Adding Insult to Injury: Mitigating the Impact of COVID-19 on Mental Health Treatment of PTSD
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Adding Insult to Injury: Mitigating the Impact of COVID-19 on Mental Health Treatment of PTSD Greg M. Reger 1
&
Barbara O. Rothbaum 2
Received: 19 June 2020 / Revised: 19 June 2020 / Accepted: 31 August 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Tremendous progress has been made in the dissemination of recommended, first-line psychotherapies for PTSD among military service members and veterans (Karlin and Cross 2014). However, recent public health infection prevention interventions for COVID-19 require widespread adoption of social distancing to slow the spread of the virus. These interventions risk negative impacts on the mental health treatment of posttraumatic stress disorder (PTSD). Technology has an important role to play in supporting outcomes during this era, particularly should fears of a “2nd wave” of COVID-19 infection come to pass.
Impact of the Public Health Management of Novel Corona Virus on PTSD Treatment The most direct impact of the spread of COVID-19 on PTSD treatment is the reduced access to treatment as the virus spreads. Non-urgent healthcare encounters are being delayed or canceled in many parts of the country. Intensive groupbased psychotherapy has ceased in some regions. This involuntary break in treatment for those engaged in PTSD therapy is concerning and the impact is not known. Recent data suggest lower attrition and better outcomes for evidence-based psychotherapy for PTSD among those with more frequent appointments, or intensive treatment (Foa et al. 2018). Social distancing also risks reinforcing PTSD-related avoidance. Theories of PTSD conceptualize patients’ attempts to manage distress through avoidance as maladaptive, as it prevents the learning essential to recovery (Foa et al. 1989). * Greg M. Reger [email protected] 1
VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA 98493, USA
2
Emory School of Medicine, 12 Executive Park Drive, Atlanta, GA 30329, USA
Exposure therapies are highly effective treatments but involve patient collaboration to block avoidance and intentionally approach previously avoided memories, situations, and places. Current social distancing directly interferes with treatment via in vivo exposure, as many patients can no longer approach common treatment assignments like crowds, some stores, and public environments. As the health crisis continues, the anxiety of the general population understandably increases with a near-constant consumption of news, which focuses attention on the many risks and concerns of the day. With “stay at home” requirements in a number of states, patients engaged in PTSD treatment have limited access to many of their traditional forms of coping (e.g., gyms, faith communities, social gatherings).
PTSD Treatment Opportunities During Pandemic To support patients with PTSD at this time, providers should consider adoption of telemental health modalities to reduce treatment interruptions. Evidence-based treatments for PTSD de
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