The Use of Prolonged Exposure Therapy Augmented With CBT to Treat Postpartum Trauma

2019 ◽  
Vol 18 (4) ◽  
pp. 239-253 ◽  
Author(s):  
Samantha A. Reina ◽  
Blanche Freund ◽  
Gail Ironson
Keyword(s):  
Prolonged Exposure ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Major Depressive ◽  
Prolonged Exposure Therapy ◽  
Postpartum Ptsd ◽  
End Of Treatment ◽  
Obstetric Emergencies ◽  
Life Threatening ◽  
Anxiety Depression

Approximately 1% to 2% of women suffer from posttraumatic stress disorder (PTSD) following childbirth, with obstetric emergencies being a key risk factor for birth-related PTSD. The current study augmented prolonged exposure (PE) with cognitive behavioral therapy (CBT) to treat symptoms of PTSD, anxiety, depression, panic disorder, and agoraphobia in a 28-year-old married Hispanic female following a life-threatening case of postpartum preeclampsia. To target distressing symptoms and reach treatment goals, the patient engaged in two preparatory sessions, 12 active PE sessions, and five supplementary CBT sessions. Posttreatment assessment indicated a significant reduction of anxiety and depressive symptoms. Panic attacks reduced in frequency and severity, and by the end of treatment, the patient no longer met criteria for PTSD, major depressive disorder (MDD), or agoraphobia. In the case of postpartum PTSD, CBT can augment PE treatment to reduce symptomatology.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Post-Traumatic Stress Disorder

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.

Implementing Prolonged Exposure Therapy for PTSD in a Context of Ongoing Adversity: A Clinical Case Study

2020 ◽  
Vol 19 (4) ◽  
pp. 258-269
Author(s):  
Duane D. Booysen ◽  
Ashraf Kagee
Keyword(s):  
Prolonged Exposure ◽  
Post Traumatic Stress ◽  
Middle Income ◽  
Care Community ◽  
Middle Income Countries ◽  
Clinical Case Study ◽  
Empirically Supported ◽  
Prolonged Exposure Therapy ◽  
End Of Treatment

Obstacles regarding the implementation of empirically supported treatments (ESTs) for mental disorders such as post-traumatic stress disorder (PTSD) still require further investigation. One notable obstacle is whether persons in low- and middle-income countries (LMICs) residing in a context of ongoing adversity would benefit from an EST for PTSD. We reflect on the utility of a brief prolonged exposure intervention at a primary care community-counseling center in South Africa. “Sam,” a 45-year-old, female was assessed at baseline, during treatment, postassessment, and at 3-month follow-up. At the beginning of treatment, Sam had a positive diagnosis for PTSD (PSSI-5 = 55, and cutoff is 23) and at the end of treatment (PSSI-5 = 17), and 3-month follow-up (PSSI-5 = 21), she had a negative diagnosis for PTSD. We reflect on the mediating effects that contextual factors such as gang violence had on the treatment process and the feasibility of implementing ESTs for PTSD in LMICs under conditions of ongoing adversity.

Reclaiming Your Life from a Traumatic Experience

2019 ◽  
Author(s):  
Barbara Olasov Rothbaum ◽  
Edna B. Foa ◽  
Elizabeth A. Hembree ◽  
Sheila A.M. Rauch
Keyword(s):  
Stress Disorder ◽  
Prolonged Exposure ◽  
Exposure Therapy ◽  
Behavioral Therapy ◽  
Traumatic Experience ◽  
Traumatic Experiences ◽  
Trauma Survivors ◽  
Ptsd Symptoms ◽  
Prolonged Exposure Therapy ◽  
Fear And Anxiety

This workbook, written for patients, is part of a brief cognitive behavioral therapy (CBT) program for individuals who are diagnosed with posttraumatic stress disorder (PTSD) or who manifest PTSD symptoms that cause distress and/or dysfunction following various types of trauma. The overall aim of the treatment is to help trauma survivors emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. The term “prolonged exposure” (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety. PE is designed to get the patient in touch with these emotions and reactions. This workbook is a companion to the Therapist’s Guide, Prolonged Exposure Therapy for PTSD.

scholarly journals Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD

2019 ◽  
Vol 70 (8) ◽  
pp. 703-713 ◽  
Author(s):  
Carissa van den Berk Clark ◽  
Rachel Moore ◽  
Scott Secrest ◽  
Peter Tuerk ◽  
Sonya Norman ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Prolonged Exposure ◽  
Exposure Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Factors Associated ◽  
Prolonged Exposure Therapy

Post-traumatic Stress Disorder

2019 ◽  
pp. 86-93
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 ◽  
Ptsd Checklist ◽  
Post Traumatic

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. Consider using a quantitative scale such as the PTSD Checklist (PCL-5).

Models and Treatment of Panic: Behavioral Therapy of Panic

1991 ◽  
Vol 5 (3) ◽  
pp. 199-214 ◽  
Author(s):  
Michelle G. Craske
Keyword(s):  
Panic Disorder ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Panic Attacks ◽  
Wait List ◽  
Global Functioning ◽  
Wait List Control ◽  
End Of Treatment ◽  
Behavioral Treatments

In this presentation, the results from two studies examining the effectiveness of behavioral treatments for panic disorder are presented. In the first study, a dismantling treatment study design was used to compare relaxation training, exposure and cognitive procedures, the combination of relaxation plus expoosure and cognitive procedures, and a Wait-List control. Subjects with panic disorder and mild or no agoraphobic avoidance were compared immediately after the 15-week treatment program and 6 months and 24 months later. Overall, exposure and cognitive procedures were found to be more effective than relaxation for the control of panic attacks in the short term and over the long term. In the second study, the combination of relaxation plus exposure and cognitive procedures was compared to Alprazolam, Placedbo, and Wait-List control conditions. Overall, the Cognitive-Behavioral therapy condition showed strongest improvements by the end of treatment in terms of panic, general enxiety and global functioning. Finally, it was noted that although exposure and cognitive procedures effectively controlled panic attacks in approximately 80% of subjects (immediately post treatment and 24-months post treatment), only 50% of the subjects were no longer distressed in general.

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