Modern pharmacological treatments for anxiety disorders are safer and more tolerable than they were 30 years ago. Unfortunately, treatment efficacy and duration have not improved in most cases despite a greater understanding of the pathophysiology of anxiety. Moreover, innovative treatments have not reached the market despite billions of research dollars invested in drug development. In reviewing the literature on current treatments, we argue that evidence-based practice would benefit from better research on the causes of incomplete treatment response as well as the comparative efficacy of drug combinations and sequencing. We also survey two broad approaches to the development of innovative anxiety treatments: the continued development of drugs based on specific neuroreceptors and the pharmacological manipulation of fear-related memory. We highlight directions for future research, as neither of these approaches is ready for routine clinical use.

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Objective This study compared changes in emotion regulation and trait affect over the course of PTSD treatment with either prolonged exposure (PE) therapy or sertraline in adults with and without a history of childhood abuse (CA). Method Two hundred adults with PTSD received 10 weeks of PE or sertraline. Emotion regulation and trait affect were assessed at pre- and post-treatment and at six-month follow-up with the Emotion Regulation Questionnaire (Gross & John, 2003), the Negative Mood Regulation Scale (Catanzaro & Mearns, 1990), and the Positive and Negative Affect Scale (Watson, Clark, & Tellegen, 1988). Results Individuals with and without a history of CA did not differ from one another at pre-treatment on PTSD severity, emotion regulation, or positive/negative affect. In addition, treatment was effective at improving emotion regulation and trait affect in those with and without a history of CA, and no significant differences in emotion regulation or trait affect emerged at post-treatment or at six-month follow-up between adults with and without a history of CA. Furthermore, non-inferiority analyses indicated that the emotion regulation and trait affect outcomes of individuals with a history of CA were no worse than those of individuals without a history of CA. Conclusion These findings cast doubt on the assumption that CA is associated with worse emotion regulation following PTSD treatment, arguing against assertions that a history of CA itself is a contraindication for traditional PTSD treatment, and that there is a clear necessity for additional interventions designed at targeting assumed emotion regulation deficits.

The effects of current posttraumatic stress disorder (PTSD) interventions on emotion regulation are relatively unknown. Many conceptualize PTSD as a disorder of emotion dysregulation, and clinicians often fear that emotion regulation impairments will not change with stand-alone PTSD treatments, particularly for individuals with pre-existing emotion regulation difficulties. The present study examined changes in emotion regulation (expressive suppression, cognitive reappraisal, negative mood regulation) with prolonged exposure (PE) therapy or sertraline, specifically examining whether those with higher pre-existing emotion regulation difficulties improve over treatment on these indices. Individuals with chronic PTSD (N = 200) received 10 weeks of PE or sertraline and were followed through 6-month follow-up. Emotion regulation was assessed at pre- and post-treatment and at 3- and 6-month follow-up. Individuals with poorer initial emotion regulation showed greater improvement on all indices of emotion regulation, regardless of which treatment they received. Changes occurred during active treatment and were maintained over follow-up. These findings have both theoretical and clinical implications, arguing that emotion regulation is not impaired across all individuals with PTSD and that PE and sertraline effectively address emotion regulation difficulties.

The relationship between reductions in PTSD and depression during PE is transactional. Regardless of whether PTSD or depression decreases first, reduction in the other symptom cluster is likely to follow. (PsycINFO Database Record