Rapid recovery – massed treatment for PTSD

In this episode of the PTSD Bytes podcast, host Dr. Colleen Becket-Davenport discusses massed treatments for PTSD with Dr. Jennifer Schuster Wachen, a clinical research psychologist at the Women’s Health Science Division of the National Center for PTSD, a consultant with the VA PTSD Consultation Program, and associate professor in the Department of Psychiatry at the Boston University Chobanian & Avedisian School of Medicine.

Massed treatments for PTSD

“Massed treatment” refers to delivering psychotherapy in a shorter timeframe than usual. For instance, a standard treatment may have you attending therapy sessions once a week for multiple months. Massed treatment might mean that you attend therapy sessions three times a week (or more), so the course of therapy is completed much more quickly.

In other words, the treatment itself is condensed or “massed” together. You can still participate in therapy in one-on-one sessions with your therapist. Massed treatments can also be done in small groups as well.

Research has shown that massed treatments can be as effective as treatment delivered in the standard way. However, we don’t yet know which types of people, conditions or situations would be best suited for massed treatments. Some people may like the idea of completing therapy in such a short amount of time but others might find that less appealing—for various reasons.

Logistical factors can also play a role in deciding if frequent sessions are more doable. Talk with your provider about your preferences and choose what sounds best to you.

Structure of massed treatments

A provider can deliver massed treatments three or more times per week via regular clinic visits or telehealth. In addition, existing programs designed for service members and Veterans include more comprehensive options.

Two- to three-week intensive outpatient programs

• Consists of intensive outpatient programs with daily treatment sessions.
• Each day includes one or more session of trauma-focused therapy (groups or individual).
• Other activities may include groups to address topics such as stress management or sleep problems, yoga, other physical activities and nutrition counseling.

Trauma-focused therapy programs

• Include just the trauma-focused therapy delivered more frequently without extra programming.
• Offer evidence-based treatment for PTSD delivered three to five days per week.
• May also include check-in groups that provide support a few times throughout the day with time allotted to complete therapy take-home assignments.

Benefits and drawbacks of massed treatment programs

Potential benefits

• More likely to help people complete a full course of therapy (dropout rates for massed treatment are much lower than for regular weekly treatments).
• Reduces the amount of time for life events (such as job changes, serious illnesses, and family emergencies) to get in the way of attending sessions.
• May be easier for someone to clear time to come to therapy for a few weeks straight, rather than having to attend an appointment once a week across several months.
• Having more frequent sessions may help people stay more engaged with treatment and reduce the tendency to avoid often associated with PTSD.  

Potential drawbacks

• Concerns that daily, trauma-focused therapy might be too much to tolerate. 
• Need to clear your schedule to attend multiple sessions during a week and complete assignments between sessions.

Helpful tips for pursuing massed treatment for PTSD

How to find this type of treatment?

Most of the programs offering massed treatments are either within VA or in community programs that specifically serve Veterans, such as the Warrior Care Network program. If a Veteran’s local VA facility is not offering this yet, it may be possible to get massed treatment through virtual care from another program within VA. Non-Veterans can also seek out providers in the community who are trained in evidence-based treatments for PTSD and ask about the possibility of having multiple sessions per week.

How to get the most out of a massed PTSD treatment?

It is important to commit to attending therapy regularly and completing assignments between sessions, which may mean clearing your schedule of other obligations as much as possible. Furthermore, because the content of the therapy moves quicker in mass treatments, it is helpful to communicate with your provider if you’re having any challenges with the treatment or the assignments so that any concerns are quickly addressed.

Are there helpful digital resources?

If you’re doing a massed version of cognitive processing therapy (CPT) or prolonged exposure (PE), there are free mobile apps that can be used to support these therapies: CPT Coach and PE Coach. Both have tools to help you complete homework assignments between sessions. You can also use the apps after treatment to continue tracking symptoms and practicing the skills learned in therapy.

Additional links

• Learn more about massed treatment options.
• Learn more about VA mental health apps.
• Find mental health treatment at VA.
• Find mental health treatment outside of VA.
• More PTSD Bytes episodes.

If you are a Veteran who is experiencing a crisis or supporting a loved one who is, call 988 and press 1 for immediate assistance, or chat online at VeteransCrisisLine.net/chat.