Therapy is first line for PTSD.

But what goes on in the session?

And how do you prevent PTSD when your patient calls you after an assault or a major accident?

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

We continue with our coverage of PTSD, inspired by the American Journal of Psychiatry,

new review by Ariya Shalov and colleagues from NYU.

Psychotherapy is first line for PTSD,

because it works better and lasts longer than medications.

However, there is an exception to this rule,

patient preference.

And naturally, you're not going to force a patient to therapy if they don't want to go.

But clinical trials of PTSD also find that outcomes are better when patients are randomized

to their preferred treatment, whether therapy or meds.

There are several therapies that work for PTSD and we'll review them here.

Drawing from evidence in a Cochrane style review of 70 studies involving nearly 5,000 patients.

First is trauma-focused CBT. This therapy involves prolonged exposure sessions where the patient

re-experiences the trauma in a new way.

Now, there are dropout rates sometimes with this therapy because this kind of exposure is bound to trigger anxiety.

But hopefully, unlike the original traumatic experience, the therapeutic re-experience of the trauma is going to be done in a structured,

graded, and supported way, and it will also be paired with a sense of calm, such as incorporating

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