title: Trauma-focused psychotherapy after a trial of medication for chronic PTSD: pilot observations.
abstract: BACKGROUND
  To date, all clinical trials using a single therapeutic modality (psychotherapy or pharmacotherapy) have found that even the best validated treatments for adults with chronic Posttraumatic Stress Disorder (PTSD) leave a substantial proportion of patients with disabling residual symptoms.
  
  
  METHODS
  We reviewed the treatment course of three research patients with PTSD who received trauma-focused psychotherapy after experiencing a partial response to medication. Structured diagnostic interviews, validated symptom measures, and standardized treatment approaches were used to assess treatment response.
  
  
  RESULTS
  All patients partially benefited from medication treatment, and the degree of benefit varied substantially. Also, all patients experienced an additional reduction in PTSD symptoms after a time-limited course of prolonged exposure therapy (PE). This finding differs from anecdotal observations among U.S. War veterans and has never been documented systematically among civilian adults with chronic PTSD.
  
  
  CONCLUSIONS
  Maximizing treatment outcome in adults with chronic PTSD may require additional psychotherapy after a partial medication response, and further study is warranted.
authors.affiliation: Columbia University College of Physicians and Surgeons, Anxiety Disorders Clinic, New York State Psychiatric Institute, USA.
authors.forename: Randall D
authors.initials: RD
authors.lastname: Marshall
authors.forename: Jaime H
authors.initials: JH
authors.lastname: Cárcamo
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
authors.forename: Michael
authors.initials: M
authors.lastname: Liebowitz
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents