Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example

Abstract Objective The main purpose of the trial was to test if a brief trauma focused cognitive-behavior therapy (prolonged exposure; PE) provided within 72h after a trauma could be effective in decreasing the incidence of post-traumatic stress disorder (PTSD), replicating and extending findings from an earlier trial. After a pilot study (N=10), which indicated feasible and deliverable study procedures and interventions, we subsequently launched an RCT with a target sample size of 352 participants randomized to either three sessions PE or non-directive support. Due to an unforeseen major reorganization at the hospital, the RCT was discontinued after 32 included participants. Results In this paper, we highlight obstacles and lessons learned from our feasibility work, relevant for preventive psychological interventions for PTSD in emergency settings. One important finding was the high degree of attrition: only 78% and 34% respectively came back for the two months and six-months assessments. There were also difficulties in reaching eligible patients immediately after the event. Based on our experiences, we envisage that alternative models of implementation might overcome these obstacles, for example, with remote delivery of both assessments and treatment, combined with multiple recruitment procedures. Lessons learned from this terminated RCT are discussed in depth.

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Post-Traumatic Stress Disorder

Concussion Care Manual ◽

10.1093/med/9780199383863.003.0011 ◽

2014 ◽

pp. 55-60

Author(s):

David L Brody

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Prolonged Exposure ◽

Behavioral Therapy ◽

Mood Stabilizer ◽

Post Traumatic Stress ◽

Prolonged Exposure Therapy ◽

Post Traumatic ◽

Specific Expertise

In many contexts, the trauma that caused the concussion can also trigger a strong stress response. Take a focused history from the patient and collateral source for hyperarousal, nightmares, avoidance, emotional numbing, dissociation, and prior diagnosis of post-traumatic stress disorder (PTSD). Assess safety. Severe PTSD can lead to suicide. Refer to a psychologist or counselor with specific expertise in PTSD for prolonged exposure therapy or cognitive behavioral therapy. Optimize sleep. Start an anxiolytic antidepressant. Prescribe prazosin for nightmares. Ideally, use short-acting benzodiazepines only for emergencies. Advise the patient to stop drinking alcohol. Treat chronic pain aggressively if present. Consider a second-line mood stabilizer if necessary. Don’t be afraid to use stimulants if the patient also has impairing attention deficit once the PTSD symptoms are under reasonable control.

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A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings

CNS Spectrums ◽

10.1017/s1092852920001455 ◽

2020 ◽

pp. 1-8

Author(s):

Érica Panzani Duran ◽

Felipe Corchs ◽

Andrea Vianna ◽

Álvaro Cabral Araújo ◽

Natália Del Real ◽

...

Keyword(s):

Cognitive Therapy ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Prolonged Exposure ◽

Dropout Rate ◽

Dysfunctional Attitudes ◽

Post Traumatic Stress ◽

Post Traumatic ◽

Secondary Outcomes

Abstract Background. Post-traumatic stress disorder (PTSD) is a prevalent mental health condition that is often associated with psychiatric comorbidities and changes in quality of life. Prolonged exposure therapy (PE) is considered the gold standard psychological treatment for PTSD, but treatment resistance and relapse rates are high. Trial-based cognitive therapy (TBCT) is an effective treatment for depression and social anxiety disorder, and its structure seems particularly promising for PTSD. Therefore, we evaluated the efficacy of TBCT compared to PE in patients with PTSD. Methods. Ninety-five patients (77.6% females) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for PTSD were randomly assigned to receive either TBCT (n = 44) or PE (n = 51). Patients were evaluated before and after treatment, and at follow-up 3 months after treatment. The primary outcome was improvement in PTSD symptoms as assessed by the Davidson Trauma Scale (DTS). Secondary outcomes were depression, anxiety, and dysfunctional attitudes assessed by the Beck Depression/Anxiety Inventories and Dysfunctional Attitudes Scale, as well as the dropout rate. Results. A significant reduction in DTS scores was observed in both arms, but no significant difference between treatments. Regarding the secondary outcomes, we found significant differences in depressive symptoms in favor of TBCT, and the dropout rate was lower in the TBCT group than the PE group. Conclusion. Our preliminary results suggest that TBCT may be an effective alternative for treating PTSD. Further research is needed to better understand its role and the mechanisms of change in the treatment of this disorder.

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Trauma―Focused Treatment for PTSD With Comorbid Psychosis: A Case Report

Clinical Case Studies ◽

10.1177/1534650120980069 ◽

2020 ◽

pp. 153465012098006

Author(s):

Stephanie Cherestal ◽

Kate L. Herts

Keyword(s):

Case Report ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Rating Scales ◽

Stress Disorder ◽

Prolonged Exposure ◽

Psychotic Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic ◽

Treatment Targeting

Post-traumatic stress disorder is often a condition left untreated in patients also meeting criteria for psychotic disorders. While many clinicians who treat patients with these co-occurring conditions choose to avoid treatment targeting symptoms of PTSD for fear of de-stabilizing these individuals or exacerbating psychotic symptomatology, little is currently known about how patients respond to treatment for PTSD in the context of ongoing psychotic symptoms. Additionally, research is scarce regarding the clinical profile of individuals who develop psychotic symptoms secondary to a traumatic stressor, in the absence of any premorbid symptomatology. The purpose of this case report is to outline the case of an individual, “Mary” who developed psychotic symptoms secondary to a traumatic stressor in her middle age and to describe her response to treatment targeting her symptoms of PTSD. Mary presented with core symptoms of PTSD that emerged following a traumatic car crash. She developed psychotic symptoms (auditory and visual hallucinations) several weeks later. Mary underwent a treatment course of Prolonged Exposure targeting her symptoms of PTSD, with careful work done to monitor any changes in psychotic symptomatology while engaging in this treatment. Standardized measures such as the Post-traumatic Stress Disorder Checklist-5 (PCL-5) and the Psychotic Symptom Rating Scales were administered to assess Mary’s progress throughout treatment. This case report provides a comprehensive summary of Mary’s 16-week course of Prolonged Exposure therapy, which resulted in a significant reduction in PTSD symptomatology as demonstrated by a 72% decrease in scores on the PCL-5 from the initiation to the conclusion of treatment.

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