Prolonged Exposure Therapy for Chronic Combat-Related PTSD: A Case Report of Five Veterans

ABSTRACTProlonged exposure (PE) therapy has been found efficient in reducing posttraumatic stress disorder (PTSD) symptoms mostly among rape victims, but has not been explored in combat-related PTSD. Five patients with severe chronic PTSD, unresponsive to previous treatment (medication and supportive therapy) are described. Patients were evaluated with the PTSD Symptom Scale–Interview, and Beck Depression Inventory, before and after 10–15 sessions of PE therapy. All five patients showed marked improvement with PE, with a mean decrease of 48% in PTSD Symptom Scale–Interview score and 69% in Beck Depression Inventory score. Moreover, four patients maintained treatment gains or kept improving 6–18 months after the treatment. The results suggest that PE was effective in reducing combat-related chronic PTSD symptoms.

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The Child PTSD Symptom Scale: An Investigation of Its Psychometric Properties

Journal of Interpersonal Violence ◽

10.1177/0886260515596536 ◽

2015 ◽

Vol 32 (15) ◽

pp. 2237-2256 ◽

Cited By ~ 10

Author(s):

Regan W. Stewart ◽

Chad Ebesutani ◽

Christopher F. Drescher ◽

John Young

Keyword(s):

Psychometric Properties ◽

Factor Structure ◽

Discriminant Validity ◽

Ptsd Symptom ◽

High Reliability ◽

Self Report ◽

Ptsd Symptoms ◽

Symptom Scale ◽

Structure Reliability ◽

Child Ptsd

The current study addresses the need for accurate measurement of posttraumatic stress disorder (PTSD) symptoms in youth by investigating the psychometric properties of the Child PTSD Symptom Scale (CPSS). The factor structure, reliability, and concurrent and discriminant validity of the CPSS were investigated in a sample of 206 6th- to 12th-grade adolescents. Exploratory and confirmatory factor analysis supported a single-factor structure, which was contrary to the hypothesized three-factor structure. Scores comprising this one-factor structure were also associated with high reliability (α = .93), and tests of concurrent and discriminant validity were also strong. The implications of these findings are discussed, with particular emphasis on future directions for research on self-report measures for adolescent PTSD symptoms.

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Long-term follow-up of a randomised controlled trial of prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: a task-shifted intervention

Psychological Medicine ◽

10.1017/s0033291720002731 ◽

2020 ◽

pp. 1-9

Author(s):

Jaco Rossouw ◽

Elna Yadin ◽

Debra Alexander ◽

Soraya Seedat

Keyword(s):

Prolonged Exposure ◽

Ptsd Symptom ◽

Post Treatment ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Prolonged Exposure Therapy ◽

Supportive Counselling ◽

Post Traumatic ◽

Ptsd Symptom Severity

Abstract Background Empirical evidence on the longer-term effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed. The aim of the study was to evaluate the maintenance of treatment gains achieved in a comparative study of effectiveness of prolonged exposure therapy for adolescents (PE-A) and supportive counselling (SC) in adolescents with PTSD up to 24-months post-treatment. Method Sixty-three adolescents (13–18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7–14 sessions of treatment provided by trained and supervised non-specialist health workers (NSHWs). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale, at pretreatment, post-treatment, and at 3-, 6-, 12- and 24-months post-treatment follow-up (FU) evaluations. Results Participants in both the prolonged exposure and SC treatment groups attained a significant reduction in PTSD symptoms and maintained this reduction in PTSD symptoms at 12- and 24-month assessment. Participants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving SC at 12-months FU [difference in PE-A v. SC mean scores = 9.24, 95% CI (3.66–14.83), p < 0.001; g = 0.88] and at 24-months FU [difference in PE-A v. SC mean scores = 9.35, 95% CI (3.53–15.17), p = 0.002; g = 0.68]. Conclusions Adolescents with PTSD continued to experience greater benefit from prolonged exposure treatment than SC provided by NSHWs in a community setting 12 and 24 months after completion of treatment.

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Die deutsche Version der Modified PTSD Symptom Scale (MPSS): Erste psychometrische Befunde zu einem Screeningverfahren für posttraumatische Symptomatik

Zeitschrift für Klinische Psychologie und Psychotherapie ◽

10.1026/0084-5345.30.3.159 ◽

2001 ◽

Vol 30 (3) ◽

pp. 159-163 ◽

Cited By ~ 5

Author(s):

Carsten Spitzer ◽

Gerit Abraham ◽

Konrad Reschke ◽

Harald J. Freyberger

Keyword(s):

Ptsd Symptom ◽

Symptom Scale

Zusammenfassung. Theoretischer Hintergrund: Bisherige Selbstbeurteilungsinstrumente zur Abbildung posttraumatischer Belastungsstörungen (PTSD) berücksichtigen häufig den Symptomschweregrad nicht; außerdem setzen sie voraus, daß das Trauma bekannt sein muß. Fragestellung: Wir untersuchten die psychometrischen Eigenschaften eines Screeningverfahrens, das unabhängig von einem bekannten Trauma auch die Symptomintensität erfaßt. Methode: Die Modified PTSD Symptom Scale (MPSS) wurde bei 103 stationär psychiatrischen Patienten eingesetzt, die auch mit einem standardisierten Interview (DIA-X) untersucht wurden. Ergebnisse: Die Werte für Cronbachs Alpha lagen zwischen .88 und .94. Die Übereinstimmung zwischen MPSS-Verdachts- und DIA-X-Diagnosen lag zwischen 65% und 82%. Die innere Konsistenz ähnelt denen anderer Verfahren. Schlußfolgerungen: Für den klinischen Kontext erweist sich die MPSS dadurch vorteilhaft, daß sie die PTSD-Symptomatologie unabhängig von einem bekannten Trauma in ihrer Häufigkeit und ihrem Schweregrad erfaßt.

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Physical Exercise as Treatment for PTSD: A Systematic Review and Meta-Analysis

Military Medicine ◽

10.1093/milmed/usab497 ◽

2021 ◽

Author(s):

Frida Björkman ◽

Örjan Ekblom

Keyword(s):

Subgroup Analysis ◽

Symptom Severity ◽

Ptsd Symptom ◽

Meta Analysis ◽

Secondary Outcome ◽

Study Quality ◽

Ptsd Symptoms ◽

Military Trauma ◽

Exercise Type ◽

Ptsd Symptom Severity

ABSTRACT Introduction Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults. Materials and Methods Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI. Results Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: −0.15 to 0.51), and no sign of publication bias was found. Conclusions Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.

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An exploration of the utility of hypnosis in pain management among rural pain patients

Palliative & Supportive Care ◽

10.1017/s1478951507070216 ◽

2007 ◽

Vol 5 (2) ◽

pp. 147-152 ◽

Cited By ~ 3

Author(s):

THOMAS THORNBERRY ◽

JENNIFER SCHAEFFER ◽

PETER D. WRIGHT ◽

MINDI C. HALEY ◽

KENNETH L. KIRSH

Keyword(s):

Pain Management ◽

Beck Depression Inventory ◽

Pain Treatment ◽

Treatment Center ◽

Poor Responders ◽

Chart Audit ◽

Symptom Scale ◽

Noninvasive Treatment ◽

Perceived Disability ◽

Pain Patients

Objective: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center.Methods: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale.Results: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19–78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t(1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. “Poor” responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the “good” responders, F(1,187) = 7.2, p < .01.Significance of results: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients.

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Using Prolonged Exposure With an Older Male U.S. Veteran With Childhood Sexual Abuse-Related PTSD

Clinical Case Studies ◽

10.1177/1534650118819140 ◽

2018 ◽

Vol 18 (2) ◽

pp. 115-127 ◽

Cited By ~ 2

Author(s):

Elissa McCarthy ◽

Joan M. Cook

Keyword(s):

Sexual Abuse ◽

Childhood Sexual Abuse ◽

Randomized Clinical Trials ◽

Prolonged Exposure ◽

Case Reports ◽

Future Research ◽

Sexual Assaults ◽

Meaningful Improvement ◽

Chronic Ptsd

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.

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