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Paridaen P, Voorendonk EM, Gomon G, Hoogendoorn EA, van Minnen A, de Jongh A. Changes in comorbid depression following intensive trauma-focused treatment for PTSD and complex PTSD. Eur J Psychotraumatol 2023; 14:2258313. [PMID: 37796651 PMCID: PMC10557564 DOI: 10.1080/20008066.2023.2258313] [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: 05/18/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The extent to which intensive trauma-focused treatment for individuals with post-traumatic stress disorder (PTSD) is also effective in treating comorbid major depressive disorder (MDD) remains unclear. OBJECTIVE The purpose of the present study was to test the hypothesis that brief intensive trauma-focused therapy for PTSD is associated with significant reductions in depressive symptoms and loss of diagnostic status of MDD. METHODS A total of 334 adult patients with PTSD (189 patients who were also diagnosed with MDD) underwent a brief intensive trauma-focused treatment programme consisting of EMDR therapy, prolonged exposure, physical activity, and psychoeducation. At pre-treatment, post-treatment and 6-month follow-up, severity and diagnostic status of PTSD and MDD were assessed. A linear mixed model was used to analyze changes in the severity of PTSD and depressive symptoms, whereas a generalized linear mixed model was used to determine changes in the MDD diagnostic status. RESULTS Treatment resulted in a significant and strong decrease of PTSD and MDD symptoms at post-treatment (d = 2.34 and 1.22, respectively), and at 6-month follow-up (d = 1.67 and 0.73, respectively). The proportion of patients fulfilling the diagnostic status of MDD changed from 57% at pre-treatment to 33% at the 6-month follow-up. Although the initial response to treatment did not differ between patients with and without comorbid MDD, for both groups a significant relapse in depressive symptoms was found after six months, which could be explained almost entirely by the presence of CPTSD at baseline. CONCLUSIONS The results support the notion that brief, intensive trauma-focused treatment is highly effective for individuals with PTSD and comorbid MDD. Because patients with CPTSD are vulnerable to relapse in depressive symptoms, this target group may require additional treatment.
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Affiliation(s)
- Paul Paridaen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Antes GGZ, Dordrecht
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Georgy Gomon
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- School of Psychology, Queen’s University, Belfast, Northern Ireland
- Institute of Health and Society, University of Worcester, Worcester, UK
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Kip A, Schoppe L, Arntz A, Morina N. Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis. J Anxiety Disord 2023; 99:102772. [PMID: 37699277 DOI: 10.1016/j.janxdis.2023.102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Imagery rescripting (ImRs) is frequently applied to treat different psychological complaints. We conducted an updated meta-analysis based on randomised controlled trials on the efficacy of ImRs for mental disorders associated with aversive memories. Medline, PsycInfo, and Web of Science were searched up to May 2023. Seventeen trials were included with a total of 908 participants (417 in the ImRs condition), suffering from posttraumatic stress disorder, anxiety disorders, depression, or eating disorders. Random effect models yielded an overall effect of g = 0.68 (95 % CI 0.18 to 1.18; k = 7) compared to passive controls (mostly waitlist). The effect compared to (prolonged) exposure, cognitive restructuring, and EMDR was non-significant (g = -0.01; 95 % CI -0.18 to 0.15; k = 11). Follow-up assessments indicated a long-term treatment effect. Results suggest that ImRs can effectively treat a variety of psychological disorders and produce similar treatment effects as evidence-based interventions. Limitations include the bounded number of included trials for each mental disorder. The meta-analysis was registered on PROSPERO (CRD42020220696) and received no funding.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Luisa Schoppe
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS Amsterdam, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
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Pruiksma KE, Taylor DJ, Wachen JS, Straud CL, Hale WJ, Mintz J, Young-McCaughan S, Peterson AL, Yarvis JS, Borah EV, Dondanville KA, Litz BT, Resick PA. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med 2023; 19:1389-1398. [PMID: 36988304 PMCID: PMC10394372 DOI: 10.5664/jcsm.10584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are common in military personnel with posttraumatic stress disorder (PTSD) and may persist following treatment. This study examined service members seeking treatment for PTSD, reporting insomnia symptoms, nightmares, excessive daytime sleepiness, and potential obstructive sleep apnea at baseline and the impact of sleep disturbances on a course of PTSD treatment. METHODS In this secondary analysis, sleep was evaluated in 223 service members who participated in a randomized clinical trial comparing Cognitive Processing Therapy for PTSD delivered in individual or group formats. Sleep assessments included the Insomnia Severity Index, the Trauma-Related Nightmare Survey, and Epworth Sleepiness Scale administered at baseline and 2 weeks posttreatment. RESULTS Following PTSD treatment, there were significant improvements for insomnia symptoms (MΔ = -1.49; d = -0.27), nightmares (MΔ = -0.35; d = -0.27), and excessive daytime sleepiness (MΔ = -0.91; d = -0.16). However, mean scores remained in clinical ranges at posttreatment. Participants with baseline insomnia symptoms had worse PTSD severity throughout treatment. Participants with baseline excessive daytime sleepiness or probable obstructive sleep apnea had greater PTSD severity reductions when treated with Cognitive Processing Therapy individually vs. in a group. Those with insomnia symptoms, nightmare disorder, and sleep apnea had greater depressive symptoms throughout treatment. CONCLUSIONS Insomnia symptoms, nightmares, and excessive daytime sleepiness were high at baseline in service members seeking treatment for PTSD. While sleep symptoms improved with PTSD treatment, these sleep disorders were related to worse treatment outcomes with regards to symptoms of PTSD and depression. Individual Cognitive Processing Therapy is recommended over group Cognitive Processing Therapy for patients with either excessive daytime sleepiness or probable obstructive sleep apnea. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Group vs. Individual Cognitive Processing Therapy for Combat-related PTSD; URL: https://clinicaltrials.gov/ct2/show/NCT02173561; Identifier: NCT02173561. CITATION Puriksma KE, Taylor DJ, Wachen JS, et al. Self-reported sleep problems in active-duty US Army personnel receiving posttraumatic stress disorder treatment in group or individual formats: secondary analysis of a randomized clinical trial. J Clin Sleep Med. 2023;19(8):1389-1398.
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Affiliation(s)
- Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
| | - Jennifer Schuster Wachen
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
| | - Elisa V. Borah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- School of Social Work, University of Texas at Austin, Austin, Texas
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brett T. Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - on behalf of the STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Psychology, University of North Texas, Denton, Texas
- Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
- School of Social Work, University of Texas at Austin, Austin, Texas
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
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Walter KH, Hunt WM, Otis NP, Kline AC, Miggantz EL, Thomsen CJ, Glassman LH. Comparison of behavioral activation-enhanced cognitive processing therapy and cognitive processing therapy among U.S. service members: A randomized clinical trial. Psychiatry Res 2023; 326:115330. [PMID: 37418778 DOI: 10.1016/j.psychres.2023.115330] [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: 05/10/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) frequently co-occur and can cause significant impairment. Data are lacking as to whether interventions targeting both PTSD and MDD may improve treatment outcomes among individuals with this comorbidity compared with existing evidence-based PTSD treatments alone. This randomized trial compared the effectiveness of cognitive processing therapy (CPT) enhanced with behavioral activation (BA+CPT) versus CPT among 94 service members (52 women and 42 men; age M = 28.5 years) with comorbid PTSD and MDD. The primary outcome was clinician-administered depression symptom severity on the Montgomery-Åsberg Depression Rating Scale (MADRS) from pretreatment through 3-month follow-up. Intent-to-treat analyses using multilevel models showed statistically and clinically significant decreases in MADRS scores for both conditions over time, with no significant differences between BA+CPT and CPT. Secondary depression and PTSD symptom outcomes followed a similar pattern of results. For diagnostic MDD and PTSD outcomes using available data, no statistically significant differences between treatments emerged at posttreatment or 3-month follow-up. Sessions attended, dropout rate, and treatment satisfaction did not significantly differ between treatments. Outcomes were comparable for both treatments, suggesting that BA+CPT and CPT were similarly effective psychotherapy options for comorbid PTSD and MDD.
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Affiliation(s)
- Kristen H Walter
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA.
| | - W Michael Hunt
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA, USA
| | - Nicholas P Otis
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Alexander C Kline
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Erin L Miggantz
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
| | - Cynthia J Thomsen
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA
| | - Lisa H Glassman
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA
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5
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Understanding veteran barriers to specialty outpatient PTSD clinical care. J Anxiety Disord 2023; 95:102675. [PMID: 36854224 DOI: 10.1016/j.janxdis.2023.102675] [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: 06/07/2022] [Revised: 12/28/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Veterans seeking treatment for posttraumatic stress disorder (PTSD) commonly report general and veteran-specific barriers to treatment such as stigma and challenges with navigating the Veterans Health Affairs (VHA) system. This study aimed to characterize barriers endorsed by a national sample of veterans seeking care in VHA PTSD specialty outpatient clinics, as well as to examine the impact of demographics on endorsed barriers. METHODS This study included 17,069 veterans referred to PTSD specialty outpatient clinics in the VHA during Fiscal Year 2019. Barriers to care, demographics, clinical concerns, and PTSD symptom severity (PCL-5) were assessed at intake. RESULTS Veterans (mean age=47.6 years, 83.3% male) endorsed an average of 2.39 barriers. The most commonly endorsed barriers included difficulty interacting with others (37.9%), difficulty being in public (33.8%), work (30.3%), concern for finances (20%), and difficulty getting out of bed (19.5%). A significant minority of veterans (22%) endorsed no barriers. Male sex (23.1%) and White race (23.6%) were associated with a greater likelihood of reporting no barriers. CONCLUSIONS These findings indicate the need for a comprehensive approach to addressing multi-faceted barriers for veterans seeking treatment in PTSD specialty clinics. Findings also highlight the potential importance of tailoring strategies to reduce barriers based on demographic and clinical characteristics such as race, sex, and degree of avoidance. Future research should seek to longitudinally examine the impact of barriers on treatment engagement.
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Walter KH, Levine JA, Madra NJ, Beltran JL, Glassman LH, Thomsen CJ. Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines. J Trauma Stress 2022; 35:988-998. [PMID: 35218250 PMCID: PMC9306964 DOI: 10.1002/jts.22807] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 01/24/2023]
Abstract
Psychological comorbidity, the co-occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence of a comorbid PTSD diagnosis. This study examined gender differences in prevalence estimates for conditions comorbid with PTSD using medical records for 523,626 active duty U.S. Sailors and Marines who entered the military over an 8-year period. Using chi-square tests of independence, we detected statistically significant gender differences for specific comorbid conditions in the subsample of 9,447 service members with a PTSD diagnosis. Women were more likely than men to have PTSD with comorbid adjustment, OR = 1.35; depressive, OR = 1.71; and generalized anxiety or other anxiety disorders, OR = 1.16, with the largest effects for eating, OR = 12.60, and personality disorders, OR = 2.97. In contrast, women were less likely than men to have a diagnosis of PTSD with comorbid alcohol use, OR = 0.69, and drug use disorders, OR = 0.72, with the largest effects for insomnia, OR = 0.42, and traumatic brain injury, OR = 0.17. No significant gender differences emerged for comorbid bipolar, obsessive-compulsive, panic/phobic, psychotic, or somatoform/dissociative disorders, ps = .029-.314. The results show gender differences in conditions comorbid with PTSD generally align with internalizing and externalizing dimensions. Differences in comorbidities with PTSD between women and men could have implications for treatment development and delivery.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jordan A. Levine
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Naju J. Madra
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Lisa H. Glassman
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Cynthia J. Thomsen
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
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Hardy A, Good S, Dix J, Longden E. "It hurt but it helped": A mixed methods audit of the implementation of trauma- focused cognitive-behavioral therapy for psychosis. Front Psychiatry 2022; 13:946615. [PMID: 36311513 PMCID: PMC9606605 DOI: 10.3389/fpsyt.2022.946615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Emerging evidence supports the safety, acceptability, and efficacy of trauma therapies for people experiencing post-traumatic stress and psychosis, despite common concerns about iatrogenic harm when processing trauma memories for this population. However, to date there have been no mixed-method studies examining whether trauma-focused therapy can be implemented in routine care. This study reports an audit of a post-traumatic stress in psychosis clinic based in an inner-city trust in the U.K. National Health Service. MATERIALS AND METHODS People under the care of psychosis community mental health teams with a significant history of past trauma were referred to the clinic by their multidisciplinary clinicians. Referral outcomes were recorded, including the proportion of people for whom trauma-focused cognitive-behavior therapy for psychosis was indicated. Post-traumatic stress symptoms were assessed pre- and post-therapy for clinically significant change on the Post-traumatic Stress Checklist (version 4) and Post-traumatic Stress Checklist (version 5). A subgroup of service users was also interviewed about their experience of therapy, with transcripts analyzed using inductive thematic analysis. RESULTS Seventy one service-users were referred to the clinic between 2014 and 2018, of which 51 (71.8%) attended an assessment. Of these, 20 (39.2%) were identified as having clinically significant PTSD symptoms with re-experiencing and were offered trauma-focused cognitive-behavior therapy for psychosis. Sixteen (80%) accepted and completed therapy, with no dropouts, and received a mean of 17.54 sessions (SD = 17.60, range = 12-91). There were no serious adverse events related to therapy. Clinically significant change was observed in 68.8% (n = 11) of the therapy group and post-therapy six people (37.5%) no longer met the threshold for clinically significant PTSD. Six service users completed an interview about their therapy experiences with findings organized within four main themes and associated subthemes: (1) Perseverance, (2) Establishing safety, (3) The challenges of therapy, and (4) Rebuilding one's life after trauma. CONCLUSION Trauma-focused cognitive-behavior therapy for psychosis can be safe, acceptable, and effective when implemented in routine care. Lived experience perspectives highlight the emotional demands of therapy and long-term impact of trauma, thus underscoring the necessity of sufficient support and continuity of care both during and after therapy.
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Affiliation(s)
- Amy Hardy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sophie Good
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jayde Dix
- North East London NHS Foundation Trust, London, United Kingdom
| | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Burton MS, Marks EH, Bedard-Gilligan MA, Feeny NC, Zoellner LA. The effect of perceived life stress on posttraumatic stress disorder treatment outcome. J Trauma Stress 2021; 34:1219-1227. [PMID: 34719829 DOI: 10.1002/jts.22744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022]
Abstract
Life stress following trauma exposure is a consistent predictor of the development of posttraumatic stress disorder (PTSD). However, there is a dearth of research on the effect of life stress on PTSD treatment outcomes. The current study examined the effects of pretreatment levels of perceived life stress on treatment outcome in a sample of 200 individuals with PTSD who were randomized to receive either prolonged exposure (PE) therapy or sertraline as part of a clinical trial. Life stress over the year prior to treatment significantly interacted with treatment type to predict higher residual PTSD symptom severity, as assessed using the PTSD Symptom Scale-Interview, among participants who received sertraline but not those who received PE, β = .24, p = .017, ∆R2 = .03. These findings were similar for self-reported depression severity, β = .27, p = .008, ∆R2 = .04. Adherence to either PE homework or sertraline compliance did not mediate this association nor did life stress predict treatment retention for either treatment arm. Higher levels of perceived life stress may serve as a prescriptive predictor of PTSD treatment outcome, with PE remaining efficacious regardless of heightened pretreatment life stress. These findings encourage clinician confidence when providing PE to individuals with higher levels of life stress. Future researchers should examine the impact of PTSD treatment on perceived and objective measures of life stress to improve treatment for individuals who experience chronic stress.
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Affiliation(s)
- Mark S Burton
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth H Marks
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | | | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lori A Zoellner
- Department of Psychology, University of Washington, Seattle, Washington, USA
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9
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Burton MS, Cooper AA, Mello PG, Feeny NC, Zoellner LA. Latent Profiles of Comorbid Depression as Predictors of PTSD Treatment Outcome. Behav Ther 2021; 52:970-981. [PMID: 34134835 PMCID: PMC8543494 DOI: 10.1016/j.beth.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) frequently co-occurs with major depressive disorder, and empirically supported PTSD treatments consistently improve depression. However, both diagnoses are heterogeneous and specific patterns of symptom overlap may be related to worse treatment outcome. Two hundred individuals with chronic PTSD participated in a doubly randomized preference trial comparing prolonged exposure and sertraline. Latent Profile Analysis was used to identify classes based on PTSD and depression symptoms prior to starting treatment. A three-class model best fit the data, with a high depression and PTSD severity class (distressed), a moderate depression and low PTSD avoidance class (depressive), and a low depression and high PTSD avoidance class (avoidant). The avoidant class showed the lowest rates of major depressive disorder diagnosis and transdiagnostic vulnerabilities to depression. Patients in the distressed class experienced more robust PTSD treatment response, with no differences between prolonged exposure and sertraline. These findings highlight the role of avoidance in nondepressed PTSD presentations while also demonstrating that co-occurring depression is not contraindicated in evidence-based PTSD treatment.
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10
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Kline AC, Cooper AA, Rytwinski NK, Feeny NC. The Effect of Concurrent Depression on PTSD Outcomes in Trauma-Focused Psychotherapy: A Meta-Analysis of Randomized Controlled Trials. Behav Ther 2021; 52:250-266. [PMID: 33483121 PMCID: PMC7826446 DOI: 10.1016/j.beth.2020.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
The co-occurrence of depression with posttraumatic stress disorder (PTSD) is common and associated with greater severity and impairment than PTSD alone, but the effects on PTSD treatment outcomes are unclear. This study investigated the impact of baseline depression on PTSD symptom change and dropout in a meta-analysis of 44 randomized controlled trials (N = 4,866) of trauma-focused psychotherapies for PTSD. Analyses included 107 active (k = 71) and control (k = 36) conditions. Baseline depression was indexed within samples as (a) continuous symptom severity (e.g., Beck Depression Inventory), standardized across depression measures and (b) proportion of patients with comorbid depressive disorder diagnosis. Among active conditions reporting continuous depression scores (k = 62), greater depression severity predicted smaller PTSD treatment effect sizes (ß = -.36, p = .002), but not dropout (ß = .25, p = .18). Categorical depressive diagnosis rates (k = 29)-reported less frequently-were not associated with treatment effects or dropout in active conditions. Greater depression severity may reflect a risk factor for attenuated response in PTSD psychotherapies, potentially demanding complementary strategies within trauma-focused interventions. Variability between trials in baseline depression symptoms may suggest the need to consider this sample characteristic when comparing treatment outcomes across studies.
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Affiliation(s)
- Alexander C. Kline
- Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, Ohio, USA 44106-7123
| | - Andrew A. Cooper
- University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Nina K. Rytwinski
- Walsh University, School of Behavioral and Health Sciences, 2020 East Maple St., North Canton, OH, USA, 44720
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, 11220 Bellflower Road, Cleveland, Ohio, USA 44106-7123
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11
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Angelakis S, Weber N, Nixon RDV. Comorbid posttraumatic stress disorder and major depressive disorder: The usefulness of a sequential treatment approach within a randomised design. J Anxiety Disord 2020; 76:102324. [PMID: 33137600 DOI: 10.1016/j.janxdis.2020.102324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Cognitive Processing Therapy (CPT) and Behavioural Activation Therapy (BA) were used to treat individuals with comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Fifty-two individuals (48 women, 4 men) were randomized to CPT alone (n = 18), CPT then BA for MDD (n = 17), or BA then CPT (n = 17). Presenting trauma was primarily interpersonal (87 %). Participants were assessed at pre-, posttreatment, and 6-month follow-up. PTSD and MDD symptoms were the main outcome of interest; trauma cognitions, rumination, and emotional numbing were secondary outcomes. All groups showed sizeable reductions in PTSD and depression (effect sizes at follow-up ranging between 1.02-2.54). A pattern of findings indicated CPT/BA showed better outcomes in terms of larger effect sizes and loss of diagnoses relative to CPT alone and BA/CPT. At follow-up greater numbers of the CPT/BA group were estimated to have achieved good end-state for remission of both PTSD and depression (49 %, CI95 [.26, .73]) relative to CPT alone (18 %, CI95 [.03, .38]) and BA/CPT (11 %, CI95 [.01, .29]). Although tempered by the modest sample size, the findings suggest that individuals with comorbid PTSD and MDD may benefit from having PTSD targeted first before remaining MDD symptoms are addressed.
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Affiliation(s)
- Samantha Angelakis
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
| | - Nathan Weber
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
| | - Reginald D V Nixon
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
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12
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Cooper DK, Bachem R, Meentken MG, Aceves L, Barrios AGP. Cumulative Lifetime Adversity and Depression among a National Sample of U.S. Latinx Immigrants: Within-group Differences in Risk and Protective Factors Using Data from the HCHS/SOL Sociocultural Ancillary Study. ACTA ACUST UNITED AC 2020; 8:202-220. [PMID: 33095211 DOI: 10.1037/lat0000145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Latinx immigrants are exposed to multiple stressors before, during, and after migration. However, most past research has assumed the effects of these stressors are uniform across Latinx groups despite considerable within-group variation. The purpose of this study was to (a) assess the moderating effects of several risk and protective factors on the association between cumulative lifetime adversity and depression among U.S. Latinx immigrants and (b) examine the extent to which risk and protective processes differed between Latinx subgroups. Method Data came from a cross-sectional secondary dataset, called the HCHS/SOL Sociocultural Ancillary Study. The sample (N = 2893) was identified using stratified random probability sampling in four of the largest Latinx metropolitan areas: the Bronx, NY, San Diego, CA, Chicago, IL, and Miami, FL. We included four Latinx subgroups in our study: Puerto Ricans, Cubans, Mexicans, and Dominicans. Results Results from multi-group regression analyses suggested that social support moderated the association between cumulative lifetime adversity and depression. However, further subgroup analyses showed the moderation effect was only present for Cuban and Dominican immigrants. We also found that perceived discrimination moderated the association between lifetime adversity and depression for Cuban immigrants and ethnic identity moderated the relationship between lifetime adversity and depression for Dominican immigrants. Conclusions Our results provide preliminary evidence for the presence of within-group differences in responses to adverse events among Latinx immigrant groups. Results can be used to inform the development of mental health interventions tailored to the specific needs of various Latinx immigrant populations.
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Affiliation(s)
| | - Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University
| | - Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center-Sophia Children's Hospital
| | - Lorena Aceves
- Department of Human Development and Family Studies, the Pennsylvania State University
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13
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Melton H, Meader N, Dale H, Wright K, Jones-Diette J, Temple M, Shah I, Lovell K, McMillan D, Churchill R, Barbui C, Gilbody S, Coventry P. Interventions for adults with a history of complex traumatic events: the INCiTE mixed-methods systematic review. Health Technol Assess 2020; 24:1-312. [PMID: 32924926 DOI: 10.3310/hta24430] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people. OBJECTIVE To identify candidate psychological and non-pharmacological treatments for future research. DESIGN Mixed-methods systematic review. PARTICIPANTS Adults aged ≥ 18 years with a history of complex traumatic events. INTERVENTIONS Psychological interventions versus control or active control; pharmacological interventions versus placebo. MAIN OUTCOME MEASURES Post-traumatic stress disorder symptoms, common mental health problems and attrition. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017. REVIEW METHODS Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist. RESULTS One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs. LIMITATIONS Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented. CONCLUSIONS Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder. FUTURE WORK Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities. STUDY REGISTRATION This study is registered as PROSPERO CRD42017055523. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Holly Dale
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Peter Coventry
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
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14
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Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Alden LE, Matthews LR, Wagner S, Fyfe T, Randall C, Regehr C, White M, Buys N, Carey MG, Corneil W, White N, Fraess-Phillips A, Krutop E. Systematic literature review of psychological interventions for first responders. WORK AND STRESS 2020. [DOI: 10.1080/02678373.2020.1758833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- L. E. Alden
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - L. R. Matthews
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - S. Wagner
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - T. Fyfe
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - C. Randall
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - C. Regehr
- Faculty of Social Work, University of Toronto, Toronto Ontario, Canada
| | - M. White
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - N. Buys
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - M. G. Carey
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - W. Corneil
- School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - N. White
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - A. Fraess-Phillips
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - E. Krutop
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
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16
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Yaacoub H, Haddad C, Dib T, Zoghbi M, Assaad S, Obeid S, Sacre H, Hallit S, Kazour F. Posttraumatic stress disorders and depression among male inpatient adults involved in the Lebanese war. Perspect Psychiatr Care 2020; 56:263-269. [PMID: 31318076 DOI: 10.1111/ppc.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/10/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE to evaluate factors associated with posttraumatic stress disorder (PTSD) and depression in a sample of hospitalized Lebanese adult males who directly or indirectly were involved in armed conflicts. DESIGN Cross-sectional. METHODS Seventy-seven hospitalized males were enrolled between June and December 2016. The Hamilton Anxiety and Depression Scale and the Mini International Neuropsychiatric Interview were used to assess anxiety, depression, and PTSD. RESULTS Participation in war (adjusted odds ratio [ORa] = 6.35) and depression (ORa = 1.08) were associated with higher PTSD, whereas age (ORa = 0.94) and substance use (ORa = 0.19) were associated with lower PTSD. Anxiety (β = .87), substance use (β = 6.27) and PTSD (β = 8.78; P = .008) were associated with higher depression. PRACTICE IMPLICATIONS People who experienced war conflicts (directly or indirectly) are more prone to suffer from mental health disorders.
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Affiliation(s)
- Hiba Yaacoub
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Tania Dib
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Shafika Assaad
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Francois Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon.,INSERM U930, équipe 4 "Troubles Affectifs", Université François-Rabelais de Tours, Parc de Grandmont, Tours, France
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17
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Abstract
OBJECTIVES As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression. METHODS PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias. RESULTS The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality. CONCLUSIONS The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Dennis Anheyer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
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18
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Holder N, Shiner B, Li Y, Madden E, Neylan TC, Seal KH, Lujan C, Patterson OV, DuVall SL, Maguen S. Timing of evidence-based psychotherapy for posttraumatic stress disorder initiation among Iraq and Afghanistan war veterans in the Veterans Health Administration. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 12:260-271. [PMID: 31343206 DOI: 10.1037/tra0000496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) were widely disseminated to treat posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA). However, few Iraq and Afghanistan war veterans (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], Operation New Dawn [OND]) diagnosed with PTSD have received CPT/PE and many initiate CPT/PE after substantial delay. Veterans who do not initiate CPT/PE or initiate CPT/PE after delay may have poorer treatment outcomes. This study aimed to identify predictors of CPT/PE initiation and timing. METHODS Participants included OEF/OIF/OND veterans diagnosed with PTSD who received psychotherapy between 2001 and 2017 in the VHA (n = 265,566). Logistic regression analysis was utilized to predict initiating CPT/PE (vs. no CPT/PE). Multinomial logistic regression analysis was utilized to predict not initiating or initiating delayed CPT/PE versus "early CPT/PE" (< 1 year after first mental health visit). Analyzed predictors included demographic, military, and clinical complexity variables (e.g., comorbidities, reported military sexual trauma [MST] history). RESULTS Seventy-Seven percent of veterans did not initiate CPT/PE, with 7.4% initiating early and 15.4% initiating delayed CPT/PE. Reported MST history (odds ratio [OR] = 1.45, 95% CI [1.39, 1.51]) and history of suicidal ideation/attempt (OR = 1.42, 95% CI [1.38, 1.46]) were strong predictors of CPT/PE initiation versus no CPT/PE. Comorbid pain (relative risk ratio [RRR] = 1.35, 95% CI [1.30, 1.42]) and depressive disorders (RRR = 1.37, 95% CI [1.32, 1.43]) were associated with increased likelihood of delayed versus early CPT/PE. CONCLUSIONS Most veterans in our study did not initiate CPT/PE. Generally, clinical complexity variables increased likelihood of initiating CPT/PE and initiating CPT/PE more than 1 year after first mental health visit. Additional research is needed to understand whether CPT/PE delay results from receipt of alternative intervention due to clinical complexity variables. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Olga V Patterson
- Department of Veterans Affairs Salt Lake City Health Care System
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System
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19
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A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD. J Anxiety Disord 2019; 64:45-54. [PMID: 30978622 DOI: 10.1016/j.janxdis.2019.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. METHOD This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. RESULTS Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. CONCLUSIONS PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00539279.
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20
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Bailey KA, Baker AL, McElduff P, Kay-Lambkin F, Kavanagh DJ. Do outcomes of cognitive-behaviour therapy for co-occurring alcohol misuse and depression differ for participants with symptoms of posttraumatic stress? J Ment Health 2019; 30:12-19. [PMID: 30862293 DOI: 10.1080/09638237.2019.1581354] [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: 10/27/2022]
Abstract
BACKGROUND Although post-traumatic stress disorder (PTSD) often co-occurs with depression and alcohol use disorder (AUD), treatment settings may not screen for PTSD symptoms. AIMS To explore the effects of PTSD symptoms in participants seeking treatment for depression and alcohol misuse by capitalising on the DAISI (Depression and Alcohol Integrated and Single focussed Interventions) project. METHODS Participants (N = 220) with current depressive symptoms and alcohol misuse were recruited from the DAISI project, a randomised controlled trial with four treatment arms. PTSD symptoms were assessed at baseline by the Posttraumatic Stress Diagnostic Scale and again at the 3-month assessment. RESULTS McNemars t-test assessed for changes in PTSD symptom severity and PTSD symptom clusters at the 3-month assessment. Repeated measures multivariate analysis of variance assessed for changes in PTSD symptoms, by DAISI treatment allocation. At the 3-month assessment, participants with PTSD reported significant reductions in PTSD symptoms (except intrusion) and a lower rate of PTSD, and responded better to integrated depression-alcohol misuse CBT than to the alcohol/depression single-focussed or brief interventions. CONCLUSION Integrated depression and alcohol misuse CBT may be effective for PTSD symptoms, but intrusions may need to be addressed specifically.
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Affiliation(s)
- Kylie A Bailey
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - David J Kavanagh
- Child Health Research. Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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21
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Walter KH, Levine JA, Highfill-McRoy RM, Navarro M, Thomsen CJ. Prevalence of Posttraumatic Stress Disorder and Psychological Comorbidities Among U.S. Active Duty Service Members, 2006-2013. J Trauma Stress 2018; 31:837-844. [PMID: 30398680 DOI: 10.1002/jts.22337] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
Among active duty service members, posttraumatic stress disorder (PTSD) diagnoses have increased dramatically since 2000. Because psychiatric comorbidity is more common for PTSD than for other mental health disorders, we examined the prevalence estimates of disorders comorbid or trimorbid with PTSD in this study. The medical records of 523,626 female and male active duty Sailors and Marines who entered the U.S. military between 2006 and 2013 were examined for diagnoses of PTSD and 14 potentially comorbid disorders. Results showed that 1.8% of military members had a PTSD diagnosis; among those with PTSD, 83.3% had a comorbid mental health disorder, and 62.2% had a third (i.e., trimorbid) disorder. Most frequently, PTSD co-occurred with depressive disorder (49.0%), adjustment disorder (37.0%), generalized anxiety disorder (36.1%), and alcohol use disorder (26.9%). All disorders we examined were significantly more likely to be diagnosed in service members with PTSD than in those without PTSD, odds ratios = 1.52-29.63. For service members with PTSD, comorbid mental health disorders are the rule rather than the exception. Consequently, it is important that clinicians also assess for other disorders and select treatment options that address both PTSD and comorbid conditions.
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Affiliation(s)
- Kristen H Walter
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Jordan A Levine
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Robyn M Highfill-McRoy
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Melissa Navarro
- Leidos, Reston, Virginia, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| | - Cynthia J Thomsen
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
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22
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Müller M, Ajdacic-Gross V, Rodgers S, Kleim B, Seifritz E, Vetter S, Egger ST, Rössler W, Castelao E, Preisig M, Vandeleur C. Predictors of remission from PTSD symptoms after sexual and non-sexual trauma in the community: A mediated survival-analytic approach. Psychiatry Res 2018; 260:262-271. [PMID: 29220684 DOI: 10.1016/j.psychres.2017.11.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/31/2017] [Accepted: 11/25/2017] [Indexed: 01/07/2023]
Abstract
Epidemiological data on the chronicity of posttraumatic stress disorder (PTSD) symptoms in relation to trauma type and underlying pathways are rare. The current study explored how PTSD symptoms change over time across different trauma types and examined mediators of their persistence. A trauma-exposed community sample, whereof approximately one quarter met diagnostic criteria for PTSD, provided retrospective data on the duration of PTSD symptoms. Those who remitted and those who had not at the time of assessment were compared regarding worst trauma, symptom severity, comorbidity, demographic and treatment-seeking variables. Time to remission was estimated using Cox proportional hazard models including candidate predictors of remission. A mediated survival analysis was used to explore indirect pathways that explain trauma-specific differences in remission times. Both the full sample and PTSD subgroup were analyzed separately. Overall, lower socio-economic status, lifetime and childhood sexual trauma, symptom severity, comorbid depression and past treatment were associated with non- and longer remissions. PTSD avoidance symptoms and comorbid depression were found to mediate longer remission times after lifetime or childhood sexual trauma. Our findings provide insight into the mechanisms and complicating factors of remission from PTSD symptoms after trauma, which might have important implications for therapeutic interventions.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Wulf Rössler
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Germany
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23
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Walter KH, Glassman LH, Michael Hunt W, Otis NP, Thomsen CJ. Evaluation of an integrated treatment for active duty service members with comorbid posttraumatic stress disorder and major depressive disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials 2017; 64:152-160. [PMID: 29107036 DOI: 10.1016/j.cct.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 01/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with major depressive disorder (MDD) in both civilian and military/veteran populations. Existing, evidence-based PTSD treatments, such as cognitive processing therapy (CPT), often reduce symptoms of both PTSD and depression; however, findings related to the influence of comorbid MDD on PTSD treatment outcomes are mixed, and few studies use samples of individuals with both conditions. Behavioral activation (BA), an approach that relies on behavioral principles, is an effective treatment for depression. We have integrated BA into CPT (BA+CPT), a more cognitive approach, to address depressive symptoms among active duty service members with both PTSD and comorbid MDD. We describe an ongoing randomized controlled trial investigating the efficacy of our innovative, integrated BA+CPT intervention, compared with standard CPT, for active duty service members with PTSD and comorbid MDD. We detail the development of this integrated treatment, as well as the design and implementation of the randomized controlled trial, to evaluate its effect on symptoms.
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Affiliation(s)
- Kristen H Walter
- Leidos, 140 Sylvester Road, San Diego, CA 92106-3521, United States; Leidos, 140 Sylvester Road, San Diego, CA 92106-3521, United States.
| | - Lisa H Glassman
- Leidos, 140 Sylvester Road, San Diego, CA 92106-3521, United States.
| | - W Michael Hunt
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA, United States.
| | - Nicholas P Otis
- Leidos, 140 Sylvester Road, San Diego, CA 92106-3521, United States.
| | - Cynthia J Thomsen
- Health and Behavioral Sciences, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, United States.
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Cooper AA, Zoellner LA, Roy-Byrne P, Mavissakalian MR, Feeny NC. Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline? J Consult Clin Psychol 2017; 85:873-882. [PMID: 28504542 PMCID: PMC5578884 DOI: 10.1037/ccp0000220] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Negative trauma-related belief change has been found to predict subsequent improvement in symptoms of posttraumatic stress disorder (PTSD) in prolonged exposure (PE) and other therapies, consistent with several psychological theories of treatment change (e.g., Foa & Kozak, 1986). However, belief change has not been examined in selective serotonin reuptake inhibitors such as sertraline. We examined processes associated with symptom improvement in 2 treatments for PTSD, hypothesizing that belief change would robustly predict PTSD improvement in patients treated with PE but not those treated with sertraline, reflecting moderation by treatment. METHOD Patients with chronic PTSD (N = 134; 78% women, 71.6% Caucasian, M = 38.1 years, SD = 11.8) received 10 weeks of PE or sertraline in a randomized, controlled trial. Patients reported PTSD and depression symptoms, and trauma-related beliefs (Post-Traumatic Cognitions Inventory; Foa, Ehlers, Clark, D Tolin, & Orsillo, 1999) at pretreatment, every treatment session, and posttreatment. RESULTS Using time-lagged mixed regression models, change in trauma-related beliefs predicted subsequent PTSD symptom improvement, an effect moderated by treatment and particularly strong in PE (d = 0.93) compared with sertraline (d = 0.35). Belief change also predicted depressive symptom improvement but more modestly and bidirectionally, with no difference by treatment modality. CONCLUSIONS Trauma-related belief change precedes PTSD improvement more robustly in PE than in sertraline and with greater specificity compared with depressive symptoms. These findings highlight potentially divergent processes contributing to symptom change in these PTSD treatments, with belief change as a key mechanism of PE. (PsycINFO Database Record
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Affiliation(s)
- Andrew A Cooper
- Department of Psychological Sciences, Case Western Reserve University
| | | | | | | | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University
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25
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Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. J Affect Disord 2017; 213:70-77. [PMID: 28192737 DOI: 10.1016/j.jad.2017.02.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The purpose of this review was to investigate the efficacy and safety of yoga interventions in treating patients with major depressive disorder. METHODS MEDLINE, Scopus, and the Cochrane Library were screened through December 2016. Randomized controlled trials (RCTs) comparing yoga to inactive or active comparators in patients with major depressive disorder were eligible. Primary outcomes included remission rates and severity of depression. Anxiety and adverse events were secondary outcomes. Risk of bias was assessed using the Cochrane tool. RESULTS Seven RCTs with 240 participants were included. Risk of bias was unclear for most RCTs. Compared to aerobic exercise, no short- or medium-term group differences in depression severity was found. Higher short-term depression severity was found for yoga compared to electro-convulsive therapy; remission rates did not differ between groups. No short-term group differences occurred when yoga was compared to antidepressant medication. Conflicting evidence was found when yoga was compared to attention-control interventions, or when yoga as an add-on to antidepressant medication was compared to medication alone. Only two RCTs assessed adverse events and reported that no treatment-related adverse events were reported. LIMITATIONS Few RCTs with low sample size. CONCLUSIONS This review found some evidence for positive effects beyond placebo and comparable effects compared to evidence-based interventions. However, methodological problems and the unclear risk-benefit ratio preclude definitive recommendations for or against yoga as an adjunct treatment for major depressive disorder. Larger and adequately powered RCTs using non-inferiority designs are needed.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Dennis Anheyer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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26
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Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:170-218. [PMID: 26854815 DOI: 10.1016/j.pnpbp.2016.01.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a serious psychiatric consequence of trauma that occurs in a proportion of individuals exposed to life-threatening events. Trauma-focused psychotherapy is often recommended as first choice for those who do not recover spontaneously. But many individuals require medications. In the US, only paroxetine (PRX) and sertraline (SRT) are FDA approved for PTSD. But response and remission rates with these medications are low, so numerous other pharmacologic interventions have been tried. To date, there has not been a systematic review of the data on what are the best next-step pharmacologic strategies for individuals who fail standard treatments. To that end, we review 168 published trials of medications other than PRX or SRT and provide a detailed analysis of the 88/168 studies that describe alternative pharmacologic interventions in patients refractory to other treatment. We also review clinical factors relevant to treatment-refractory PTSD; the neurobiology of extinction, as well as evidence-based psychotherapy and neuromodulation strategies for this condition.
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27
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de Bont PAJM, van den Berg DPG, van der Vleugel BM, de Roos C, de Jongh A, van der Gaag M, van Minnen AM. Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders. Psychol Med 2016; 46:2411-2421. [PMID: 27297048 DOI: 10.1017/s0033291716001094] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown METHOD In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points. RESULTS Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged. CONCLUSIONS In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.
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Affiliation(s)
- P A J M de Bont
- Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg,Boxmeer,The Netherlands
| | | | - B M van der Vleugel
- Community Mental Health Service GGZ Noord-Holland Noord,Alkmaar,The Netherlands
| | - C de Roos
- MHO Rivierduinen,Leiden,The Netherlands
| | - A de Jongh
- Department of Behavioral Sciences,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam,Amsterdam,The Netherlands
| | - M van der Gaag
- Department of Clinical Psychology,VU University Amsterdam and EMGO Institute for Health and Care Research,Van der Boechorststraat 1,BT Amsterdam,The Netherlands
| | - A M van Minnen
- Radboud University Nijmegen, Behavioural Science Institute,NijCare,HE Nijmegen,The Netherlands
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28
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De Jongh A, Resick PA, Zoellner LA, van Minnen A, Lee CW, Monson CM, Foa EB, Wheeler K, Broeke ET, Feeny N, Rauch SAM, Chard KM, Mueser KT, Sloan DM, van der Gaag M, Rothbaum BO, Neuner F, de Roos C, Hehenkamp LMJ, Rosner R, Bicanic IAE. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS. Depress Anxiety 2016; 33:359-69. [PMID: 26840244 DOI: 10.1002/da.22469] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 12/28/2015] [Accepted: 01/03/2016] [Indexed: 11/08/2022] Open
Abstract
According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.
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Affiliation(s)
- Ad De Jongh
- Department of Social Dentistry (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom
| | | | - Lori A Zoellner
- Department of Psychology, University of Washington, Seattle, Washington
| | - Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, NijCare, The Netherlands.,MHO 'Pro Persona', Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands
| | - Christopher W Lee
- School of Psychology and Exercise Science, Murdoch University, Western Australia, Australia
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Edna B Foa
- Department of Psychology, Center for the treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, Philadelphia, Pennsylvania
| | | | - Erik ten Broeke
- Private Practice for Cognitive Behavioural Therapy Deventer/Bathmen, The Netherlands
| | - Norah Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Sheila A M Rauch
- VA Ann Arbor Healthcare System, University of Michigan Medical School, Michigan, Massachusetts
| | - Kathleen M Chard
- Cincinnati VA Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts
| | - Denise M Sloan
- VA National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Parnassia Psychiatric Institute, The Hague, The Netherlands, Amsterdam, The Netherlands
| | | | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Carlijn de Roos
- Psychotrauma Center for Children and Youth, MHO Rivierduinen, Leiden, The Netherlands
| | - Lieve M J Hehenkamp
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rita Rosner
- Department of Psychology, Catholic University, Eichstätt-Ingolstadt, Germany
| | - Iva A E Bicanic
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands
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