1
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Feder A, Kowalchyk ML, Brinkman HR, Cahn L, Aaronson CJ, Böttche M, Presseau C, Fred-Torres S, Markowitz JC, Litz BT, Yehuda R, Knaevelsrud C, Pietrzak RH. Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms. Psychiatry Res 2024; 336:115885. [PMID: 38603979 DOI: 10.1016/j.psychres.2024.115885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average "large" effect size improvement, d = 1.49). Significant and "moderate-to-large" main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62-1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.
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Affiliation(s)
- Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mary L Kowalchyk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah R Brinkman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah Cahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy J Aaronson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Böttche
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Candice Presseau
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans' Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Sharely Fred-Torres
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute, Department of Clinical Therapeutics, New York, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA
| | - Brett T Litz
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA; Boston University, Boston, Department of Psychological and Brain Sciences, MA, USA; Veterans' Administration Boston Healthcare System, Epidemiological Research and Information Center, Boston, MA, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Neuroscience, New York, NY, USA; James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA
| | - Christine Knaevelsrud
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
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2
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Markowitz JC, Milrod BL. Affect-Focused and Exposure-Focused Psychotherapies. Am J Psychother 2024:appipsychotherapy20230012. [PMID: 38247343 DOI: 10.1176/appi.psychotherapy.20230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The authors discuss the two broad domains of affect-focused and exposure-focused psychotherapies, defining the characteristics and potential advantages and disadvantages of each. The two domains differ in their theoretical approaches, structures, and techniques. Exposure-focused therapies have come to dominate research and practice, leading to the relative neglect of affect-focused therapies. When the two approaches have been examined in well-conducted clinical trials, they generally appear to be equally beneficial for treating common mood, anxiety, and trauma disorders, although further research may better define differential therapeutics. The authors argue for better training in affect awareness and tolerance across psychotherapies and use a brief case vignette to illustrate several aspects of these different approaches.
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Affiliation(s)
- John C Markowitz
- Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York City (Markowitz); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Milrod)
| | - Barbara L Milrod
- Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York City (Markowitz); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Milrod)
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3
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Kummar AS, Correia H, Tan J, Fujiyama H. An 8-week compassion and mindfulness-based exposure therapy program improves posttraumatic stress symptoms. Clin Psychol Psychother 2023. [PMID: 37947043 DOI: 10.1002/cpp.2929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
The persistence of posttraumatic stress symptoms (PTSS) can be debilitating. However, many people experiencing such symptoms may not qualify for or may not seek treatment. Potentially contributing to ongoing residual symptoms of PTSS is emotion dysregulation. Meanwhile, the research area of mindfulness and compassion has grown to imply emotion regulation as one of its underlying mechanisms; yet, its influence on emotion regulation in PTSS cohort is unknown. Here, we explored the potential effectiveness of an 8-week Compassion-oriented and Mindfulness-based Exposure Therapy (CoMET) for individuals with PTSS using a waitlist control design. A total of 28 individuals (27 females, age range = 18-39 years) participated in the study (17 CoMET; 11 waitlist control). Following CoMET, participants reported significant decreases in PTSS severity (from clinical to non-clinical levels), emotion dysregulation and experiential avoidance, as well as significant increases in mindfulness, self-compassion and quality of life. Electroencephalogram-based brain network connectivity analysis revealed an increase in alpha-band connectivity following CoMET in a network that includes the amygdala, suggesting that CoMET successfully induced changes in functional connectivity between brain regions that play a crucial role in emotion regulation. In sum, the current study demonstrated promising intervention outcomes of CoMET in effectively alleviating the symptoms of PTSS via enhanced emotion regulation.
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Affiliation(s)
- Auretta Sonia Kummar
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
| | - Helen Correia
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
- Psychological Sciences, Australian College of Applied Professions, Perth, Western Australia, Australia
| | - Jane Tan
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
| | - Hakuei Fujiyama
- School of Psychology, College of Health & Education, Murdoch University, Perth, Western Australia, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Western Australia, Australia
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4
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Shea MT, Krupnick JL, Sautter FJ, Mete M, Green BL, Norman SB, Finley SL, Eaton E. A randomized clinical trial comparing Interpersonal Psychotherapy with Prolonged Exposure for the treatment of PTSD in veterans. J Anxiety Disord 2023; 99:102770. [PMID: 37738685 DOI: 10.1016/j.janxdis.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
Trauma-focused therapies are recommended as first-line treatments for posttraumatic stress disorder (PTSD), but many veterans do not complete or sufficiently respond to these treatments. Interpersonal Therapy (IPT) is a non-trauma focused approach that directly addresses the interpersonal and social impairments associated with PTSD. This two-site randomized controlled equivalence trial compared IPT with Prolonged Exposure (PE) in improving PTSD symptoms and interpersonal functioning in 109 veterans with PTSD. Secondary outcomes included functioning and quality of life. We hypothesized that IPT would be statistically equivalent to PE in reducing PTSD symptoms, and superior to PE in improving interpersonal functioning and secondary outcomes of work and social adjustment and quality of life. PTSD symptom severity decreased significantly in both treatments from pre- to post-treatment. Although IPT improved as much as PE and treatments did not differ significantly, the 95 % confidence interval for the difference between the groups did not fall completely within the margin of equivalence. IPT was not superior to PE in improvement in interpersonal functioning or on secondary outcomes. Findings from multi-level linear mixed models using longitudinal data (posttreatment, three and six month follow up) for the primary outcomes of PTSD and interpersonal functioning were consistent with the post-treatment analyses. Although statistically inconclusive in terms of equivalence, the comparable reduction in PTSD symptoms slightly favoring IPT suggests that IPT is an acceptable alternative to gold-standard trauma-focused treatments for veterans with PTSD.
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Affiliation(s)
- M Tracie Shea
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Janice L Krupnick
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Frederic J Sautter
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States of America; Tulane University Health Sciences Center, New Orleans, LA, United States of America
| | - Mihriye Mete
- MedStar Health Research Institute, Washington, DC, United States of America
| | - Bonnie L Green
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Sonya B Norman
- National Center for PTSD, Executive Division, VA Medical Center, White River Junction, VT, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, United States of America
| | - Shauna L Finley
- Brown Medicine Primary Care, Providence, RI, United States of America
| | - Erica Eaton
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
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5
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Flatot-Blin D, Rey A, Derynck F, Fossard O, Khalfa S. Clinical Efficiency and Acceptability of EMDR and MOSAIC Therapy for PTSD. Healthcare (Basel) 2023; 11:2226. [PMID: 37570464 PMCID: PMC10418657 DOI: 10.3390/healthcare11152226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
Eye movement desensitization and reprocessing (EMDR) therapy is one of the therapies recommended by the World Health Organization (2013) to treat posttraumatic stress disorder (PTSD). Although efficient, repeated exposure to the traumatic memory may reduce its acceptability to patients. The therapy "eye movement and alternate stimulation for brain integration" (MOSAIC in French) was developed to improve acceptability and reduce pain by drawing on the patient's internal resources. MOSAIC therapy focuses on the body sensations that the patient wants to experience and avoids having to relive the traumatic memories. This observational study aimed to compare the clinical efficiency of EMDR and MOSAIC therapy for PTSD and to measure the well-being generated by both therapies. Twenty-six PTSD patients (17 females and 9 males, mean age 37.01 years, SD = 13.06) received treatment by psychiatrists and/or psychologists trained with EMDR or MOSAIC therapy. Both patient groups achieved a significant decrease in PTSD symptoms as measured with the PCL-5. However, fewer sessions were required with the MOSAIC therapy than with EMDR therapy. As expected, the level of well-being experienced by the patient during the therapy, assessed using the Lickert scale, was higher with MOSAIC than with EMDR therapy from the first session. These findings provide the first evidence of the efficacy of MOSAIC therapy treatment, which now needs to be corroborated in a larger randomized clinical trial.
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Affiliation(s)
- Deborah Flatot-Blin
- Laboratoire de Psychologie Cognitive, CNRS, Aix Marseille University, 13003 Marseille, France
- Laboratoire de Neurosciences Cognitives, CNRS, Aix Marseille University, 13003 Marseille, France
- Assistance Publique des Hôpitaux de Marseille, 13005 Marseille, France
| | - Arnaud Rey
- Laboratoire de Psychologie Cognitive, CNRS, Aix Marseille University, 13003 Marseille, France
- Institute of Language and Communication and the Brain, CNRS, Aix Marseille University, 13604 Aix-en-Provence, France
| | - Flavie Derynck
- Assistance Publique des Hôpitaux de Marseille, 13005 Marseille, France
| | | | - Stephanie Khalfa
- Laboratoire de Neurosciences Cognitives, CNRS, Aix Marseille University, 13003 Marseille, France
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6
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Liang L, Bonanno GA, Hougen C, Hobfoll SE, Hou WK. Everyday life experiences for evaluating post-traumatic stress disorder symptoms. Eur J Psychotraumatol 2023; 14:2238584. [PMID: 37650243 PMCID: PMC10472851 DOI: 10.1080/20008066.2023.2238584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Abstract
Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms.Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796).Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms.Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = -.427 to -.224, 95% confidence intervals [-.543 to -.359, -.310 to -.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = -.285 to -.096, 95% confidence intervals [-.379 to -.189, -.190 to -.003], p values < .05).Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.
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Affiliation(s)
- Li Liang
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China
| | - George A. Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Clint Hougen
- Gordon F. Derner School of Psychology, Adelphi University, New York, NY, USA
| | - Stevan E. Hobfoll
- STAR Consultants – STress, Anxiety and Resilience, Salt Lake City, UT, USA
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, People’s Republic of China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, People’s Republic of China
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7
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Dynamic Psychotherapy as a PTSD Treatment for Firefighters: A Case Study. Healthcare (Basel) 2022; 10:healthcare10030530. [PMID: 35327008 PMCID: PMC8954085 DOI: 10.3390/healthcare10030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.
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8
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Zehetmair C, Kaufmann C, Tegeler I, Klippel A, Nagy E, Kindermann D, Friederich HC, Nikendei C. Stabilisierungsgruppe für traumatisierte männliche
Geflüchtete in einer Erstaufnahmeeinrichtung des Landes
Baden-Württemberg: Konzept und Erfahrungen. Psychother Psychosom Med Psychol 2021; 71:473-476. [PMID: 34517421 DOI: 10.1055/a-1584-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungGeflüchtete erleben vielfach traumatisierende Ereignisse im Heimatland
und auf der Flucht, die in dieser Gruppe zu einer erhöhten
Prävalenz der Posttraumatischen Belastungsstörung
führen. Traumaorientierte stabilisierende Techniken können vor
allem in der frühen post-migratorischen Phase eine erste psychosoziale
Stabilisierung traumatisierter Geflüchteter bewirken. In diesem Beitrag
wird das klinische Konzept der offenen Stabilisierungsgruppe für
männliche, traumatisierte Geflüchtete im Erstaufnahme- und
Registrierungszentrum „Patrick-Henry Village“ des Landes
Baden-Württemberg vorgestellt. Die Stabilisierungsgruppe in englischer
Sprache folgt einem offenen Gruppenkonzept mit einer wiederkehrenden Struktur
bestehend aus Begrüßungsrunde, dem gemeinsamen Üben von
Achtsamkeits- und imaginativen Stabilisierungsübungen und einer
Abschlussrunde. Die bisherigen Erfahrungen zeigen, dass das Konzept einer
offenen Stabilisierungsgruppe im Kontext einer Erstaufnahme- und
Registrierungsstelle für Geflüchtete gut implementierbar ist.
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Affiliation(s)
- Catharina Zehetmair
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Claudia Kaufmann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Inga Tegeler
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Anne Klippel
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Ede Nagy
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - David Kindermann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Hans-Christoph Friederich
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Nikendei
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
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9
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Rationale, design, and methods of a two-site randomized controlled trial: Comparative effectiveness of two treatments for posttraumatic stress disorder in veterans. Contemp Clin Trials 2021; 105:106408. [PMID: 33872802 DOI: 10.1016/j.cct.2021.106408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
PTSD is associated with serious problems in interpersonal functioning, including higher rates of marital conflict and divorce, disrupted relationships with family and friends, estrangement from others and social isolation. Cognitive behavioral and trauma focused treatments are effective for treating PTSD symptoms, but a substantial proportion of individuals, particularly veterans, with PTSD, do not engage, complete, or fully respond to these treatments, and the effects of these treatments on interpersonal functioning are unknown. There is a critical need for alternative treatments with established efficacy, and for treatments that directly address problems in relationship functioning. Interpersonal Psychotherapy for PTSD (IPT-PTSD) is a promising candidate for such a treatment. This paper describes the rationale, design, and methods of the first randomized controlled equivalence trial comparing IPT-PTSD with a first-line gold standard treatment for PTSD (Prolonged Exposure; PE) in the treatment of PTSD in veterans. Both treatments include up to 12 weekly individual sessions. Assessments were conducted at baseline, following sessions four and eight, end of treatment, and 3 and 6 months post-treatment. Primary hypotheses are that IPT-PTSD will be statistically equivalent to PE in reducing the severity of PTSD symptoms, and superior to PE in improving interpersonal functioning. Secondary hypotheses propose that IPT will be superior to PE in improving overall social adjustment and quality of life, and in reducing suicidal ideation. Findings from this study have the potential to improve treatment options for veterans struggling with PTSD and interpersonal problems.
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10
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Capone C, Norman SB, Haller M, Davis B, Shea MT, Browne K, Lang AJ, Schnurr PP, Golshan S, Afari N, Pittman J, Allard CB, Westendorf L. Trauma Informed Guilt Reduction (TrIGR) therapy for guilt, shame, and moral injury resulting from trauma: Rationale, design, and methodology of a two-site randomized controlled trial. Contemp Clin Trials 2020; 101:106251. [PMID: 33326878 DOI: 10.1016/j.cct.2020.106251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023]
Abstract
Guilt, shame, and moral injury (MI) are common reactions following exposure to traumatic events and are associated with greater severity of several mental health problems, including posttraumatic stress disorder (PTSD), depression, increased risk of suicidal ideation and poorer psychosocial functioning. Trauma-Informed Guilt Reduction (TrIGR) is a transdiagnostic psychotherapy to address guilt, shame, and MI stemming from traumatic events. The primary goals of TrIGR are to help patients accurately appraise their trauma and to re-engage with their values in order to lead a more meaningful life. This paper presents the rationale, design, and methodology of a two-site randomized controlled trial (RCT) examining the efficacy of TrIGR compared to Supportive Care Therapy (SCT) in a sample of U.S. veterans (N = 145) who endorse guilt related to a traumatic event that occurred during military deployment. This study is the first RCT powered to investigate TrIGR's efficacy on reducing posttraumatic guilt, as measured by the Trauma Related Guilt Inventory (TRGI), in comparison to an active control condition. In addition, the study will examine a range of secondary and exploratory outcomes including shame, quality of life, suicidal ideation, substance use, and PTSD and depression symptoms. Findings from this efficacy study will be essential in informing future efficacy and effectiveness trials.
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Affiliation(s)
- Christy Capone
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA; Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Sonya B Norman
- National Center for PTSD, Executive Division, VA Medical Center, 215 North Main Street, White River Junction, VT 05009, USA; VA Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Moira Haller
- Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, School of Medicine, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Brittany Davis
- James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL 33613, USA
| | - M Tracie Shea
- Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Kendall Browne
- Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center; 21 S. University Ave, Philadelphia, PA 19104, USA; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S. Columbian Way, MC: S-116-ATC, Seattle, WA 98136, USA; Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Ariel J Lang
- Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, School of Medicine, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, VA Medical Center, 215 North Main Street, White River Junction, VT 05009, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Shahrokh Golshan
- Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, School of Medicine, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - James Pittman
- VA Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Carolyn B Allard
- Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA; California School of Professional Psychology at Alliant International University, 10455 Pomerado Rd, San Diego, CA 92131, USA
| | - Laura Westendorf
- Veterans Affairs San Diego Healthcare System, Research Service (MC116B), 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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