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Wibbelink CJM, Lee CW, Bachrach N, Dominguez SK, Ehring T, van Es SM, Fassbinder E, Köhne S, Mascini M, Meewisse ML, Menninga S, Morina N, Rameckers SA, Thomaes K, Walton CJ, Wigard IG, Arntz A. The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial. Trials 2021; 22:848. [PMID: 34838102 PMCID: PMC8626728 DOI: 10.1186/s13063-021-05712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05712-9.
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Affiliation(s)
- Carlijn J M Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands.
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Nathan Bachrach
- GGZ Oost Brabant, RINO Zuid and Tilburg University, Kluisstraat 2, 5427 EM, Boekel, the Netherlands
| | - Sarah K Dominguez
- School of Psychology and Exercise Science, Murdoch University and Sexual Assault Resource Centre, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany
| | - Saskia M van Es
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Sandra Köhne
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Magda Mascini
- GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC, Heerhugowaard, the Netherlands
| | - Marie-Louise Meewisse
- Abate, Centre of Expertise in Anxiety and Trauma, Postweg 3, 1601 SX, Enkhuizen, the Netherlands
| | - Simone Menninga
- PsyQ Beverwijk, Parnassia Groep, Leeghwaterweg 1a, 1951 NA, Velsen-Noord, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Muenster, Germany
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Sinai Center, the Psychotrauma Expertise Center of Arkin and Amsterdam UMC, location VUmc, Department Psychiatry and Department of Anatomy and Neuroscience, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, the Netherlands
| | - Carla J Walton
- Centre for Psychotherapy, Hunter New England Mental Health Service, NSW, Australia, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Ingrid G Wigard
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
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Personality beliefs, coping strategies and quality of life in a cognitive-behavioral therapy for posttraumatic stress disorder. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2019.100135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bourdon DÉ, El-Baalbaki G, Girard D, Lapointe-Blackburn É, Guay S. Schemas and coping strategies in cognitive-behavioral therapy for PTSD: A systematic review. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Plag J, Petzold MB, Gechter J, Liebscher C, Ströhle A. Patients' characteristics and their influence on course of fear during agoraphobic symptom provocation: may SS(N)RI treatment compensate unfavorable individual preconditions? Nord J Psychiatry 2018; 72:325-335. [PMID: 29644923 DOI: 10.1080/08039488.2018.1457178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients' characteristics and antidepressants are discussed to be relevant in the context of phobic exposure. AIMS To identify patients characteristics associated with a differential course of fear during disorder-specific symptom provocation as well as to elucidate the effect of selective serotonin-(noradrenalin-) reuptake inhibitors [SS(N)RI] on development of fear in the context of re-exposure to the phobic stimuli. METHODS Twenty-eight clinically well-characterized patients with panic disorder and agoraphobia (PD/AG) were classified into subjects who show a reduction of fear ('Fear-') during a symptom provocation via a picture-based paradigm (T1) and those who did not ('Fear+'). Subsequently, SS(N)RI treatment was administered to all patients and subjects were re-exposed to the feared stimuli after 8 weeks of treatment (T2). Moreover, brain activity within the 'fear network' was measured via functional magnetic resonance imaging (fMRI) at T1 and T2. RESULTS Fear - were significantly younger and demonstrated increased exposure-related fear as well as stronger activity in several fear-related brain areas than Fear+. We found significant improvements in all clinical parameters after pharmacological intervention for the whole sample (T1-T2; all measures p < .02). However, reduction of fear as well as activation in (para)limbic structures during symptom provocation were now attenuated in Fear - but increased in Fear+. CONCLUSIONS Advanced age may predict a therapeutically unfavorable course of fear during agoraphobic symptom provocation. Since we found no negative impact of medication on fear development at all, there was some evidence that SS(N)RI treatment might improve the individual ability to get involved with the agoraphobic stimuli while conducting disorder-specific exposure.
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Affiliation(s)
- Jens Plag
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Moritz B Petzold
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Johanna Gechter
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Carolin Liebscher
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Andreas Ströhle
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
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Moran LR, Kaplan C, Aguirre B, Galen G, Stewart JG, Tarlow N, Auerbach RP. Treatment Effects following Residential Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder. ACTA ACUST UNITED AC 2018; 3:117-128. [PMID: 30778398 DOI: 10.1080/23794925.2018.1476075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Dialectical behavior therapy (DBT) is an empirically supported treatment for borderline personality disorder (BPD) in adults, however fewer studies have examined outcomes in adolescents. This study tested the effectiveness of an intensive 1-month, residential DBT treatment for adolescent girls meeting criteria for BPD. Additionally, given well-established associations between BPD symptoms and childhood abuse, the impact of abuse on treatment outcomes was assessed. Participants were female youth (n = 53) aged 13-20 years (M = 17.00, SD = 1.89) completing a 1-month residential DBT program. At pre-treatment, participants were administered a diagnostic interview and self-report measures assessing BPD, depression, and anxiety symptom severity. Following one month of treatment, participants were re-administered the self-report instruments. Results showed significant pre- to post-treatment reductions in both BPD and depression symptom severity with large effects. However, there was no significant change in general anxious distress or anxious arousal over time. The experience of childhood abuse (sexual, physical, or both) was tested as moderator of treatment effectiveness. Although experiencing multiple types of abuse was related to symptom severity, abuse did not moderate the effects of treatment. Collectively, results indicate that a 1-month residential DBT treatment with adolescents may result in reductions in BPD and depression severity but is less effective for anxiety. Moreover, while youth reporting abuse benefitted from treatment, they were less likely to achieve a clinically significant reduction in symptoms.
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Affiliation(s)
- Lyndsey R Moran
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cynthia Kaplan
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Blaise Aguirre
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Gillian Galen
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jeremy G Stewart
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naomi Tarlow
- Department of Psychology, University of Miami, FL, USA
| | - Randy P Auerbach
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA
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Amati F, Banks C, Greenfield G, Green J. Predictors of outcomes for patients with common mental health disorders receiving psychological therapies in community settings: a systematic review. J Public Health (Oxf) 2017; 40:e375-e387. [DOI: 10.1093/pubmed/fdx168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- F Amati
- NIHR CLAHRC NWL, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - C Banks
- WHO Collaborating Centre for Public Health Training and Education, School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - G Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - J Green
- CNWL NHS Foundation Trust, Academic Lead at NIHR CLAHRC NWL, London, UK
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Complexity in obsessive-compulsive and body dysmorphic disorder – a functional approach to complex difficulties. COGNITIVE BEHAVIOUR THERAPIST 2017. [DOI: 10.1017/s1754470x17000113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD) can take many different forms of presentations. The term ‘complex’ is common and inconsistently used in both OCD and BDD. Practitioners often refer to complex OCD or BDD when patients present with severe co-morbid problems, often in the context of personality difficulties, dissociation, difficult early relationships and trauma; or when the illness is chronic and debilitating with previous multiple treatment failures. Current best-evidence treatment protocols for both disorders focus heavily on exposure and response prevention (E/RP) but with moderate success, particularly in patients who are deemed ‘complex’, and often those with relevant shame and/or disgust-based past experiences. The aim of the present paper is to (a) describe factors that contribute to complexity in OCD and BDD, and (b) link these with theory and practice. We emphasize the importance of understanding both the function of OCD and BDD-related behaviours (rather than the content of obsessions or compulsion), and the context in which they occur such as the family. We illustrate complexity in OCD and BDD using real case material, using a functional and contextual approach to formulate the client's difficulties, and demonstrate how E/RP can be enhanced successfully with imagery rescripting, family work, and compassion-focused therapy.
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Thiel N, Hertenstein E, Nissen C, Herbst N, Külz AK, Voderholzer U. The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. J Pers Disord 2013; 27:697-715. [PMID: 23795757 DOI: 10.1521/pedi_2013_27_104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effect of comorbid personality disorders (PD) on treatment outcomes in obsessive-compulsive disorder (OCD) is unclear. The authors systematically review results from investigations of therapy outcomes in adult patients with OCD and a comorbid PD. PsycINFO and MEDLINE were searched for original articles. Twenty-three studies assessing PDs through interviews were selected. Cluster A PDs, particularly schizotypal PD, narcissistic PD, and the presence of two or more comorbid PDs, were associated with poorer treatment outcomes in patients with OCD. With regard to other PDs and clusters, the results are inconsistent or the sample sizes are too small to reach a conclusion. OCD patients with different comorbid PDs differ in their therapeutic response to treatment. To optimize the treatment of OCD, the predictive value of PDs on the treatment outcome should be further investigated, and treatment of Axis I and II comorbidity requires more attention.
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Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J Affect Disord 2013; 145:143-55. [PMID: 22999891 DOI: 10.1016/j.jad.2012.07.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. METHODS A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. RESULTS The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. LIMITATIONS Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. CONCLUSIONS The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.
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Affiliation(s)
- Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology, University of Tromsø, Norway.
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Temperamental traits as predictors of effectiveness of psychotherapy (prolonged exposure) for PTSD in a group of motor vehicle accident survivors. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2013. [DOI: 10.5114/cipp.2013.40636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Dorrepaal E, Thomaes K, Smit JH, Veltman DJ, Hoogendoorn AW, van Balkom AJLM, Draijer N. Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study. Eur J Psychotraumatol 2013; 4:21171. [PMID: 24224077 PMCID: PMC3820917 DOI: 10.3402/ejpt.v4i0.21171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/05/2013] [Accepted: 09/14/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment. OBJECTIVE In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment. METHOD In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N=14) with the non-adaptive patients (N=24) as revealed by a cluster analysis. RESULTS We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc, patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems. CONCLUSIONS Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.
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Affiliation(s)
- Ethy Dorrepaal
- GGZ inGeest, Amsterdam, The Netherlands ; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands ; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands ; PsyQ, Parnassiagroep, The Hague, The Netherlands
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Beason-Smith M, Hiatt EL, Grubbs KM, Teng EJ. Managing the Approach-Avoidance Dialectic in Treating a Complex Veteran With Panic and Posttraumatic Stress Disorder. Clin Case Stud 2012. [DOI: 10.1177/1534650112442109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive-behavioral therapy (CBT) is the treatment of choice for panic disorder (PD); however, the effectiveness of the treatment is often thought to be diminished in the presence of comorbid conditions. PD and posttraumatic stress disorder (PTSD) commonly co-occur in veteran populations, potentially complicating the effective treatment of each disorder. The individual presented in this case is a female veteran in her mid-50s who received treatment for PD and presented with significant comorbidities (PTSD, histrionic personality traits, major depressive disorder, and chronic suicidality). She participated in an intensive weekend treatment for PD that involved psychoeducation, cognitive restructuring, and interoceptive exposure. This case illustrates the challenges in implementing a manualized treatment for panic with a diagnostically complex veteran and the improvement in panic symptoms despite comorbid presentation.
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Affiliation(s)
| | - Emily L. Hiatt
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine
| | | | - Ellen J. Teng
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center
- Baylor College of Medicine
- Health Services Research & Development Center of Excellence, Houston, TX, USA
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Walter KH, Bolte TA, Owens GP, Chard KM. The Impact of Personality Disorders on Treatment Outcome for Veterans in a Posttraumatic Stress Disorder Residential Treatment Program. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9393-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Shafran R, Clark D, Fairburn C, Arntz A, Barlow D, Ehlers A, Freeston M, Garety P, Hollon S, Ost L, Salkovskis P, Williams J, Wilson G. Mind the gap: Improving the dissemination of CBT. Behav Res Ther 2009; 47:902-9. [DOI: 10.1016/j.brat.2009.07.003] [Citation(s) in RCA: 397] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Personality disorders are gaining a similar level of attention in the primary care literature as afforded to mood, anxiety, and substance abuse disorders. A personality disorder-comorbid with a medical or other psychiatric diagnosis-presents a challenge for primary care physicians because of diagnostic and treatment dilemmas, as well as management of the physician's interpersonal reaction to the patient. This article reviews research on prevalence, clinical presentation and assessment, and treatment, with specific recommendations for primary care physicians. Strategies to enhance the physician-patient relationship, including the use of empathic skills and the facilitation of physician well-being, are presented. Integrating these tools into routine practice can lead to more satisfying treatment relationships between primary care physicians and patients who have personality disorders.
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Affiliation(s)
- Maria Devens
- University of Illinois at Chicago, Department of Family Medicine (m/c 663), 1919 W. Taylor Street, Chicago, IL 60612, USA.
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Abstract
PURPOSE OF REVIEW To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. RECENT FINDINGS Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. SUMMARY Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.
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Affiliation(s)
- Peter Tyrer
- Department of Psychological Medicine, Imperial College, London, UK.
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