Effectiveness of Prolonged Exposure Therapy on Social Support and Severity of Symptoms in the Patients with Posttraumatic Stress Disorder

Introduction: Posttraumatic stress disorder is a set of clinical symptoms that occurs following exposure to life-threatening events, and affects a variety of psychological variables. The aim of the present study was to evaluate the effectiveness of prolonged exposure therapy on social support and the severity of symptoms in patients with post-traumatic stress disorder. Methods: This was a quasi-experimental study with pretest, post-test and a two-month follow-up design and a control group. Using stratified sampling method, 30 patients (15 subjects in each group) with post-traumatic stress disorder referred to Farabi Psychiatric Clinic in Kermanshah City selected and they were randomly assigned. The Mean age of the sample group was 31.9.The study inclusion criteria was having PTSD based on clinical interview. The study exclusion criteria included having psychosis symptoms, drug addiction. The data were collected by structured clinical interview (SCID-I), social support scale (MOS), and the fifth edition of the post-traumatic stress disorder index (PCL-5). Data were analyzed by repeated measures ANOVA test. Results: The results showed that prolonged exposure therapy was significantly effective in increasing social support (F=2/66, P<0/01) and reducing the severity of symptoms (F=42/19, P<0/01) among the patients with post-traumatic stress disorder. Conclusion: These results indicate that prolonged exposure therapy can alleviate the symptoms of the patients with post-traumatic stress disorder.

Introduction and Overview

This chapter provides an introduction to efficacious treatments for posttraumatic stress disorder (PTSD). Despite efficacy of these treatments, many patients do not respond to them or experience persistent symptoms. Efficacious psychotherapies for PTSD used at the Veterans Administration (VA), including prolonged exposure therapy and cognitive processing therapy, are described. While these treatments can be helpful, many patients are avoidant of trauma processing and homework. Furthermore, both treatments tend to focus on one central trauma, to which exposure exercises are targeted, whereas most Veterans experience multiple traumas. An overview of the development and framework of trauma-focused psychodynamic psychotherapy (TFPP), a PTSD-symptom focused brief psychodynamic therapy, is presented. A brief background of psychoanalytic and psychodynamic literature and thinking about trauma is provided to further frame the place of TFPP

Posttraumatic stress disorder treatment preference: cognitive processing therapy, prolonged exposure therapy, or pharmacotherapy?

Of the available treatments for Posttraumatic Stress Disorder (PTSD), Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and pharmacotherapy are the protocols with the strongest research support. To investigate individuals’ preferences for treatment, participants were asked to read descriptions of CPT, PE, and pharmacotherapy, choose which one they think they would prefer should they require treatment, and rate their perceptions of treatment credibility. Two simultaneous studies were conducted: one with undergraduate and the other with online participants, and the latter had higher scores on measures of symptom distress. CPT was the first choice in both studies and was considered the most credible option. Undergraduate participants preferred PE as their second choice, while online participants picked pharmacotherapy. Undergraduate participants found PE to be more credible than pharmacotherapy, while online participants found them to be equally credible. Both groups chose psychotherapy alone as their first choice when given the option to combine psychotherapy and pharmacotherapy.

Posttraumatic stress disorder treatment preference: cognitive processing therapy, prolonged exposure therapy, or pharmacotherapy?

Of the available treatments for Posttraumatic Stress Disorder (PTSD), Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and pharmacotherapy are the protocols with the strongest research support. To investigate individuals’ preferences for treatment, participants were asked to read descriptions of CPT, PE, and pharmacotherapy, choose which one they think they would prefer should they require treatment, and rate their perceptions of treatment credibility. Two simultaneous studies were conducted: one with undergraduate and the other with online participants, and the latter had higher scores on measures of symptom distress. CPT was the first choice in both studies and was considered the most credible option. Undergraduate participants preferred PE as their second choice, while online participants picked pharmacotherapy. Undergraduate participants found PE to be more credible than pharmacotherapy, while online participants found them to be equally credible. Both groups chose psychotherapy alone as their first choice when given the option to combine psychotherapy and pharmacotherapy.

Preliminary Effectiveness of Brief Prolonged Exposure Therapy for PTSD: Expanding Access to Effective Therapies

Over the last three decades, several empirically supported trauma therapies have been developed to treat post-traumatic stress disorder (PTSD). Yet issues such as access to treatments and dropout are ongoing barriers to adequate dissemination and implementation, especially in low resource settings. To this end, we present results on the preliminary effectiveness of a brief prolonged exposure therapy (PE) for PTSD in South Africa, a low resource setting. Based on a case-series design, seven participants ( n = 7) from diverse socio-cultural backgrounds were recruited and started a six-session brief PE for PTSD and co-morbid depression and anxiety. To examine the treatment outcomes, participants were assessed at baseline, during treatment, post-intervention, and at 3-month follow-up. Overall, brief PE reduced symptoms of PTSD, depression, and anxiety from baseline to post-intervention, and at 3-month follow-up. A downward trend in symptoms was evident during treatment, with slight symptom variations during exposure sessions. In conclusion, a six-session brief PE intervention produced positive outcomes for PTSD, depression, and anxiety at two community counseling centers in South Africa. We reflect on the implementation of brief PE in a South African context.

Resting-state connectivity subtype of comorbid PTSD and alcohol use disorder moderates improvement from integrated prolonged exposure therapy in Veterans

Background Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid and are associated with significant functional impairment and inconsistent treatment outcomes. Data-driven subtyping of this clinically heterogeneous patient population and the associated underlying neural mechanisms are highly needed to identify who will benefit from psychotherapy. Methods In 53 comorbid PTSD/AUD patients, resting-state functional magnetic resonance imaging was collected prior to undergoing individual psychotherapy. We used a data-driven approach to subgroup patients based on directed connectivity profiles. Connectivity subgroups were compared on clinical measures of PTSD severity and heavy alcohol use collected at pre- and post-treatment. Results We identified a subgroup of patients associated with improvement in PTSD symptoms from integrated-prolonged exposure therapy. This subgroup was characterized by lower insula to inferior parietal cortex (IPC) connectivity, higher pregenual anterior cingulate cortex (pgACC) to posterior midcingulate cortex connectivity and a unique pgACC to IPC path. We did not observe any connectivity subgroup that uniquely benefited from integrated-coping skills or subgroups associated with change in alcohol consumption. Conclusions Data-driven approaches to characterize PTSD/AUD subtypes have the potential to identify brain network profiles that are implicated in the benefit from psychological interventions – setting the stage for future research that targets these brain circuit communication patterns to boost treatment efficacy.

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.