Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder

The purpose of the present study is to examine the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with post-traumatic stress disorder (PTSD). For this purpose, a framework was determined by using findings of the research and explanations at the conceptual level. PTSD is a mental disorder that is experienced after traumatic events, affects individuals cognitively, emotionally, and behaviorally and threatens the integrity of an individual's life. EMDR therapy is a therapy that imaginatively reveals the past or traumatic experiences of the client through eye movements and other bilateral stimuli (two-way sound or tactile stimulus), facilitates information processing processes. Whereas EMDR was initially an approach developed for adults, it was later used for children and adolescents. The fact that it gives positive results in a short time and these positive results continue in follow-up studies has increased the interest in using EMDR for children and adolescents with PTSD. The use of EMDR for children and adolescents has allowed their problems to be resolved in a timely manner and reduced PTSD symptoms. This situation has drawn attention to the importance of using EMDR in the practice of psychological counselors working in school environments, leading places where they work with children and adolescents, and where the first preventive and interventional studies are carried out. Therefore, it is considered that the use of EMDR will be functional in overcoming these negative life experiences of many students who have been directly or indirectly exposed to traumatic experiences during the COVID-19 epidemic period.

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Prolonged exposure as early intervention in an emergency department context: lessons learned from a terminated RCT.

10.21203/rs.2.11136/v1 ◽

2019 ◽

Author(s):

Maria Bragesjö ◽

Filip Arnberg ◽

Erik Andersson

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Prolonged Exposure ◽

Lessons Learned ◽

Post Traumatic Stress ◽

Target Sample Size ◽

Post Traumatic ◽

Event Based ◽

High Degree

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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Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: task-shifting randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.2018.130 ◽

2018 ◽

Vol 213 (4) ◽

pp. 587-594 ◽

Cited By ~ 9

Author(s):

Jaco Rossouw ◽

Elna Yadin ◽

Debra Alexander ◽

Soraya Seedat

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Prolonged Exposure ◽

Ptsd Symptom ◽

Post Traumatic Stress ◽

Supportive Counselling ◽

Post Traumatic ◽

Ptsd Symptom Severity

BackgroundEmpirical evidence on the effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed.AimsTo evaluate the comparative effectiveness of prolonged exposure and supportive counselling in adolescents with PTSD.MethodSixty-three adolescents (13–18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7–14 sessions of treatment (trial registration in the Pan African Clinical Trials Registry: PACTR201511001345372). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale at pre-treatment, post-treatment, and at 3- and 6-month follow-up.ResultsParticipants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving supportive counselling (between group differences at post-intervention, mean 12.49, 95% CI 6.82–18.17, P<0.001; d = 1.22). A similar effect size was maintained at 3-month (d = 0.85) and 6-month (d = 1.02) follow-up assessments.ConclusionsAdolescents with PTSD experienced greater benefit from prolonged exposure treatment when provided by non-specialist health workers (nurses) in a community setting.Declaration of interestNone.

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