Pharmacological Adjuncts and Evidence-Supported Treatments for Trauma

2016 ◽  
Author(s):  
Nina N. Karpova
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Strategies ◽  
Neural Circuitry ◽  
Therapeutic Interventions ◽  
Pharmacological Agents ◽  
Evidence Supported Treatments

A large proportion of humans experienced a traumatic event in their lifetime, with more than 10% developing posttraumatic stress disorder (PTSD), panic disorder, phobias, and other fear/anxiety disorders. The neural circuitry of fear responses is highly conserved in humans as well as rodents, and this allows for translational research using animal models of fear. Fear/anxiety disorders in humans are most efficiently treated by exposure-based psychotherapy (i.e., cognitive behavioral therapy; CBT), the main aspects of which are closely modeled by extinction training in Pavlovian fear conditioning and extinction paradigms in rodents. To improve the efficacy of psychotherapy, pharmacological agents potent for enhancing learning and memory consolidation processing should be developed to combine with exposure-based therapy. The purpose of these adjunctive pharmacological agents is to promote fear memory erasure and the consolidation of extinction memories, thus providing a combined treatment of increased effectiveness. This review discusses established pharmacological adjuncts to behavioral therapeutic interventions for fear/anxiety disorders. The mechanisms of action of these adjuncts, as well as the evidence for and against the pharmacological treatment strategies and their limitations are discussed.

scholarly journals Introduction—Treatment Resistance: Concepts and Management in Mood and Anxiety Disorders

CNS Spectrums ◽  
2002 ◽  
Vol 9 (S14) ◽  
pp. 5-5
Author(s):  
Mark H. Rapaport
Keyword(s):  
Anxiety Disorders ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Resistance ◽  
Rational Approach ◽  
Individual Treatment ◽  
Therapeutic Approaches ◽  
Important Data ◽  
Mood And Anxiety Disorders

This supplement to CNS Spectrums focuses on exciting emerging data on therapeutic approaches that can help the clinician with difficult-to-treat patients. Over the last decade, there have been tremendous advances in our conceptualization of difficult-to-treat patients, including diagnostic, psychotherapeutic, pharmacotherapeutic, and somatic approaches. A series of articles addressing these advances in the field are presented in this supplement.Edna B. Foa, PhD, has been a leading expert in cognitive-behavioral therapy (CBT) for anxiety disorders for many years. Foa and colleagues provide a thoughtful analysis of the particular components of CBT that may be responsible for its efficacy in anxiety disorders. This article goes beyond simple trials looking at the efficacy of CBT or combined treatment with pharmacotherapy and CBT. Foa and colleagues identify individual treatment and patient factors as well as the interaction between the two, that may influence treatment response. Treatment of posttraumatic stress disorder is used as a model for helping us understand this exciting work.Next, Waguih William IsHak, MD, presents important data about the use of practical and pragmatic treatment paradigms in patients with mood and anxiety disorders. Dr. IsHak emphasizes the importance of standardized structured approaches to facilitate understanding of the breadth of psychopathology present in the patient. The model Dr. IsHak proposes for the evaluation and conceptualization of the patient facilitates the integration of biological factors, psychological factors, and psychosocial variables. His algorithms go beyond merely a technique for assessment and present a rational approach to therapy for patients. These algorithms are limited by existing data, but the steps elaborated within the algorithm are powerful and useful for the clinician. This article serves as a useful guide for both trainees and clinicians with many years in practice.

Combining Cognitive-Behavioral Therapy and Pharmacotherapy for the Treatment of Panic Disorder

2006 ◽  
Vol 20 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Jasper A. J. Smits ◽  
Conall M. O’Cleirigh ◽  
Michael W. Otto
Keyword(s):  
Panic Disorder ◽  
Combination Treatment ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Treatment Strategies ◽  
Cognitive Behavior ◽  
Short Term ◽  
Medication Treatment ◽  
Novel Approaches

This article focuses on the role of combination treatment strategies in the management of panic disorder (PD). Despite short-term benefits, there is not consistent evidence for a longer-term advantage of combined treatment over cognitive-behavior therapy alone. In discussing this result, we place emphasis on ways in which medication treatment may interfere with the learning of safety in relation to feared cues in PD. These considerations are placed in the context of animal and human studies of factors that interfere with the extinction of fears. Strategies to overcome this interference are also discussed as are novel approaches to combination treatment.

scholarly journals Confronting Trauma's Early Aftermath and the Risk for Posttraumatic Stress Disorder

CNS Spectrums ◽  
2006 ◽  
Vol 11 (8) ◽  
pp. 585-586
Author(s):  
Ehud Klein
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Acute Stress ◽  
Traumatic Event ◽  
Acute Stress Disorder ◽  
Clinical Syndrome ◽  
Therapeutic Interventions ◽  
Psychological Resources

Posttraumatic stress disorder (PTSD) is a well-defined clinical syndrome that develops in individuals who have witnessed or been exposed to an event that involves a direct threat to life or physical and/or psychological integrity.While numerous studies indicate that PTSD will develop in 15% to 25% of trauma victims, time-limited responses develop in a larger portion of victims during the first 48–72 hours (acute stress reaction) and to a lesser extent over the first 4 weeks (acute stress disorder). Many of those who suffer from acute posttraumatic symptoms eventually recover and overcome the consequences of the traumatic event. However, ∼30% to 50% of those with acute stress disorder will eventually develop PTSD. It is obvious that some individuals are vulnerable to the adverse effects of trauma while others have neurobiological and psychological resources that make them resilient to the long-term impact of traumatic exposure. The identification of risk factors and early predictors for PTSD is thus of major importance for identifying those at risk and for initiating therapeutic interventions aimed to reduce long-term morbidity and suffering.

Cognitive Behavioral Therapy in a Group of Militaries With Posttraumatic Stress Disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S513-S513
Author(s):  
H. El Kefi ◽  
W. Abdelghaffar ◽  
A. Baatout ◽  
C. Bechikh Brahim ◽  
W. Krir ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Cognitive Behavioral Therapy ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Behavioral Approach ◽  
Cognitive Behavioral ◽  
Relaxation Techniques ◽  
Competing Interest

IntroductionPosttraumatic stress disorder (PTSD) has a high prevalence and severe impact in military populations. Cognitive behavioral therapy (CBT) is indicated in this condition but it is a structured therapy that requires patients’ motivation and doctors’ availability.Objectives and aimsAssess feasibility and effectiveness of CBT in a military group with PTSD.MethodsA group of six militaries that witnessed the same traumatic event (an armed attack) and were diagnosed with PTSD were involved in a structured individual session CBT with one therapist. An assessment using the PTSD checklist for DSM (PCL) was performed initially and in halfway therapy. The therapy included an education about PTSD, a cognitive restructuring, a behavioral approach via home tasks and relaxation techniques.ResultsThe initial PCL scores varied from 25 to 55. All patients were initially on sick leave. Five patients had adjunctive antidepressant medications and one patient was only on therapy. Three patients showed no motivation and were excluded after 3 sessions. Two patients have had 7 weekly sessions and were able to return to work in the same place. One patient with severe PTSD had 2 sessions monthly, he had slight clinical improvement and could not come back to military work. The three patients who are still in therapy have improved PCL scores.ConclusionsCBT can be effective in PTSD. The outcome depends on initial severity of PTSD and assiduity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Empirical Evidence for the Outcomes of Therapeutic Video Games for Adolescents With Anxiety Disorders: Systematic Review (Preprint)

2017 ◽  
Author(s):  
Steven Barnes ◽  
Julie Prescott
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Stress Reactivity ◽  
Behavioral Therapy ◽  
Experimental Studies ◽  
Therapeutic Interventions ◽  
Care Practice ◽  
Inclusion Criteria ◽  
Attention Bias Modification ◽  
Research Journal

BACKGROUND Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (ADs) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. The existing therapeutic interventions (eg, cognitive behavioral therapy, CBT; attention bias modification, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of eHealth (health care practice supported by electronic processes and communication) and mHealth (versions of eHealth using mobile devices) interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable, and personalized virtual environments. Although some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety. OBJECTIVE The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in anxiety symptoms in adolescent samples. METHODS A systematic search of the existing academic literature published between 1990 and July 2017 was conducted using the databases Journal of Medical Internet Research, Journal Storage, Psychology Articles, Psychology Info, ScienceDIRECT, and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated. RESULTS A total of 5 studies (N=410 participants) met the inclusion criteria, and 3 gamified anxiety interventions for adolescents were identified. The papers included a mixture of randomized controlled trials, quasi-experimental studies, and usability studies comprising quantitative and qualitative measures, with varying degrees of mixed methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by a low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by a control-game selection. CONCLUSIONS Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms.

scholarly journals Diverse mechanisms and treatment strategies to confront fatigue in multiple sclerosis: A systematic review

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 563
Author(s):  
Sumanth Khadke ◽  
tehmina siddique
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Cochrane Review ◽  
Treatment Strategies ◽  
Individual Treatment ◽  
Positive Effects ◽  
Positive Effect

Background: Firm conclusions about the applicability of treatment methods other than pharmacotherapy in treating fatigue in multiple sclerosis (MS) remain elusive. Our objective is to synthesize and review the epidemiological literature systematically and find an effective therapeutic plan for fatigue. The effect of individual treatment and combined treatment strategies are studied. Methods: An electronic database search included EBSCO, PubMed, SCIENCE DIRECT and Scopus from January 1, 2013, to September 30, 2018. Search terms used are “Fatigue AND Multiple sclerosis AND therapy”. The articles included in the study are open access, published in last five years, not restricted to region and language. The search included randomized controlled trials (RCTs), observational studies, and systematic reviews. Results: We included 13 systematic reviews, 10 RCTs and 7 observational studies. A Cochrane review on 3206 patients showed exercise therapy to have a positive effect on fatigue in RRMS patients. The EPOC trial showed switching interferon therapy or glatiramer to fingolimod showed improved fatigue levels. The FACETS trial showed incorporating behavioral therapy to ongoing recommended therapy is beneficial. Few observational studies demonstrated that fatigue is influenced by pain, mood problems, and depression. Conclusions: The diverse pathology of fatigue related to MS is important in understanding and quantifying the role of each causal factor. Evidence reveals a positive effect on fatigue levels of RRMS patients with regular CBT and exercise-based combination therapy. Progressive forms of the disease have the worst prognosis. Individually aerobic exercises, behavioral therapy and pharmacotherapy have positive effects. A modified amalgamation of the same is a better hope for MS patients.

Treating Posttraumatic Stress Disorder: A Timely Update on Therapeutic Strategies

2020 ◽  
Vol 7 (1) ◽  
pp. 107-116
Author(s):  
Quanguang Zhang ◽  
◽  
Yong Li ◽  
Lorelei Tucker
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Behavioral Therapy ◽  
Therapeutic Strategies ◽  
Psychological Disorder ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Current Lines

Posttraumatic stress disorder (PTSD) is a psychological disorder that can develop after an individual experiences or witnesses a traumatic event. PTSD is startlingly common in veterans, victims of assault, those undergoing extreme medical care, and the clinicians that treat them. This growing mental health crisis has been dramatically exacerbated by the stressors and tragic events of the ongoing global COVID-19 pandemic. In this review, we will discuss the different classes of treatment for PTSD and examine current lines of research in each. First, we explore how the field of psychotherapy approaches PTSD, with focus placed on exposure therapy, cognitive behavioral therapy, and more. We then describe current pharmacological strategies for PTSD treatment and several prominent therapeutic strategies currently undergoing clinical and pre-clinical trials. Next, we investigate novel approaches that integrate principles of psychotherapy with seemingly unconventional elements and discuss how these unique components may impact recovery. Finally, we explore how telemedicine has been implemented to expand access to care, which is particularly critical in a time of social distancing and economic disparity. We hope that by summarizing current clinical practice and outlining cutting-edge research, this review can elucidate the field and highlight gaps in knowledge that merit further investigation that may lead to more effective and accessible treatment for PTSD patients.

Neuroimaging of anxiety disorders

2020 ◽  
pp. 938-947
Author(s):  
Gregor Leicht ◽  
Christoph Mulert
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Treatment Strategies ◽  
Panic Attacks ◽  
Anterior Cingulate ◽  
Therapeutic Interventions ◽  
Human Models ◽  
Neural Processes ◽  
Pathophysiological Role

Neuroimaging has extensively contributed to the identification of the neurobiological basis of anxiety and the pathophysiological mechanisms underlying anxiety disorders. Studies in human models of anxiety, as well as investigations in anxiety disorder patients, consistently demonstrated the pathophysiological role of a ‘fear network’ comprising the amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex. This chapter reviews the main neuroimaging findings from human models of anxiety disorders such as fear conditioning, fear generalization, and pharmacologically induced panic attacks. Moreover, the chapter summarizes evidence from research in patients aiming to identify the neural processes underlying the pathophysiology of clinically relevant anxiety disorders. Finally, the chapter provides an overview on neurobiological aspects of successful therapeutic interventions, which might prospectively contribute to the refinement of existing approaches, the prediction of the success of certain treatment strategies in individual patients, and the development of more effective options for the treatment of anxiety disorders.

EMDR in Psychosis: Guidelines for Conceptualization and Treatment

2013 ◽  
Vol 7 (4) ◽  
pp. 208-224 ◽  
Author(s):  
David P. G. Van den Berg ◽  
Berber M. Van der Vleugel ◽  
Anton B. P. Staring ◽  
Paul A. J. De Bont ◽  
Ad De Jongh
Keyword(s):  
Life Events ◽  
Childhood Trauma ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Significant Proportion ◽  
Treatment Strategies ◽  
Psychotic Symptoms ◽  
Case Examples ◽  
Early Life Events ◽  
Method Approach

A significant proportion of clients with psychosis have experienced childhood trauma and suffer from comorbid posttraumatic stress disorder. Research indicates that exposure to distressing early life events plays an important role in the emergence and persistence of psychotic symptoms—either directly or indirectly. The Two Method Approach of EMDR conceptualization and recent findings on reprocessing of psychosis-related imagery fit with the existing cognitive models of psychosis. This article presents a series of preliminary guidelines for conceptualizing EMDR treatment in psychosis, which are based on both theory and clinical experience and are illustrated with case examples. Several obstacles and related treatment strategies for using EMDR in psychosis are described. EMDR in psychosis can very well be combined with other standard interventions such as psychotropic medication and cognitive behavioral therapy.

Functional Neurocircuitry and Neuroimaging Studies of Anxiety Disorders

2017 ◽  
Author(s):  
Madeleine S. Goodkind ◽  
Amit Etkin
Keyword(s):  
Emotion Regulation ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Emotional Reactivity ◽  
Stress Disorder ◽  
Specific Phobia ◽  
Neural Circuitry ◽  
Generalized Anxiety ◽  
Cognitive Responses ◽  
Anxiety And Fear

Anxiety and fear serve adaptive functions and include wide-ranging subjective, physiological, behavioral, and cognitive responses. When these reactions are present chronically, and to a heightened degree that generalizes to signals beyond those that are objectively dangerous, one sees emergence of clinical anxiety disorders. Historically, anxiety disorders have been conceptualized as disruptions in fear processing, though more recent accounts also highlight changes in emotional reactivity beyond fear and deficits in emotion regulation. In this chapter, we review the neural circuitry relevant for fear processing and for emotional reactivity and regulation more broadly. We then review neuroimaging studies of social anxiety disorder, specific phobia, generalized anxiety disorder, panic disorder, and posttraumatic stress disorder. We highlight areas of overlap between disorders as well as disorder-specific perturbations.

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