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June 27, 2007

Posttraumatic Stress Disorder and Cognitive Behavioral Therapy

JAMA. 2007;297(24):2694-2695. doi:10.1001/jama.297.24.2694

To the Editor: In their study of the treatment of women with posttraumatic stress disorder (PTSD), Dr Schnurr and colleagues1 reported the superiority of prolonged exposure over present-centered therapy. We believe that their use of present-centered therapy as a comparison group is problematic.

Present-centered therapy was described as “clinically relevant” and as a “control for the nonspecific benefits of therapy.” Present-centered therapy was used so that the effects of prolonged exposure could be attributed to prolonged exposure rather than the purported “benefits of good therapy.” Present-centered therapy, however, did not appear to represent a bona fide therapy. The treatment was described as primarily involving discussion and review of “general daily difficulties,” specifically prohibiting any exposure or cognitive restructuring. Their methods article discusses present-centered therapy in more detail, stating that if the patient mentions “trauma-related issues, the therapist gently redirects her to discuss other material.”2

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