scholarly journals Internet-based cognitive behavioral therapy versus internet-based modified present-centered therapy for world trade center responders and survivors with posttraumatic stress disorder: rationale and design of a randomized controlled trial

2021 ◽  
Vol 8 (3) ◽  
pp. 202
Author(s):  
Hannah R. Brinkman ◽  
Mary L. Kowalchyk ◽  
Leah Cahn ◽  
Cindy J. Aaronson ◽  
Maria Böttche ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Randomized Controlled Trial ◽  
World Trade ◽  
Stress Disorder ◽  
Controlled Trial ◽  
World Trade Center ◽  
Evidence Based ◽  
Ptsd Symptoms ◽  
Randomized Controlled ◽  
Trade Center

<p><strong>Background:</strong> Nearly two decades following the 9/11/2001 world trade center (WTC) attacks, a substantial proportion of WTC rescue and recovery workers (“responders”) and WTC survivors continue to experience WTC-related posttraumatic stress disorder (PTSD) symptoms. Internet-based cognitive behavioral therapies (I-CBT) are short-term, evidence-based, scalable treatments with the potential to reach large numbers of symptomatic WTC workers and survivors. However, no I-CBT studies have been conducted in the WTC cohort.</p><p><strong>Methods:</strong> This report describes the rationale and design of an ongoing randomized controlled trial comparing integrative testimonial therapy (ITT), an I-CBT, to an active comparison treatment, internet-based modified present-centered therapy. The primary aim is to evaluate the efficacy of ITT in mitigating WTC-related PTSD symptoms in WTC responders and survivors with full or subthreshold WTC-related PTSD. The efficacy of ITT in reducing comorbid depressive and anxiety symptoms, and improving functioning, quality of life, and post-traumatic growth will additionally be evaluated. Saliva samples are also collected to explore genetic and epigenetic biomarkers of treatment response.</p><p><strong>Conclusions: </strong>This is the first I-CBT trial to compare ITT to a credible and active treatment, controlling for critical third-variable explanations of superiority (e.g., non-specific therapy effects). This RCT bridges an important research gap in the rising field of I-CBT interventions and adds to the literature on the design of trials investigating evidence-based treatments for PTSD in WTC- and other trauma-affected populations. </p><p><strong>Trial registration: </strong>This trial was registered on clinicalTrials.gov on May 16, 2017 (NCT03154151).</p>

scholarly journals Results of the first randomized controlled trial of integrated cognitive-behavioral therapy for eating disorders and posttraumatic stress disorder

2021 ◽  
pp. 1-10
Author(s):  
Kathryn Trottier ◽  
Candice M. Monson ◽  
Stephen A. Wonderlich ◽  
Ross D. Crosby
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Eating Disorders ◽  
Randomized Controlled Trial ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Ptsd Symptoms ◽  
Randomized Controlled

Abstract Background Eating disorders (EDs) and posttraumatic stress disorder (PTSD) frequently co-occur and can share a functional relationship. The primary aim of this initial randomized controlled trial was to determine whether integrated cognitive-behavioral therapy (CBT) for co-occurring ED-PTSD was superior to standard CBT for ED in improving PTSD symptoms. Intervention safety and desirability, as well as the relative efficacy of the treatments in improving anxiety, depression, and ED symptomatology, were also examined. Methods Following a course of intensive ED treatment, individuals with ED-PTSD were recruited to participate and randomized to integrated CBT for ED-PTSD or standard CBT for ED. The sample consisted of 42 individuals with a range of ED diagnoses. Outcomes were assessed at end-of-treatment, 3-, and 6-month follow-up using interview and self-report measures. Results Mixed models revealed significant interactions of time and therapy condition on clinician-rated and self-reported PTSD symptom severity favoring Integrated CBT for ED-PTSD. Both treatments were associated with statistically significant improvements in PTSD, anxiety, and depression. Improvements were maintained at 3- and 6-month follow-up. There was good safety with both interventions, and satisfaction with both treatments was high. However, there was a stronger preference for integrated treatment. Conclusions Integrating CBTs for PTSD and ED following intensive ED treatment is safe, desirable, and efficacious for improving PTSD symptoms. Future studies with larger sample sizes are needed to determine whether Integrated CBT for ED-PTSD provides benefits over standard CBT for ED with respect to ED outcomes.

The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting

2021 ◽  
pp. 1-17
Author(s):  
Marcella L. Woud ◽  
Simon E. Blackwell ◽  
Lorika Shkreli ◽  
Felix Würtz ◽  
Jan Christopher Cwik ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Randomized Controlled Trial ◽  
Cognitive Bias ◽  
Stress Disorder ◽  
Controlled Trial ◽  
Cognitive Bias Modification ◽  
Ptsd Symptoms ◽  
Randomized Controlled ◽  
Scenario Task ◽  
Bias Modification

Introduction: Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. Objective: We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. Methods: We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. Results: In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82–1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39–1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23–1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI –0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. Conclusions: Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.

Posttraumatic Stress Disorder in Daily Life Among World Trade Center Responders: Temporal Symptom Cascades

2020 ◽  
Author(s):  
Camilo Ruggero ◽  
Keke Schuler ◽  
Monika A. Waszczuk ◽  
Jennifer Callahan ◽  
Ateka A. Contractor ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
World Trade ◽  
Stress Disorder ◽  
Daily Life ◽  
Critical Role ◽  
World Trade Center ◽  
Ptsd Symptoms ◽  
Symptom Dimensions ◽  
Trade Center

Posttraumatic stress disorder (PTSD) symptoms are common in the immediate aftermath of a trauma, but it is their persistence over time that leads to a diagnosis. This pattern highlights the critical role of symptom maintenance to understanding and treating the disorder. Relatively few studies have explored whether PTSD symptoms may be interacting or triggering one another to worsen and maintain the disorder, a dynamic we refer to as “symptom cascades.” Additionally, little work has tested how other maintenance factors, such as stress, contribute to such events in daily life. The present study in a group (N = 202) of World Trade Center (WTC) responders oversampled for PTSD tested day-to-day temporal associations among PTSD symptom dimensions (i.e., intrusions, avoidance, numbing, and hyperarousal) and stress across one week. Longitudinal models found hyperarousal on a given day predicted increased PTSD symptoms the next day, with the effect sizes almost double compared to other symptom dimensions or daily stress. Intrusions, in contrast, showed little prospective predictive effects, but instead were most susceptible to the effects from other symptoms the day before. Avoidance and numbing showed weaker bidirectional effects. Findings are from a unique population and based on naturalistic observation. Results are consistent with the idea of symptom cascades, they underscore hyperarousal’s strong role in forecasting short-term increases in PTSD (even more than stress per se) and they raise the prospect of highly specific ecological momentary interventions to potentially disrupt PTSD maintenance in daily life.

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