scholarly journals Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?

2019 ◽  
Vol 48 (1) ◽  
pp. 38-53
Author(s):  
Cynthia L. Lancaster ◽  
Daniel F. Gros ◽  
Michael C. Mullarkey ◽  
Christal L. Badour ◽  
Therese K. Killeen ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Prolonged Exposure ◽  
Exposure Therapy ◽  
Psychological Symptoms ◽  
Depression Symptoms ◽  
Post Traumatic Stress ◽  
Concurrent Treatment ◽  
Symptom Exacerbation ◽  
Post Traumatic

AbstractBackground: Although exposure-based therapy is a well-established, effective treatment for post-traumatic stress disorder (PTSD), some practitioners report reluctance to implement it due to concerns that it may exacerbate symptoms of PTSD and commonly comorbid disorders, such as substance use disorders (SUD).Aim: This study compared the exacerbation of psychological symptoms among participants with comorbid PTSD and SUD who received either SUD treatment alone or SUD treatment integrated with exposure therapy for PTSD.Method: Participants (N = 71) were treatment-seeking, military Veterans with comorbid PTSD and SUD who were randomized to 12 individual sessions of either (1) an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE); or (2) a non-exposure-based, SUD-only treatment (Relapse Prevention; RP). We examined between-group differences in the frequency of statistically reliable exacerbations of PTSD, SUD and depression symptoms experienced during treatment.Results: At each of the 12 sessions, symptom exacerbation was minimal and generally equally likely in either treatment group. However, an analysis of treatment completers suggests that RP participants experienced slightly more exacerbations of PTSD symptoms during the course of treatment.Conclusions: This study is the first to investigate symptom exacerbation throughout trauma-focused exposure therapy for individuals with comorbid PTSD and SUD. Results add to a growing literature which suggests that trauma-focused, exposure-based therapy does not increase the risk of symptom exacerbation relative to non-exposure-based therapy.

Session 12: Review and Termination

2014 ◽  
pp. 195-204
Author(s):  
Sudie E. Back ◽  
Edna B. Foa ◽  
Therese K. Killeen ◽  
Katherine L. Mills ◽  
Maree Teesson ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Patient Feedback ◽  
Post Traumatic

This chapter describes the last session (session 12) of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. In this chapter, the therapist is instructed to assess the patient’s progress since the beginning of treatment and review areas in need of continued work. Finally, this chapter instructs the therapist on how to elicit and provide the patient feedback, and treatment is terminated.

Outline of This Treatment Program

2014 ◽  
pp. 25-42
Author(s):  
Sudie E. Back ◽  
Edna B. Foa ◽  
Therese K. Killeen ◽  
Katherine L. Mills ◽  
Maree Teesson ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Substance Use Disorder ◽  
Treatment Program ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Focus Questions

This chapter provides the therapist with an outline of the COPE treatment and components of each session (e.g. check-in, review homework, post-traumatic stress disorder [PTSD] focus, substance use disorder focus). Questions regarding who can deliver the therapy are addressed, as well as questions regarding the role of medications. Finally, special considerations for delivering treatment to patients with PTSD and comorbid substance use disorders are reviewed for the therapist.

Introductory Information for Therapists

2014 ◽  
pp. 1-24
Author(s):  
Sudie E. Back ◽  
Edna B. Foa ◽  
Therese K. Killeen ◽  
Katherine L. Mills ◽  
Maree Teesson ◽  
...  
Keyword(s):  
Substance Use ◽  
Diagnostic Criteria ◽  
Substance Use Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Program Reviews

This chapter provides the therapist with introductory information on the program, reviews the COPE treatment and how it works, and discusses what type of patients are most appropriate for the COPE therapy. In addition, it provides the therapist with the diagnostic criteria for post-traumatic stress disorder (PTSD) and substance use disorders.

Pain and Addiction in Patients with Post-Traumatic Stress Disorder (DRAFT)

2018 ◽  
Author(s):  
Steven A. Eraker
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Psychiatric Symptoms ◽  
Primary Care Providers ◽  
Psychiatric Diagnoses ◽  
Care Providers ◽  
Post Traumatic Stress ◽  
Basic Principles ◽  
Post Traumatic

Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.

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