IPT Could Be a Better Alternative to Exposure-Based PTSD Therapy

Caregivers have long embraced exposure-focused therapies as their favorite PTSD treatment. The logic, of course, is that stressing acclimatization habituation to trauma triggers remains an essential component of recovery. And while this approach remains effective (as well as popular), it’s not the panacea it appears to be. High dropout rates – along with annoyingly persistent symptoms – remain constant hurdles.

A nascent – but growing – body of research has emerged that underscores the efficacy of affect-focused therapies, which focus on emotional processing rather than the original exposure to trauma. Interpersonal psychotherapy (IPT), developed originally for depression, appears to be successfully adapted for PTSD patients. IPT  focuses on understanding emotions in the context of interpersonal interactions.

Contrary to exposure-based therapies, IPT helps patients reconnect with their emotions, acknowledge them as consequential, and rely on them to navigate relationships. PTSD patients, who frequently struggle with emotional numbness, learn to identify and understand their feelings. This helps them re-establish trust and reconstruct their ability to function socially.

Perhaps most importantly, IPT doesn’t depend on reliving traumatic events. Instead, this therapeutic approach tackles social and emotional consequences, which helps guide patients toward a complete recovery.

Breaking Down the Data

The Journal of Clinical Psychiatry published a paper earlier in 2024 that details a meta-analysis of studies on IPT that targeted PTSD patients, This review covered 13 outcome studies on adults with syndromal PTSD, split across between civilian and military populations.

The civilian research showed promising results, with IPT often producing outcomes comparable to Prolonged Exposure (PE) therapy or pharmacotherapy. Key trials, including randomized controlled trials (RCTs), demonstrated IPT’s effectiveness in reducing PTSD, depression, and anxiety symptoms. This held especially true for patients with comorbid depression or trauma tied to sexual assault.

Studies of military veterans, though fewer and smaller scale, also suggested that IPT could help. Again, this appeared to be particularly beneficial for survivors of sexual trauma.

Nevertheless, the same problem cropped back up. Veterans dropped out at higher rates than their civilian counterparts. And while open trials revealed mostly positive results, some newer trials appear to offer stronger evidence comparing IPT and PE for veteran patients.

Overall, IPT has proven to be a promising PTSD treatment, especially for patients with comorbid conditions such as depression. But the authors emphasized the need for more data, particularly among military populations.

Either way, IPT’s concentration on interpersonal relationships might offer unique advantages for sexual trauma survivors.

Drawing Conclusions

IPT has proven just as effective as most other PTSD treatments, even though the number and breadth of the existing research remains lacking.

The data hasn’t provided any negative RCTs among adults (so far). And IPT has proven beneficial for multiple trauma populations, such as civilians and veterans. Additionally, IPT might offer advantages for patients with comorbid major depressive disorder (MDD), who often struggle with exposure therapies.

While exposure therapy remains the predominant PTSD treatment, it might not be the best option for ongoing trauma situations, especially in regions plagued by conflict. IPT, which doesn’t rely on trauma exposure, could be a better option.

Some researchers suggest that exposure therapy might better address re-experiencing symptoms, while IPT could improve social functioning. But studies have failed to consistently support this.

In general, the best chance for PTSD symptom improvement appears to lie in a combination of therapies.

The authors also note that there’s a significant Dutch study still underway that’s analyzing  IPT and exposure therapies, with a focus on patients resistant to traditional treatment. Despite some variations in session lengths and formats across studies, results consistently demonstrate IPT’s efficacy, making it a viable non-exposure treatment for PTSD, alongside existing first-line therapies such as PE and SSRIs.

Finally, the VA’s guidelines stop short of endorsing IPT, even though civilian trials and studies advise a change in approach. In light of this latest data, IPT should be considered a valuable alternative for PTSD patients seeking non-exposure-based therapies, particularly for those reluctant – or unable to – endure exposure therapy.

Further Reading

Making Sense of PTSD’s Emotional Numbing

Women Veterans Face 67% Higher Risk of Inappropriate PTSD Prescriptions

High PTSD Rates in LGBTQ Community Demand A Better Approach