By the fact that work is supporting the treatment of PTSD one could assume it is a supportive environment
While we have not gathered data on the duration of illness (to commencing treatment), there is a sense that they are earlier into treatment, due to the accessibly. While I do not think there is one reason for these great results, early intervention in a supportive ethos is the foundation to a great recovery. My money would be on that preventing therapeutic drift in independent and private practice is key to a great recovery.
Finding Out How CBT at Efficacy Can Help
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