scholarly journals Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

2021 ◽  
Vol 10 (19) ◽  
pp. 4522
Author(s):  
Chris M. Hoeboer ◽  
Danielle A. C. Oprel ◽  
Rianne A. De Kleine ◽  
Brian Schwartz ◽  
Anne-Katharina Deisenhofer ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Treatment Outcomes ◽  
Posttraumatic Stress ◽  
Childhood Abuse ◽  
Stress Disorder ◽  
Prolonged Exposure ◽  
Controlled Trial ◽  
Skills Training ◽  
Ptsd Symptoms ◽  
Promising Tool

Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). Methods: We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. Results: More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens’ d = 0.55) and self-reported PTSD symptoms (Cohens’ d = 0.47). Conclusion: Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.

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.

Foundations of Prolonged Exposure

2019 ◽  
pp. 1-22
Author(s):  
Edna B. Foa ◽  
Elizabeth A. Hembree ◽  
Barbara Olasov Rothbaum ◽  
Sheila A. M. Rauch
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Emotional Distress ◽  
Emotional Processing ◽  
Stress Disorder ◽  
Prolonged Exposure ◽  
Traumatic Events ◽  
Ptsd Symptoms ◽  
Imaginal Exposure

Foundations of prolonged exposure (PE) include (1) education about common reactions to trauma, what maintains trauma-related symptoms, and how PE reduces posttraumatic stress disorder (PTSD) symptoms; (2) repeated in vivo confrontation with situations, people, or objects that the patient is avoiding because they are trauma-related and cause emotional distress such as anxiety, shame, or guilt; and (3) repeated, prolonged imaginal exposure to the trauma memories followed by processing the details of the event, the emotions, and the thoughts that the patient experienced during the trauma. The aim of in vivo and imaginal exposure is to enhance emotional processing of traumatic events by helping the patient face the trauma memories and reminders and process the emotions and thoughts, as well as the details of the trauma that emerge during revisiting experiences.

Is This Program Right for You?

2019 ◽  
pp. 11-16
Author(s):  
Barbara Olasov Rothbaum ◽  
Edna B. Foa ◽  
Elizabeth A. Hembree ◽  
Sheila A. M. Rauch
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Prolonged Exposure ◽  
Traumatic Event ◽  
Trauma Survivors ◽  
Ptsd Symptoms ◽  
Natural Recovery ◽  
Trauma Survivor ◽  
Motivation For Treatment

Not every trauma survivor needs a trauma-focused treatment like prolonged exposure (PE). Many studies have shown that natural recovery works very well for many people who experience a traumatic event. In fact, posttraumatic stress disorder (PTSD) symptoms and other trauma reactions are very common and happen for almost everyone right after a trauma, but then these symptoms and reactions decrease a lot for many people, especially over the first 3 months. This chapter helps trauma survivors determine if PE therapy is appropriate for them, and, if so, the chapter provides motivation for treatment.

Interpersonal Psychotherapy for Posttraumatic Stress Disorder

2016 ◽  
Author(s):  
John C. Markowitz
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Prolonged Exposure ◽  
Controlled Trial ◽  
Public Health Problem ◽  
Interpersonal Psychotherapy ◽  
Randomized Controlled ◽  
Chronic Ptsd ◽  
Treatable Condition

Posttraumatic stress disorder (PTSD) is a prevalent, debilitating public health problem. It is a treatable condition, but the predominant approach to treatment has involved exposing patients to their worst fears, the reminders of their traumas. Many patients and therapists find this process unpleasant, and exposure-based treatment does not help everyone. We recently studied Interpersonal Psychotherapy (IPT), a non-exposure treatment that focuses on restoring the numbed emotions of patients with PTSD and helping patients use them to reconstruct a sense of safety in their environment. IPT focuses on patients’ feelings as helpful signals in current interpersonal encounters, not on reconstructing past traumatic events. IPT worked as well as Prolonged Exposure, the best-tested exposure-based treatment, in a randomized controlled trial for patients with chronic PTSD. Moreover, IPT had advantages for the half of patients who suffered both from PTSD and from major depression. This book describes for clinicians the use of IPT and its emotion- and attachment-based approach.

scholarly journals Proof of Concept for the Autobiographical Memory Flexibility (MemFlex) Intervention for Posttraumatic Stress Disorder

2021 ◽  
pp. 216770262098257
Author(s):  
Ali Reza Moradi ◽  
Maryam Piltan ◽  
Mohammad Hasan Choobin ◽  
Parviz Azadfallah ◽  
Peter Watson ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Autobiographical Memory ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Low Cost ◽  
Controlled Trial ◽  
Strong Predictor ◽  
Ptsd Symptoms ◽  
Proof Of Concept ◽  
Memory Flexibility

Autobiographical memory distortions are a key feature of posttraumatic stress disorder (PTSD). In this proof-of-concept randomized controlled trial ( N = 43), we evaluated an autobiographical memory flexibility intervention, MemFlex. We aimed to determine whether the mechanism-focused intervention, which aims to improve autobiographical memory processes, may also affect other cognitive predictors of PTSD and potentially reduce PTSD symptoms in Iranian trauma survivors diagnosed with PTSD. Results indicated significant, moderate to large between-groups effect sizes in favor of MemFlex, relative to wait-list control, for the targeted cognitive mechanism of autobiographical memory flexibility and PTSD symptoms. A large, significant effect was also observed on maladaptive posttraumatic cognitions—a strong predictor of PTSD prognosis, which is a key target of high-intensity cognitive therapies for PTSD. Findings support future completion of a scaled-up trial to evaluate treatment efficacy of MemFlex for PTSD to determine whether MemFlex may offer a culturally adaptive, low-cost, low-intensity intervention able to improve cognitive mechanisms of PTSD.

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