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Fortney JC, Kaysen DL, Engel CC, Cerimele JM, Nolan JP, Chase E, Blanchard BE, Hauge S, Bechtel J, Moore DL, Taylor A, Acierno R, Nagel N, Sripada RK, Painter JT, DeBeer BB, Bluett E, Teo AR, Morland LA, Heagerty PJ. Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial: A protocol for a pragmatic comparative effectiveness trial with baseline results. Contemp Clin Trials 2024; 144:107606. [PMID: 38866094 DOI: 10.1016/j.cct.2024.107606] [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: 04/14/2024] [Revised: 05/16/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND There have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for PTSD, and neither was conducted in primary care. Therefore, this protocol paper describes a pragmatic trial that compares outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, this pragmatic trial also compares the outcomes of those switching or augmenting treatments. METHOD Patients screening positive for PTSD (n = 700) were recruited from the primary care clinics of 7 Federally Qualified Health Centers (FQHC) and 8 Department of Veterans Affairs (VA) Medical Centers and randomized in the ratio 1:1:2 to one of three treatment sequences: 1) selective serotonin reuptake inhibitor (SSRI) followed by augmentation with Written Exposure Therapy (WET), 2) SSRI followed by a switch to serotonin-norepinephrine reuptake inhibitor (SNRI), or 3) WET followed by a switch to SSRI. Participants complete surveys at baseline, 4 months, and 8 months. The primary outcome is PTSD symptom severity as measured by the PTSD Checklist (PCL-5). RESULTS Average PCL-5 scores (M = 52.8, SD = 11.1) indicated considerable severity. The most common bothersome traumatic event for VA enrollees was combat (47.8%), and for FQHC enrollees was other (28.2%), followed by sexual assault (23.4%), and child abuse (19.8%). Only 22.4% were taking an antidepressant at baseline. CONCLUSION Results will help healthcare systems and clinicians make decisions about which treatments to offer to patients.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA.
| | - Debra L Kaysen
- Departments of Psychiatry and Behavioral Sciences and Public Mental Health & Population Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Charles C Engel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | | | - Erin Chase
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephanie Hauge
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Danna L Moore
- School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Ashley Taylor
- Primary Care Behavioral Health, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ron Acierno
- Ralph H. Johnson VA Healthcare System, USA; Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Nancy Nagel
- Primary Care Mental Health Integration, Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jacob T Painter
- Health Systems Research Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA; College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bryann B DeBeer
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Denver, CO, USA; VA Rocky Mountain Mental Illness, Research, Education, and Clinical Center for Suicide Prevention, Denver, CO, USA
| | - Ellen Bluett
- University of Montana, Family Medicine Residency
| | - Alan R Teo
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, Health Systems Research, VA Portland Health Care System, Portland, OR, USA
| | - Leslie A Morland
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
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Kehle-Forbes SM, Baier AL, Ackland PE, Spoont M, Polusny MA, Schnurr PP, Galovski T, Meis L. "It made me feel more alive": A qualitative analysis of quality of life improvements following completion of trauma-focused therapy for posttraumatic stress disorder. J Trauma Stress 2024. [PMID: 39095940 DOI: 10.1002/jts.23091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024]
Abstract
Posttraumatic stress disorder (PTSD) is associated with poor quality of life. Although randomized clinical trial data show improvements in quality of life following trauma-focused therapies (TFTs), including prolonged exposure therapy (PE) and cognitive processing therapy (CPT), less is known about how these improvements are experienced from the trauma survivor's perspective. A national sample of 60 veterans who recently completed TFT as part of routine care at U.S. Department of Veterans Affairs facilities participated in semistructured qualitative interviews during which the impact of treatment on quality of life was explored. Following a mixed deductive/inductive approach, six interrelated themes describing changes in quality of life emerged: full participation in social activities, greater emotional intimacy in relationships, improvements in parenting, expanded engagement in hobbies and community, increased occupational commitment and confidence, and more joy in life. The data highlight the positive impact of treatment on quality of life and provide depth to quantitative findings demonstrating improvements in quality of life following TFT.
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Affiliation(s)
- Shannon M Kehle-Forbes
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Allison L Baier
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Princess E Ackland
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michele Spoont
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa A Polusny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Tara Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Laura Meis
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Fry KM, Bennett DC, Roberge EM, McClain CM, Rugo-Cook K, Brewczynski J, Pryor C. The effects of Religiosity, Spirituality, and sense of purpose on posttraumatic stress disorder treatment outcomes among Veterans. J Psychiatr Res 2024; 176:276-281. [PMID: 38905760 DOI: 10.1016/j.jpsychires.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Religion/spirituality (R/S) is an important and commonly used resource for coping with difficult experiences and has been shown to reduce the development of posttraumatic stress disorder (PTSD) symptoms following a trauma. However, it is not clear how R/S affects response to treatment of PTSD. OBJECTIVE The aim of this paper was to understand how Veterans' R/S and sense of purpose were related to clinical outcomes when engaging in Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE). It was predicted that Veterans identifying as R/S would have a higher sense of purpose, be more likely to complete treatment, and have greater symptom change during treatment. METHOD The study included 91 military Veterans from a VA Medical Center outpatient PTSD Clinical Team who initiated CPT or PE and responded to a question about the importance of R/S in their lives at intake. RESULTS Forty nine percent of the Veterans in this sample reported R/S were important to them and had mixed feelings about whether their life had a clear sense of purpose. Neither R/S nor sense of purpose were associated with treatment completion or response to PTSD treatment. CONCLUSION These findings suggest that once PTSD has developed, R/S or sense of purpose may not play a significant role in completion of or response to evidence-based psychotherapies (EBPs) for PTSD. EBPs for PTSD are equally effective for Veterans identifying as R/S and those who do not, which may be reflective of administering EBPs in a culturally responsive manner.
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Affiliation(s)
- Katie M Fry
- VA Salt Lake City Healthcare System, United States.
| | - Diana C Bennett
- VA Salt Lake City Healthcare System, United States; Department of Psychiatry, University of Utah Spencer Fox Eccles School of Medicine, United States
| | - Erika M Roberge
- VA Salt Lake City Healthcare System, United States; Department of Psychiatry, University of Utah Spencer Fox Eccles School of Medicine, United States
| | | | | | - Jacek Brewczynski
- VA Salt Lake City Healthcare System, United States; Department of Psychiatry, University of Utah Spencer Fox Eccles School of Medicine, United States; Department of Psychology, University of Utah, United States
| | - Cosette Pryor
- VA Salt Lake City Healthcare System, United States; Department of Psychology, University of Utah, United States
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Horn AJ, Cole S, Nazarloo HP, Nazarloo P, Davis JM, Carrier D, Bryan C, Carter CS. Severe PTSD is marked by reduced oxytocin and elevated vasopressin. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100236. [PMID: 38764609 PMCID: PMC11101686 DOI: 10.1016/j.cpnec.2024.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/21/2024] Open
Abstract
Neuroendocrine analyses of posttraumatic stress disorder (PTSD) have generally focused on hypothalamic-pituitary-adrenal (HPA) axis alterations. In the present analyses, we examine two additional neuroendocrine factors that have been previously implicated in biological stress responses: oxytocin (OT) and arginine vasopressin (AVP). Here we examined basal neuropeptide status in military veterans clinically diagnosed with PTSD (n = 29) and in two non-traumatized comparison groups with previous stress exposure (n = 11 SWAT trainees and n = 21 ultramarathon runners). PTSD patients showed low levels of plasma OT and high levels of AVP. The ratio of AVP/OT robustly related to PTSD status, and emerged as a statistically plausible mediator of relationships between the number of personal traumatic experiences and subsequent PTSD symptom burden. Over the course of behavioral therapy for PTSD, measures of OT showed a significant but modest normalization. Plasma cortisol levels were not statistically different among the three groups. This study suggests that AVP/OT ratios may represent a neuroendocrine predictor of severe PTSD, as well as a potential treatment response biomarker.
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Affiliation(s)
| | - Steve Cole
- UCLA School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, USA
| | | | | | - John M. Davis
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - David Carrier
- Department of Biology, University of Utah, Salt Lake City, UT, USA
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - C. Sue Carter
- Kinsey Institute, Indiana University, Bloomington, IN, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Ellis R, Sinnott S, Karam K, Assefa A, Osborne M, Seligowski A. Impact of cognitive behavioural therapy on neural, inflammatory, & autonomic markers in a sample with PTSD and cardiovascular risk: protocol for a pilot randomised controlled trial. Eur J Psychotraumatol 2024; 15:2378618. [PMID: 39045795 PMCID: PMC11271075 DOI: 10.1080/20008066.2024.2378618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024] Open
Abstract
Background: Individuals with posttraumatic stress disorder (PTSD) are at heightened risk for cardiovascular disease (CVD) compared to the general population. Inflammation and autonomic dysfunction are candidate mechanisms of CVD risk in PTSD; however, these mechanisms have not been well-characterised in the PTSD-CVD link. Further, these mechanisms may operate through altered stress-related neural activity (SNA). Yet, it remains unknown if changes in PTSD are associated with changes in CVD risk mechanisms.Objective: This manuscript describes the design and procedures of a pilot randomised controlled trial to assess the impact of a first-line treatment for PTSD (Cognitive Processing Therapy; CPT) versus waitlist control on mechanisms of CVD risk. Further, this study will test the hypothesis that CPT reduces CVD risk through its effects on inflammation and autonomic function and that these changes are driven by changes in SNA.Methods: Adults with PTSD and CVD risk (N = 30) will be randomised to CPT or waitlist control. Participants complete two laboratory visits (baseline and post-treatment) that include surveys, brain and peripheral imaging via 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and resting measures of autonomic function. Primary outcomes include arterial inflammation and heart rate variability. Secondary outcomes include leukopoiesis (bone marrow uptake), heart rate, and blood pressure. The indirect effects of PTSD treatment on changes in inflammation and autonomic function through SNA will also be examined.Conclusions: This study seeks to characterise candidate neuroimmune mechanisms of the PTSD-CVD link to identify treatment targets and develop personalised interventions to reduce CVD events in PTSD populations.Trial registration: ClinicalTrials.gov identifier: NCT06429293..
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Affiliation(s)
- Robyn Ellis
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Sinead Sinnott
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Krystel Karam
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alula Assefa
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Antonia Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
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Bates A, Baldwin DS, Pattison N, Moyses H, Huneke NT, Cortese S, Grocott MP, Cusack R. Eye movement desensitisation and reprocessing for survivors of life-threatening medical events. Cochrane Database Syst Rev 2024; 7:CD015640. [PMID: 39041417 PMCID: PMC11264321 DOI: 10.1002/14651858.cd015640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. SECONDARY OBJECTIVES to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD), anxiety, depression, or quality of life), or intervention (online, face-to-face, group or individual sessions).
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Affiliation(s)
- Andrew Bates
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | - Helen Moyses
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Nathan Tm Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- Dorset Healthcare University NHS Foundation Trust, Bournemouth, UK
| | - Samuele Cortese
- School of Psychology, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Michael Pw Grocott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative and Critical Care Research Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Rebecca Cusack
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Tng GYQ, Koh J, Soh XC, Majeed NM, Hartanto A. Efficacy of digital mental health interventions for PTSD symptoms: A systematic review of meta-analyses. J Affect Disord 2024; 357:23-36. [PMID: 38679205 DOI: 10.1016/j.jad.2024.04.074] [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: 03/23/2023] [Revised: 01/30/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The present systematic review aimed to synthesize the results of meta-analyses which examine the effects of digital mental health interventions (DMHIs) on post-traumatic stress disorder (PTSD) symptoms, and investigate whether intervention characteristics (i.e., technique, timeframe, and therapeutic guidance) and methodological characteristics including outcome measures and sample inclusion criteria (age, gender, socioeconomic status, country, comorbidity) moderate the efficacy of digital interventions. METHODS A systematic search of various sources (ECSCOhost PsycInfo, PubMed, Web of Science, Scopus, EBSCOhost ERIC, Google Scholar, ProQuest Dissertations & Theses) including five peer-reviewed journals was conducted to identify relevant meta-analyses up to December 2023, and 11 meta-analyses were included in the final review. RESULTS Overall, our review elucidates that DMHIs are appropriate for alleviating PTSD symptoms in adults, with more consistent evidence supporting the efficacy of cognitive behavioral therapy (CBT)-based, compared to non-CBT-based, interventions when compared to control conditions. However, we found inconclusive evidence that the efficacy of DMHIs varied according to intervention timeframe, therapeutic guidance, or sample characteristics. LIMITATIONS A relatively limited number of different populations was sampled across meta-analyses. Further, while our review focused on PTSD symptoms to indicate the efficacy of digital interventions, other indices of effectiveness were not examined. CONCLUSION Our findings indicate the clinical utility of DMHIs for managing PTSD symptoms particularly when CBT-based intervention techniques are employed.
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Affiliation(s)
| | - Jerica Koh
- Singapore Management University, Singapore
| | - Xun Ci Soh
- Singapore Management University, Singapore
| | - Nadyanna M Majeed
- Singapore Management University, Singapore; National University of Singapore, Singapore
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Snoek A, Edens R, van Ballegooijen W, Dekker J, Beekman ATF, Thomaes K. A network perspective on posttraumatic stress disorder and comorbid borderline personality disorder symptoms. Eur J Psychotraumatol 2024; 15:2367815. [PMID: 38957149 PMCID: PMC11225629 DOI: 10.1080/20008066.2024.2367815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Background: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is surrounded by diagnostic controversy and although various effective treatments exist, dropout and nonresponse are high.Objective: By estimating the network structure of comorbid PTSD and BPD symptoms, the current study illustrates how the network perspective offers tools to tackle these challenges.Method: The sample comprised of 154 patients with a PTSD diagnosis and BPD symptoms, assessed by clinician-administered interviews. A regularised partial correlation network was estimated using the GLASSO algorithm in R. Central symptoms and bridge symptoms were identified. The reliability and accuracy of network parameters were determined through bootstrapping analyses.Results: PTSD and BPD symptoms largely clustered into separate communities. Intrusive memories, physiological cue reactivity and loss of interest were the most central symptoms, whereas amnesia and suicidal behaviour were least central.Conclusions: Present findings suggest that PTSD and BPD are two distinct, albeit weakly connected disorders. Treatment of the most central symptoms could lead to an overall deactivation of the network, while isolated symptoms would need more specific attention during therapy. Further experimental, longitudinal research is needed to confirm these hypotheses.Trial registration: ClinicalTrials.gov identifier: NCT03833453.
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Affiliation(s)
- Aishah Snoek
- Arkin, Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roos Edens
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jack Dekker
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, GGZinGeest, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Arkin, Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
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9
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Deleuran DHK, Skov O, Bo S. Prolonged Exposure for Posttraumatic Stress Disorder in Patients Exhibiting Psychotic Symptoms: A Scoping Review. Clin Psychol Psychother 2024; 31:e3027. [PMID: 39074495 DOI: 10.1002/cpp.3027] [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: 04/02/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Trauma is a significant risk factor for developing psychosis. Nevertheless, psychosis is often considered grounds for not receiving trauma-focused therapy due to concerns of exacerbating psychotic symptoms. Prolonged exposure (PE) is a recognized and effective evidence-based therapy modality for the treatment of severe trauma. OBJECTIVE To assess the available empirical evidence for PE as a feasible treatment programme for posttraumatic stress disorder (PTSD) in patients with psychotic symptoms. METHOD A systematic literature search was conducted using the databases Scopus, PsycINFO (OVID) and PubMed MEDLINE in December 2023 with a priori defined eligibility criteria. The literature search identified 1226 articles, of which eight met the eligibility criteria. Five studies exploring the effects of PE treatment on patients diagnosed with PTSD and suffering from comorbid psychotic experiences were included. Three studies containing follow-up data or secondary analysis on PTSD and psychotic symptoms from original studies fulfilling the inclusion and exclusion criteria were included. Each study was assessed for quality to estimate the risk of bias. RESULTS Acknowledging the scarcity of available evidence, the results of the scoping review indicate that PE may be an effective treatment approach for reducing PTSD symptoms in patients with PTSD and comorbid psychotic symptoms. The reviewed studies found no iatrogenic effects, including no increase in psychotic symptoms. CONCLUSION PE appears to be a possibly effective PTSD treatment for patients suffering from PTSD and comorbid psychotic symptoms or disorders. However, the evidence is scarce, and larger confirmative trials are required for more conclusive evidence.
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Affiliation(s)
- D H K Deleuran
- Psychiatric Unit, Odense University Hospital, Svendborg, Denmark
| | - O Skov
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - S Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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10
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Cuijpers P, Miguel C, Ciharova M, Harrer M, Basic D, Cristea IA, de Ponti N, Driessen E, Hamblen J, Larsen SE, Matbouriahi M, Papola D, Pauley D, Plessen CY, Pfund RA, Setkowski K, Schnurr PP, van Ballegooijen W, Wang Y, Riper H, van Straten A, Sijbrandij M, Furukawa TA, Karyotaki E. Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis. World Psychiatry 2024; 23:267-275. [PMID: 38727072 PMCID: PMC11083862 DOI: 10.1002/wps.21203] [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] [Indexed: 05/13/2024] Open
Abstract
Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Djordje Basic
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ioana A Cristea
- Department of General Psychology, University of Padua, Padua, Italy
| | - Nino de Ponti
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Jessica Hamblen
- National Center for PTSD, White River Junction, VT, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sadie E Larsen
- National Center for PTSD, White River Junction, VT, USA
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Minoo Matbouriahi
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Davide Papola
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Constantin Y Plessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychosomatic Medicine, Charité Universitätsmedizin Berlin; Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Rory A Pfund
- Tennessee Institute for Gambling Education & Research, Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands
- Department of Pedagogical and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, VT, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yingying Wang
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
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11
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Molteni L, Gosling CJ, Fagan HA, Hyde J, Benatti B, Dell'Osso B, Cortese S, Baldwin DS, Huneke NTM. Effects of mindfulness-based interventions on symptoms and interoception in trauma-related disorders and exposure to traumatic events: Systematic review and meta-analysis. Psychiatry Res 2024; 336:115897. [PMID: 38636333 DOI: 10.1016/j.psychres.2024.115897] [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: 11/20/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
Interoception is defined as the sense of the internal state of the body. Dysfunctions in interoception are found in several mental disorders, including trauma-related conditions. Mindfulness-Based Interventions (MBIs) have been shown to influence interoceptive processes. Randomised controlled trials (RCTs) have investigated whether MBIs impact symptoms and interoception in patients with trauma-related disorders. We undertook a systematic review and meta-analysis to synthesize these data. We included RCTs with an MBI arm which enrolled adult patients with trauma related-disorders or exposure to a traumatic experience, and addressed changes in interoception and trauma-related symptoms. A random-effects multivariate meta-analytic model was performed to quantify group differences in score change from baseline to follow-up. Twelve studies were included in the systematic review, and eleven in the meta-analysis. Overall, MBIs showed small to moderate positive effects on both interoception and symptoms. Despite a high heterogeneity in results, sensitivity analyses confirmed the robustness of the findings. We conclude that the efficacy of MBIs on trauma-related symptoms and interoception is supported by randomised evidence. However, further research is needed to understand whether changes in interoception might underpin the effectiveness of MBIs in trauma-related disorders.
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Affiliation(s)
- L Molteni
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK; Southern Health National Health Service Foundation Trust, Southampton, UK; Department of Psychiatry, University of Milan, Department of Biomedical and Clinical Sciences "Luigi Sacco", ASST Fatebenefratelli-Sacco, Milan, Italy
| | - C J Gosling
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Université Paris Nanterre, DysCo Lab, Nanterre F-92000, France; Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France
| | - H A Fagan
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK; Southern Health National Health Service Foundation Trust, Southampton, UK
| | - J Hyde
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - B Benatti
- Department of Psychiatry, University of Milan, Department of Biomedical and Clinical Sciences "Luigi Sacco", ASST Fatebenefratelli-Sacco, Milan, Italy; Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan 20142, Italy
| | - B Dell'Osso
- Department of Psychiatry, University of Milan, Department of Biomedical and Clinical Sciences "Luigi Sacco", ASST Fatebenefratelli-Sacco, Milan, Italy; Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan 20142, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
| | - S Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent National Health Service Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University "Aldo Moro", Bari, Italy
| | - D S Baldwin
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK; Southern Health National Health Service Foundation Trust, Southampton, UK; University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - N T M Huneke
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK; Southern Health National Health Service Foundation Trust, Southampton, UK.
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12
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Greene DR, Holland-Winkler AM, Petruzzello SJ. Enjoyment and Affective Responses to Moderate and High-Intensity Exercise: A Randomized Controlled Trial in Individuals with Subsyndromal PTSD. Sports (Basel) 2024; 12:138. [PMID: 38787007 PMCID: PMC11125787 DOI: 10.3390/sports12050138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
This crossover randomized controlled trial examined the acute psychological effects of a bout of moderate-intensity continuous aerobic exercise (MICE) and a bout of high-intensity functional exercise (HIFE), relative to a no-exercise sedentary control (SED), in participants (N = 21; 15 f; 24.7 ± 9.3 years) with subsyndromal post-traumatic stress disorder (PTSD). Affective state (Energy, Tiredness, Tension, Calmness) was assessed before (Pre), immediately after (Post 0), 20-min after (Post 20), and 40-min after (Post 40) each condition. Affective valence was assessed during each condition, and exercise enjoyment was assessed at Post 0. Enjoyment was significantly greater following HIFE and MICE relative to SED. Energy was significantly increased Post 0 HIFE and MICE but decreased Post 0 SED. Tension was reduced following all conditions and was significantly lower at Post 40 relative to Pre for HIFE, MICE, and SED. Tiredness was significantly reduced at Post 40 relative to Pre following MICE only, while Calmness was significantly lower at Post 40 relative to Pre following MICE and SED. Overall, both exercise conditions were enjoyed to a greater extent than the control, but MICE may provide greater psychological benefits with respect to Calmness and Tiredness. This study is among the first to assess acute changes in affective states relative to various exercise modes in individuals living with subsyndromal PTSD.
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Affiliation(s)
- Daniel R. Greene
- Department of Kinesiology, Augusta University, 3109 Wrightsboro Road, Augusta, GA 30909, USA;
| | | | - Steven J. Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave, Urbana, IL 61801, USA;
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13
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Barhoma M, Carlsson J, Sonne C. Sertraline versus venlafaxine combined with psychotherapy in trauma-affected refugees - a follow-up study on a pragmatic randomised trial. Nord J Psychiatry 2024; 78:353-361. [PMID: 38451197 DOI: 10.1080/08039488.2024.2324357] [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: 09/22/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Research on long-term pharmacotherapy for trauma-affected refugees is scarce. The purpose of this follow-up study of a randomised trial was to investigate the effects of sertraline compared to venlafaxine in combination with psychotherapy, 6 and 18 months after end of trial. METHOD The primary outcome was PTSD symptoms, measured by the Harvard Trauma Questionnaire (HTQ). The secondary outcomes included: Hopkins Symptom Checklist-25 (HSCL-25), somatisation items of the Symptoms Checklist-90 (SCL), pain on a visual analogue scale, well-being on the WHO-5, Sheehan Disability Scale, Hamilton Depression and Anxiety scales and Global Assessment of Functioning. Moreover, the shorter version of the Recent Life Events (IRLE) was adopted to obtain information regarding the patients' treatment and life events between the follow-up periods. RESULTS Out of 195 patients eligible for intention-to-treat analyses during trial, 116 participated in the 6-month follow-up and 97 participated in the 18-month follow-up. The results of our intention-to-treat analyses revealed no significant long-term differences between the groups on the primary outcome assessing PTSD symptoms (HTQ). For the secondary outcomes significant differences were found at the 18-month follow-up in favour of venlafaxine assessing symptoms of anxiety, depression and somatisation (HSCL-25 and SCL), although only in intention-to-treat and not per-protocol analyses. CONCLUSIONS No conclusions could be drawn due to conflicting results between our intention-to-treat and per-protocol analyses.
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Affiliation(s)
- Maria Barhoma
- Department of Psychology, University of Leiden, Leiden, The Netherlands
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
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14
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van ’t Wout-Frank M, Arulpragasam AR, Faucher C, Aiken E, Shea MT, Jones RN, Greenberg BD, Philip NS. Virtual Reality and Transcranial Direct Current Stimulation for Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:437-446. [PMID: 38446471 PMCID: PMC10918574 DOI: 10.1001/jamapsychiatry.2023.5661] [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: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 03/07/2024]
Abstract
Importance Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms. Objective To test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR) is superior to sham tDCS plus VR for warzone-related PTSD. Design, Setting, and Participants This double-blind randomized clinical trial was conducted among US military veterans enrolled from April 2018 to May 2023 at a secondary care Department of Veterans Affairs hospital and included 1- and 3-month follow-up visits. Participants included US military veterans with chronic PTSD and warzone-related exposure, recruited via referral and advertisement. Patients in psychiatric treatment had to be on a stable regimen for at least 6 weeks to be eligible for enrollment. Data were analyzed from May to September 2023. Intervention Participants were randomly assigned to receive 2-mA anodal tDCS or sham tDCS targeted to the ventromedial prefrontal cortex, during six 25-minute sessions of standardized warzone VR exposure, delivered over 2 to 3 weeks. Main Outcomes and Measures The co-primary outcomes were self-reported PTSD symptoms, measured via the PTSD checklist for DSM-5 (PCL-5), alongside quality of life. Other outcomes included psychophysiological arousal, clinician-assessed PTSD, depression, and social/occupational function. Results A total of 54 participants (mean [SD] age, 45.7 [10.5] years; 51 [94%] males) were assessed, including 26 in the active tDCS group and 28 in the sham tDCS group. Participants in the active tDCS group reported a superior reduction in self-reported PTSD symptom severity at 1 month (t = -2.27, P = .02; Cohen d = -0.82). There were no significant differences in quality of life between active and sham tDCS groups. Active tDCS significantly accelerated psychophysiological habituation to VR events between sessions compared with sham tDCS (F5,7689.8 = 4.65; P < .001). Adverse effects were consistent with the known safety profile of the corresponding interventions. Conclusions and Relevance These findings suggest that combined tDCS plus VR may be a promising strategy for PTSD reduction and underscore the innovative potential of these combined technologies. Trial Registration ClinicalTrials.gov Identifier: NCT03372460.
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Affiliation(s)
- Mascha van ’t Wout-Frank
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Amanda R. Arulpragasam
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christiana Faucher
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
| | - Emily Aiken
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
| | - M. Tracie Shea
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Benjamin D. Greenberg
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Noah S. Philip
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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15
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Malhotra B, Jones LC, Spooner H, Levy C, Kaimal G, Williamson JB. A conceptual framework for a neurophysiological basis of art therapy for PTSD. Front Hum Neurosci 2024; 18:1351757. [PMID: 38711802 PMCID: PMC11073815 DOI: 10.3389/fnhum.2024.1351757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a heterogeneous condition that affects many civilians and military service members. Lack of engagement, high dropout rate, and variable response to psychotherapy necessitates more compelling and accessible treatment options that are based on sound neuroscientific evidence-informed decision-making. Art therapy incorporates elements proven to be effective in psychotherapy, such as exposure, making it a potentially valuable treatment option. This conceptual paper aims to inform the neurophysiological rationale for the use of art therapy as a therapeutic approach for individuals with PTSD. A narrative synthesis was conducted using literature review of empirical research on the neurophysiological effects of art therapy, with supporting literature on neuroaesthetics and psychotherapies to identify art therapy factors most pertinent for PTSD. Findings were synthesized through a proposed framework based on the triple network model considering the network-based dysfunctions due to PTSD. Art therapy's active components, such as concretization and metaphor, active art engagement, emotion processing and regulation, perspective taking and reframing, and therapeutic alliance, may improve symptoms of PTSD and prompt adaptive brain functioning. Given the scarcity of rigorous studies on art therapy's effectiveness and mechanisms of alleviating PTSD symptoms, the suggested framework offers a neurophysiological rationale and a future research agenda to investigate the impact of art therapy as a therapeutic approach for individuals with PTSD.
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Affiliation(s)
- Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - Laura C. Jones
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Heather Spooner
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. in support of Creative Forces: NEA Military Healing Arts Network, Bethesda, MD, United States
- Center of Arts in Medicine, University of Florida, Gainesville, FL, United States
| | - Charles Levy
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. in support of Creative Forces: NEA Military Healing Arts Network, Bethesda, MD, United States
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States
| | - John B. Williamson
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
- Center for OCD, Anxiety and Related Disorders, Department of Psychiatry, University of Florida, Gainesville, FL, United States
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16
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Wigard I, Meyerbröker K, Ehring T, Topper M, Arntz A, Emmelkamp P. Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2332104. [PMID: 38629403 PMCID: PMC11025408 DOI: 10.1080/20008066.2024.2332104] [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: 05/02/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..
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Affiliation(s)
- I. Wigard
- Parnassiagroep, Amsterdam, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Meyerbröker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - T. Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - M. Topper
- GGZ-Noord-Holland-Noord, Alkmaar, the Netherlands
| | - A. Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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17
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Petrakis IL, Meshberg-Cohen S, Nich C, Kelly MM, Claudio T, Jane JS, Pisani E, Ralevski E. Cognitive processing therapy (CPT) versus individual drug counseling (IDC) for PTSD for veterans with opioid use disorder maintained on buprenorphine. Am J Addict 2024. [PMID: 38624259 DOI: 10.1111/ajad.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There are high rates of comorbidity between posttraumatic stress disorder (PTSD) and opioid use disorder (OUD). Evidence-based trauma-focused psychotherapies such as Cognitive Processing Therapy (CPT) are a first-line treatment for PTSD. Veterans with OUD are treated primarily in substance use disorder (SUD) clinics where the standard of care is drug counseling; they often do not have access to first-line PTSD treatments. This study tested whether CPT can be conducted safely and effectively in veterans with comorbid OUD treated with buprenorphine. METHODS This 12-week, 2-site, randomized clinical trial (RCT) included open-label randomization to two groups: (a) CPT versus (b) Individual Drug Counselling (IDC) in veterans with PTSD and comorbid OUD who were maintained on buprenorphine (N = 38). RESULTS Veterans randomized to either IDC (n = 18) or CPT (n = 20) showed a significant reduction in self-reported PTSD symptoms over time as measured by the PTSD checklist (PCL-5) but there were no treatment group differences; there was some indication that reduction in PTSD symptoms in the CPT group were sustained in contrast to the IDC group. Recruitment was significantly impacted by COVID-19 pandemic, so this study serves as a proof-of-concept pilot study. DISCUSSION AND CONCLUSIONS Veterans with OUD and PTSD can safely and effectively participate in evidence-based therapy for PTSD; further work should confirm that trauma-focused treatment may be more effective in leading to sustained remission of PTSD symptoms than drug counseling. SCIENTIFIC SIGNIFICANCE This is the first study to evaluate CPT for PTSD in the context of buprenorphine treatment for OUD.
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Affiliation(s)
- Ismene L Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sarah Meshberg-Cohen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Megan M Kelly
- Department of Psychiatry, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Psychiatry, UMass Chan Medical School, North Worcester, Massachusetts, USA
| | - Tracy Claudio
- Department of Psychiatry, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Jane Serrita Jane
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Emily Pisani
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Elizabeth Ralevski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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18
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Meshberg-Cohen S, Cook JM, Bin-Mahfouz A, Petrakis IL. Written exposure therapy for veterans with co-occurring substance use disorders and PTSD: Study design of a randomized clinical trial. Contemp Clin Trials 2024; 139:107475. [PMID: 38365173 DOI: 10.1016/j.cct.2024.107475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
There are high rates of posttraumatic stress disorder (PTSD) among treatment-seeking veterans with substance use disorders (SUD). While addiction programs traditionally do not address PTSD, there is evidence that trauma treatments for individuals with this comorbidity have improved PTSD and SUD outcomes. Written exposure therapy (WET), a five-session evidence-based psychotherapy (EBP) for PTSD, has high patient satisfaction, and lower dropout compared to other EBPs for PTSD. WET may be ideally suited for clinical settings that may not have the trauma expertise found in PTSD specialty clinics, given it requires less training time, treatment sessions, preparation time, and therapist involvement than existing EBPs, and no homework assignments. This paper describes the design, methodology, and protocol of a randomized clinical trial to evaluate whether treatment as usual (TAU) plus WET (n = 51) is superior to TAU plus a neutral topic writing condition (n = 51) on both PTSD and addiction outcomes for veterans in SUD treatment. The primary hypothesis is that participants assigned to TAU+WET, compared to those in TAU+ neutral topic writing, will report reduced symptoms of PTSD. The secondary hypothesis is that veterans receiving WET will have greater decreases in number of days of substance use compared to TAU+ neutral topic controls at follow-up. Assessments will take place at baseline, post-treatment, 8-week, and 12-week follow-up. Exploratory aims will examine the association between heart rate variability and treatment outcomes. If results prove promising, they will support WET as an effective brief, easy to disseminate, adjunct to current SUD treatment for veterans with comorbid PTSD. Trial registration: ClinicalTrials.gov ID NCT05327504.
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Affiliation(s)
- Sarah Meshberg-Cohen
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America.
| | - Joan M Cook
- Yale University School of Medicine, Department of Psychiatry, United States of America
| | - Amirah Bin-Mahfouz
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America
| | - Ismene L Petrakis
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America
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Ruisch JE, Havermans DCD, Gielkens EMJ, Olff M, Daamen MAMJ, van Alphen SPJ, van Kordenoordt M, Schols JMGA, Schruers KRJ, Sobczak S. Posttraumatic stress disorder in people with dementia: study protocol. Eur J Psychotraumatol 2024; 15:2320040. [PMID: 38488137 PMCID: PMC10946268 DOI: 10.1080/20008066.2024.2320040] [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: 07/26/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.
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Affiliation(s)
- J. E. Ruisch
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - D. C. D. Havermans
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- TanteLouise, Bergen op Zoom, the Netherlands
| | - E. M. J. Gielkens
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. Olff
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - M. A. M. J. Daamen
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Cicero, Department of Treatment and Guidance, Brunssum, the Netherlands
| | - S. P. J. van Alphen
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. van Kordenoordt
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Zuyderland Care, Sittard, the Netherlands
| | - J. M. G. A. Schols
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - K. R. J. Schruers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
| | - S. Sobczak
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Science, Rotterdam, the Netherlands
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20
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MacCallum PE, Cooze JB, Ward J, Moore KA, Blundell J. Evaluating the effects of single, multiple, and delayed systemic rapamycin injections to contextual fear reconsolidation: Implications for the neurobiology of memory and the treatment of PTSD-like re-experiencing. Behav Brain Res 2024; 461:114855. [PMID: 38185381 DOI: 10.1016/j.bbr.2024.114855] [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: 09/28/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
The mechanistic target of rapamycin (mTOR) kinase is known to mediate the formation and persistence of aversive memories. Rapamycin, an mTOR inhibitor, administered around the time of reactivation blocks retrieval-induced mTOR activity and de novo protein synthesis in the brains of rodents, while correspondingly diminishing subsequent fear memory. The goal of the current experiments was to further explore rapamycin's effects on fear memory persistence. First, we examined whether mTOR blockade at different time-points after reactivation attenuates subsequent contextual fear memory. We show that rapamycin treatment 3 or 12 h post-reactivation disrupts memory persistence. Second, we examined whether consecutive days of reactivation paired with rapamycin had additive effects over a single pairing at disrupting a contextual fear memory. We show that additional reactivation-rapamycin pairings exacerbates the reconsolidation impairment. Finally, we examined if impaired reconsolidation of a contextual fear memory from rapamycin treatment had any after-effects on learning and recalling a new fear association. We show that rapamycin-impaired reconsolidation does not affect new learning or recall and protects against fear generalization. Our findings improve our understanding of mTOR- dependent fear memory processes, as well as provide insight into potentially novel treatment options for stress-related psychopathologies such as posttraumatic stress disorder.
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Affiliation(s)
- Phillip E MacCallum
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave, St. John's, Newfoundland and Labrador A1B 3X9, Canada
| | - Jane B Cooze
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave, St. John's, Newfoundland and Labrador A1B 3X9, Canada
| | - Joshua Ward
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave, St. John's, Newfoundland and Labrador A1B 3X9, Canada
| | - Kelsey Am Moore
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave, St. John's, Newfoundland and Labrador A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Ave, St. John's, Newfoundland and Labrador A1B 3X9, Canada.
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21
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Evans VD, Arenas A, Shinozuka K, Tabaac BJ, Beutler BD, Cherian K, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-Ketamine. Am J Ther 2024; 31:e155-e177. [PMID: 38518272 DOI: 10.1097/mjt.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ketamine, an arylcyclohexylamine dissociative anesthetic agent, has evolved into a versatile therapeutic. It has a rapid-onset, well-understood cardiovascular effects and a favorable safety profile in clinical use. Its enantiomeric compound, esketamine, was approved by the Food and Drug Administration in 2019 for both treatment-resistant depression and major depressive disorder with suicidal ideation. AREAS OF UNCERTAINTY Research indicates dose-dependent impacts on cognition, particularly affecting episodic and working memory following both acute administration and chronic use, albeit temporarily for the former and potentially persistent for the latter. Alongside acute risks to cardiovascular stability, ketamine use poses potential liver toxicity concerns, especially with prolonged or repeated exposure within short time frames. The drug's association with "ketamine cystitis," characterized by bladder inflammation, adds to its profile of physiological risks. THERAPEUTIC ADVANCES Data demonstrate a single intravenous infusion of ketamine exhibits antidepressant effects within hours (weighted effect size averages of depression scores (N = 518) following a single 0.5 mg/kg infusion of ketamine is d = 0.96 at 24 hours). Ketamine is also effective at reducing posttraumatic stress disorder (PTSD) symptom severity following repeated infusions (Clinician-Administered PTSD Scale scores: -11.88 points compared with midazolam control). Ketamine also decreased suicidal ideation in emergency settings (Scale for Suicidal Ideation scores: -4.96 compared with midazolam control). Through its opioid-sparing effect, ketamine has revolutionized postoperative pain management by reducing analgesic consumption and enhancing recovery. LIMITATIONS Many studies indicate that ketamine's therapeutic effects may subside within weeks. Repeated administrations, given multiple times per week, are often required to sustain decreases in suicidality and depressive symptoms. CONCLUSIONS Ketamine's comprehensive clinical profile, combined with its robust effects on depression, suicidal ideation, PTSD, chronic pain, and other psychiatric conditions, positions it as a substantial contender for transformative therapeutic application.
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Affiliation(s)
- Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Burton J Tabaac
- University of Nevada, Reno School of Medicine, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | | | - Owen S Muir
- Fermata Health, Brooklyn, NY; and
- Acacia Clinics, Sunnyvale, CA
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22
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Armstrong SB, Xin Y, Sepeda ND, Polanco M, Averill LA, Davis AK. Prospective associations of psychedelic treatment for co-occurring alcohol misuse and posttraumatic stress symptoms among United States Special Operations Forces Veterans. MILITARY PSYCHOLOGY 2024; 36:184-191. [PMID: 38377244 PMCID: PMC10880491 DOI: 10.1080/08995605.2022.2156200] [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: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023]
Abstract
This study evaluated prospective associations of ibogaine and 5-MeO-DMT treatment for risky alcohol use and post-traumatic stress disorder (PTSD) symptoms among United States (US) Special Operations Forces Veterans (SOFV). Data were collected during standard clinical operations at pre-treatment and 1-month (1 m), 3-months (3 m), and 6-months (6 m) post-treatment in an ibogaine and 5-MeO-DMT treatment program in Mexico. Of the 86 SOFV that completed treatment, 45 met criteria for risky alcohol use at pre-treatment (mean age = 44; male = 100%; White = 91%). There was a significant reduction in alcohol use from pre-treatment (M = 7.2, SD = 2.3) to 1 m (M = 3.6; SD = 3.5) post-treatment, which remained reduced through 6 m (M = 4.0; SD = 2.9; p < .001, partial eta squared = .617). At 1 m, 24% were abstinent, 33% were non-risky drinking, and 42% were risky drinkers. At 6 m, 16% were abstinent, 31% were non-risky drinking, and 53% were risky drinkers. There were no differences between responders (abstinent/non-risky drinkers) and non-responders (risky drinkers) in demographics/clinical characteristics. However, there were significant and very large differences between responders and non-responders in PTSD symptom (p < .01, d = -3.26) and cognitive functioning change (p < .01, d = -0.99). Given these findings, future clinical trials should determine whether psychedelic-assisted therapy holds promise for individuals with complex trauma and alcohol misuse who have not been successfully treated with traditional interventions.
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Affiliation(s)
- Stacey B. Armstrong
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
| | - Nathan D. Sepeda
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Lynnette A. Averill
- US Department of Veterans Affairs, Michael E. DeBakey Veterans Administration Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, The Ohio State University, Columbus, Ohio
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, Maryland
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23
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Schnurr PP, Hamblen JL, Wolf J, Coller R, Collie C, Fuller MA, Holtzheimer PE, Kelly U, Lang AJ, McGraw K, Morganstein JC, Norman SB, Papke K, Petrakis I, Riggs D, Sall JA, Shiner B, Wiechers I, Kelber MS. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2024; 177:363-374. [PMID: 38408360 DOI: 10.7326/m23-2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
DESCRIPTION The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. METHODS Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. RECOMMENDATIONS The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.
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Affiliation(s)
- Paula P Schnurr
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Jessica L Hamblen
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Jonathan Wolf
- Defense Health Agency, Falls Church, Virginia (J.W.)
| | - Rachael Coller
- Naval Medical Center San Diego, San Diego, California (R.C.)
| | - Claire Collie
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC (C.C.)
| | - Matthew A Fuller
- Veterans Health Administration Pharmacy Benefits Management Service and Case Western Reserve University School of Medicine, Cleveland, Ohio (M.A.F.)
| | - Paul E Holtzheimer
- National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (P.P.S., J.L.H., P.E.H.)
| | - Ursula Kelly
- Joseph Maxwell Cleland Atlanta VA Medical Center and Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia (U.K.)
| | - Ariel J Lang
- Center of Excellence for Stress and Mental Health at VA San Diego Healthcare System and University of California, San Diego, San Diego, California (A.J.L.)
| | - Kate McGraw
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.)
| | - Joshua C Morganstein
- Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress, Bethesda, Maryland (J.C.M.)
| | - Sonya B Norman
- National Center for PTSD, White River Junction, Vermont, and University of California, San Diego, San Diego, California (S.B.N.)
| | - Katie Papke
- National Social Work Program Office, Veterans Health Administration, Washington, DC (K.P.)
| | - Ismene Petrakis
- National Center for PTSD, West Haven, and Yale University School of Medicine, New Haven, Connecticut (I.P.)
| | - David Riggs
- Uniformed Services University of the Health Sciences, Center for Deployment Psychology, Bethesda, Maryland (D.R.)
| | - James A Sall
- Evidence Based Practice, Quality and Patient Safety, Veterans Health Administration, Washington, DC (J.A.S.)
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (B.S.)
| | - Ilse Wiechers
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC; Yale University School of Medicine, New Haven, Connecticut; and University of California, San Francisco, School of Medicine, San Francisco, California (I.W.)
| | - Marija S Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia (K.M., M.S.K.)
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24
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Wells M, Karl A, Handley R. Feasibility, acceptability and clinical benefit of a trauma-focused stabilisation group for post-traumatic stress disorder patients with complex presentations on primary care waitlists. Behav Cogn Psychother 2024; 52:119-134. [PMID: 37877221 DOI: 10.1017/s1352465823000486] [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] [Indexed: 10/26/2023]
Abstract
BACKGROUND Large numbers of people showing complex presentations of post-traumatic stress disorder (PTSD) in the NHS Talking Therapies services routinely require multi-faceted and extended one-to-one National Institute of Clinical Excellence (NICE) recommended treatment approaches. This can lead to longer waits for therapy and prolong patient suffering. We therefore evaluated whether a group stabilisation intervention delivered to patients on the waitlist for individual trauma-focused psychological treatment could help address this burden. AIMS The study aimed to ascertain a trauma-focused stabilisation group's acceptability, feasibility, and preliminary clinical benefit. METHOD AND RESULTS Fifty-eight patients with PTSD waiting for trauma-focused individual treatment were included in the study. Two therapists delivered six 5-session groups. The stabilisation group was found to be feasible and acceptable. Overall, PTSD symptom reduction was medium to large, with a Cohen's d of .77 for intent-to-treat and 1.05 for per protocol analyses. Additionally, for depression and anxiety, there was minimal symptom deterioration. CONCLUSIONS The study provided preliminary evidence for the acceptability, feasibility and clinical benefit of attending a psychoeducational group therapy whilst waiting for one-to-one trauma therapy.
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Affiliation(s)
- Michelle Wells
- Plymouth Options, Plymouth, UK
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
| | - Anke Karl
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
| | - Rachel Handley
- College of Life and Environmental Sciences (CLES), Psychology, University of Exeter, Exeter, UK
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25
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Bryan CJ, Bryan AO, Khazem LR, Aase DM, Moreno JL, Ammendola E, Bauder CR, Hiser J, Daruwala SE, Baker JC. Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. J Anxiety Disord 2024; 102:102824. [PMID: 38154445 DOI: 10.1016/j.janxdis.2023.102824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP's effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19-2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - AnnaBelle O Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Lauren R Khazem
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Darrin M Aase
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jose L Moreno
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Ennio Ammendola
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Christina Rose Bauder
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jaryd Hiser
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Samantha E Daruwala
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
| | - Justin C Baker
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
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26
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Gao Y, Gao D, Zhang H, Zheng D, Du J, Yuan C, Mingxi Ma, Yin Y, Wang J, Zhang X, Wang Y. BLA DBS improves anxiety and fear by correcting weakened synaptic transmission from BLA to adBNST and CeL in a mouse model of foot shock. Cell Rep 2024; 43:113766. [PMID: 38349792 DOI: 10.1016/j.celrep.2024.113766] [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: 06/09/2023] [Revised: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Deep brain stimulation (DBS) in the basal lateral amygdala (BLA) has been established to correct symptoms of refractory post-traumatic stress disorder (PTSD). However, how BLA DBS operates in correcting PTSD symptoms and how the BLA elicits pathological fear and anxiety in PTSD remain unclear. Here, we discover that excitatory synaptic transmission from the BLA projection neurons (PNs) to the adBNST, and lateral central amygdala (CeL) is greatly suppressed in a mouse PTSD model induced by foot shock (FS). BLA DBS revises the weakened inputs from the BLA to these two areas to improve fear and anxiety. Optogenetic manipulation of the BLA-adBNST and BLA-CeL circuits shows that both circuits are responsible for anxiety but the BLA-CeL for fear in FS mice. Our results reveal that synaptic transmission dysregulation of the BLA-adBNST or BLA-CeL circuits is reversed by BLA DBS, which improves anxiety and fear in the FS mouse model.
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Affiliation(s)
- Yan Gao
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Dawen Gao
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Hui Zhang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Danhao Zheng
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan Institute of Physics and Mathematics, Wuhan 430071, China
| | - Jun Du
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chao Yuan
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Mingxi Ma
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yao Yin
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan Institute of Physics and Mathematics, Wuhan 430071, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaohui Zhang
- State Key Laboratory of Cognitive Neuroscience & Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yizheng Wang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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27
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Xu G, Li G, Yang Q, Li C, Liu C. Explore the durability of repetitive transcranial magnetic stimulation in treating post-traumatic stress disorder: An updated systematic review and meta-analysis. Stress Health 2024; 40:e3292. [PMID: 37452747 DOI: 10.1002/smi.3292] [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: 02/20/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
The objective was to synthesize results from studies that assessed symptom relief after repetitive transcranial magnetic stimulation (rTMS) treatment for post-traumatic stress disorder (PTSD) and investigate the long-term effectiveness of rTMS for treating PTSD. We searched multiple databases for relevant randomized controlled trials of rTMS for PTSD treatment up to 1 January 2023. Two researchers evaluated the studies and focused on the CAPS and PCL as outcome indicators. We used STATA17 SE software for the data analysis. Eight articles involving 309 PTSD patients were analysed in a meta-analysis, which found that rTMS had a significant and large effect on reducing core post-traumatic symptoms [Hedges'g = 1.75, 95% CI (1.18, 2.33)]. Both low and high-frequency rTMS also significantly reduced symptoms, with the latter having a greater effect. rTMS was shown to have a long-term effect on PTSD, with all three subgroup analyses demonstrating significant results. Interestingly, no significant difference in symptom relief was found between the follow-up and completion of treatments [Hedges'g = 0.01, 95% CI (-0.30, 0.33)], suggesting that the treatment effect of rTMS is stable. The meta-analysis provides strong evidence that rTMS is effective in reducing the severity and symptoms of PTSD in patients, and follow-up studies confirm its long-term stability.
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Affiliation(s)
- Guobin Xu
- Clinical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Geng Li
- School of Physical Education, Hunan Normal University, Changsha, Hunan, China
| | - Qizhang Yang
- Clinical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Chao Li
- Clinical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Chengzhen Liu
- School of Humanities and Management Science, Southwest Medical University, Luzhou, Sichuan, China
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Lang AJ, Hamblen JL, Holtzheimer P, Kelly U, Norman SB, Riggs D, Schnurr PP, Wiechers I. A clinician's guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder. J Trauma Stress 2024; 37:19-34. [PMID: 38184799 DOI: 10.1002/jts.23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
A clinical practice guideline (CPG) is a rigorously established set of recommendations based on currently available evidence about the efficacy, safety, acceptability, and feasibility of interventions to assist with clinical decision-making. The 2023 Department of Veterans Affairs /Department of Defense Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder is described herein. The CPG recommendations are accompanied by a clinical algorithm, which incorporates principles of evidence-based practice, shared decision-making, and functional and contextual assessments of goals and outcomes. An overview of the CPG recommendations is combined with a discussion of questions that clinicians and patients may face in implementing the CPG and suggestions for how to effectively work with the CPG.
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Affiliation(s)
- Ariel J Lang
- VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jessica L Hamblen
- National Center for PTSD, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Paul Holtzheimer
- National Center for PTSD, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Ursula Kelly
- VA Atlanta Healthcare System, Decatur, Georgia, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sonya B Norman
- VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- National Center for PTSD, White River Junction, Vermont, USA
| | - David Riggs
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Ilse Wiechers
- Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Somohano VC, Cameron D, Lewis M, Denneson LM, Lovejoy TI, O'Neil ME. Characterizing and Comparing Evidence-Based Psychotherapy Utilization Among Veterans with Co-occurring PTSD and Substance Use Disorder. Subst Use Misuse 2024; 59:425-431. [PMID: 38111167 DOI: 10.1080/10826084.2023.2275566] [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] [Indexed: 12/20/2023]
Abstract
Objective: The current study sought to describe a nationally representative sample of Veterans diagnosed with co-occurring PTSD and substance use disorder (SUD) who initiated and completed evidence-based psychotherapy (EBP) for PTSD, and explored whether completion rates differed by SUD subtype. Methods: Using electronic health record data from the Veterans Health Administration (VHA) Corporate Data Warehouse, Veterans with a dual diagnosis of PTSD and SUD who initiated either Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) between January 01, 2019 and July 16, 2019 were identified (N = 2,996). Logistic analyses were employed to determine whether there were differences in EBP completion rates among Veterans with an alcohol use disorder (AUD; n = 1,383) versus all other SUDs (n = 1,613). Results: On average, Veterans were 45 years old, and identified as male, White, and non-Hispanic. Logistic regression analyses revealed there was not a significant difference between Veterans with AUD only and other SUDs in the probability of completing EBP treatment, OR = 1.02, 95% CI =0.87, 1.17, p = 0.79. Conclusions: No differences in EBP completion rates were observed between SUD subtypes, indicating that EBPs for PTSD are tolerated well for individuals with various types of SUDs and may be offered as treatment options.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
| | - David Cameron
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Meaghan Lewis
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
| | - Lauren M Denneson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Maya E O'Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
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Bowling AR, Klein AB, Sheikh IS, Dolezal ML, Alsubaie MK, Rosencrans PL, Walker RS, Bentley JA, Zoellner LA, Feeny NC. Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims. COGENT MENTAL HEALTH 2024; 3:1-18. [PMID: 38550624 PMCID: PMC10972603 DOI: 10.1080/28324765.2024.2305417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024]
Abstract
Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.
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Affiliation(s)
- Alexandra R. Bowling
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Alexandra B. Klein
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Ifrah S. Sheikh
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Michael L. Dolezal
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | | | | | | | - Jacob A. Bentley
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | - Lori A. Zoellner
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
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Rothärmel M, Mekaoui L, Kazour F, Herrero M, Beetz-Lobono EM, Lengvenyte A, Holtzmann J, Raynaud P, Cuenca M, Bulteau S, de Maricourt P, Husson T, Olié E, Gohier B, Sauvaget A, Gaillard R, Richieri R, Szekely D, Samalin L, Guillin O, Moulier V, El-Hage W, Laurin A, Berkovitch L. Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.24300998. [PMID: 38293161 PMCID: PMC10827260 DOI: 10.1101/2024.01.09.24300998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Posttraumatic stress disorder (PTSD) is a severe and frequent affection that is highly comorbid to major depressive disorder. Comorbid PTSD and depression are usually treatment-resistant, with a high risk of functional impairment and suicide. Esketamine nasal spray is a recent validated treatment for treatment-resistant depression (TRD), but its efficacy on comorbid TRD-PTSD remains insufficiently documented. In particular, flashbacks can occur during esketamine administration and their influence on clinical outcomes is unknown. Objectives Our main objective was to describe esketamine-induced traumatic flashbacks and their impact on clinical trajectories within a sample of patients with comorbid TRD-PTSD. Methods We retrospectively collected clinical data of patients receiving esketamine nasal spray for TRD with comorbid PTSD who experienced at least one flashback of their trauma during esketamine sessions across 11 psychiatric departments. Results Between February 2020 and March 2023, 22 adult patients with TRD met inclusion criteria. In sixteen patients (72.7%) flashbacks disappeared as the sessions progressed. In six patients (27.3%), esketamine treatment was stopped because of persistent flashbacks. When esketamine was continued, clinical response was observed both for depression and PTSD (depression response rate: 45.5% and remission rate: 22.7%; PTSD response rate: 45.5% and remission: 18.2%). Limitations The retrospective design of the study and the absence of a comparator group are the main limitations of our study. Conclusions Our results suggest that the occurrence of esketamine-induced traumatic flashbacks does not hinder clinical response. On the contrary, when managed appropriately and combined with targeted psychotherapy, it could even contribute to positive outcomes.
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Affiliation(s)
- Maud Rothärmel
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
| | - Lila Mekaoui
- Mental and Brain Illness Clinic, Sainte-Anne Hospital, GHU Paris – Psychiatry and Neurosciences, Paris, France
| | - François Kazour
- Department of Psychiatry and Addictology, CHU Angers, Angers, France
| | - Morgane Herrero
- Department of Psychiatry, CHU Saint Etienne, Saint Etienne, France
| | | | - Aiste Lengvenyte
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de l’Adulte, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, hôpital Nord, Grenoble, France
| | | | - Macarena Cuenca
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Samuel Bulteau
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Pierre de Maricourt
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Thomas Husson
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Bénédicte Gohier
- Department of Psychiatry and Addictology, CHU Angers, Angers, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Raphaël Gaillard
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
| | - Raphaëlle Richieri
- Service Universitaire de santé mentale et physique, Centre Expert Dépression Résistante, CHU Sainte-Marguerite, APHM, Université Aix-Marseille, Marseille, France; Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - David Szekely
- Centre Hospitalier Princesse Grace, Service de psychiatrie, Principauté de Monaco
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Olivier Guillin
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
- CHU Rouen, Normandy University, Rouen, France
| | - Virginie Moulier
- University Department of Psychiatry, Therapeutic Centre of Excellence, Institute of Psychiatry – Rouvray Hospital Centre, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
| | - Wissam El-Hage
- Centre Régional de Psychotraumatologie, Centre Hospitalier Régional
- Universitaire (CHRU) de Tours, Tours, France, 3 INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | - Andrew Laurin
- Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - Lucie Berkovitch
- University Department of Psychiatry, Pôle Hospitalo-Universitaire Psychiatrie Paris 15, Groupe Hospitalier Universitaire Paris, Paris, France
- Paris Cité University, Paris, France
- Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, New Haven, CT, 06511, United States
- Saclay CEA Centre, Neurospin, Gif-Sur-Yvette Cedex, France
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Greene T, Contractor AA, Dicker-Oren SD, Fentem A, Sznitman SR. The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study. JMIR Res Protoc 2024; 13:e51838. [PMID: 38214953 PMCID: PMC10818235 DOI: 10.2196/51838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample. OBJECTIVE This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions. METHODS We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models. RESULTS Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed. CONCLUSIONS Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51838.
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Affiliation(s)
- Talya Greene
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | | | - Andrea Fentem
- Department of Psychology, University of North Texas, Denton, TX, United States
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Salas F, Nvo-Fernández M, Leiva-Bianchi M, Sáez DA, Páeza GS, García MV, Villacura-Herrera C. Components of event-related potentials and borderline personality disorder: a meta-analysis. Eur J Psychotraumatol 2024; 15:2297641. [PMID: 38214169 PMCID: PMC10791106 DOI: 10.1080/20008066.2023.2297641] [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: 08/31/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Background: Borderline personality disorder (BPD) is characterized by symptoms associated with difficulties in emotion regulation, altered self-image, impulsivity, and instability in personal relationships. A relationship has been found between BPD symptoms and altered neuropsychological processes. Studies of event-related potentials (ERP) measured with electroencephalogram (EEG) have found neural correlates related to BPD symptoms. Of note is the P300 component, considered a potential mental health biomarker for trauma-associated disorders. However, no meta-analysis has been found to demonstrate this relationship.Objectives: To evaluate the relationship between the P300 component and BPD symptoms. To evaluate the relationship of other ERP components with BPD symptoms.Methods: The method and procedure were adjusted to the PRISMA checklist. The search was performed in three databases: WOS, Scopus and PubMed. A Random Effects Model was used to perform the analysis of the studies. In addition, a meta-regression was performed with % women, Gini and GDP. Finally, a descriptive analysis of the main results found between P300, other ERP components (LPP, P100 and ERN/Ne) and BPD symptoms was performed.Results: From a review of 485 articles, a meta-analysis was performed with six articles that met the inclusion criteria. A moderate, positive relationship was found between the P300 component and BPD symptoms (REM = .489; p < .001). It was not possible to perform meta-analyses for other ERP components (LPP, P100 and ERN/Ne) due to the low number of articles found.Conclusion: The idea that P300 could be considered for use as a biomarker to identify altered neural correlates in BPD is reinforced. In addition, a moderating effect of inequality (Gini) was detected.
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Affiliation(s)
- Fabiola Salas
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Nvo-Fernández
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Leiva-Bianchi
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Daniela Avello Sáez
- School of Occupational Therapy, Faculty of Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Geraldy Sepúlveda Páeza
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marc Via García
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Cesar Villacura-Herrera
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Talca, Chile
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Vasileva AV. [Posttraumatic stress disorder clinical guidelines and treatment standards: focus on the symptoms of the psychophysiological arousal]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-68. [PMID: 38884431 DOI: 10.17116/jnevro202412405158] [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] [Indexed: 06/18/2024]
Abstract
The article describes the main diagnostic criteria and principles of posttraumatic stress disorder (PTSD) diagnostic with the consideration of risk factors and specific clinical features. The main biomarkers search trends and existing limitations are considered. The role of the psychophysiological arousal symptoms claster is highlighted in the clinical picture of PTSD as well as in connection with the main cluster of re-experiencing symptoms activation and slowing of sanogenesis process. The necessity of PTSD detection in somatic medicine is thoroughly described. The article presents therapeutic algorithms of the latest international and Russian PTSD treatment clinical guidelines based on the individual combination of psychotherapy and psychopharmacotherapy treatment choice. Additionally the accumulated during the last decades national clinical experience of the anxiety disorders treatment, including the symptoms of psychophysiological arousal is highlighted that determined the list of the recommended drugs indicating the evidence level, in the PTSD treatment standards and guidelines. The treatment choices possibilities with the consideration of different PTSD symptoms cluster expression and comorbid states and individual case distress level specific are presented. Main evidence based psychotherapeutic methods are described.
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Affiliation(s)
- A V Vasileva
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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Brinckman B, Alfaro E, Wooten W, Herringa R. The promise of compassion-based therapy as a novel intervention for adolescent PTSD. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 15:100694. [PMID: 38283688 PMCID: PMC10817702 DOI: 10.1016/j.jadr.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
In this review, we summarize current evidence for compassion-based approaches for PTSD and the potential for their application to the adolescent PTSD population. Exposure to traumatic events is common in adolescence and PTSD remains a public health crisis. Accessibility, willingness, and engagement are significant barriers to established treatments for PTSD, with attrition rates as high as 50 %. Compassion-based therapies provide potential solutions to treatment obstacles by providing a non-threatening, transdiagnostic option unburdened by aspects of current trauma treatment which may be associated with treatment resistance (e.g., exposure, trauma narrative, induction of fear). Compassion-based approaches are intuitive for trauma treatment, as compassion activates the self-soothing system, thereby disarming the fear system and promoting affect regulation. Compassion-based treatments demonstrate reductions across a substantial range of PTSD symptoms in adults, however, in adolescents extant literature is sparse, with cross-sectional studies suggesting self-compassion is inversely associated with trauma-related psychopathology. Understanding the impact of compassion-based approaches on adolescent PTSD is warranted as the adolescent developmental period may be a particularly opportune time for this approach. Evaluation of the impact of compassion-based treatment on adolescent PTSD in clinical populations via randomized-controlled studies and comparison of its relative efficacy to current evidence-based practices is warranted.
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Affiliation(s)
- Bridget Brinckman
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Elena Alfaro
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - William Wooten
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
| | - Ryan Herringa
- University of Wisconsin-Madison, BRAVE Research Lab, 6001 Research Park Blvd., Madison, WI 53719-1176, United States
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Siegel SE, Ranney RM, Masheb RM, Huggins J, Maguen S. Associations between posttraumatic stress disorder and eating disorder symptoms among women veterans. Eat Behav 2024; 52:101851. [PMID: 38324959 DOI: 10.1016/j.eatbeh.2024.101851] [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: 08/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Recent research suggests high rates of posttraumatic stress disorder (PTSD) and eating disorder (ED) comorbidity in women veterans. This study aims to expand the literature by examining associations between PTSD and ED diagnoses and symptoms in this population. We assessed probable PTSD diagnosis and symptom clusters (intrusion, avoidance, arousal and reactivity, and negative alterations in cognition and mood [NACM]), as well as probable Binge Eating Disorder (BED) diagnosis and ED subscales (dietary restraint, shape/weight overvaluation, and body dissatisfaction) in a sample of women veterans (N = 371). We investigated significance at the standard p < .05, and the Bonferroni-corrected p < .005 cut-off to adjust for experiment-wise error. Overall, we found that probable PTSD was associated with provisional BED (p < .001) using logistic regression at both cut-offs. Probable PTSD was associated with all ED subscales (all p's < 0.003) using linear regression models also at both cut-offs. Provisional BED was associated with NACM at p < .05 (p = .046), though it did not meet significance at our conservative cut-off. NACM was also associated with shape/weight overvaluation (p = .02) and a global ED score (p = .01) at p < .05, but not at our conservative cut-off; arousal was associated with shape/weight overvaluation (p = .04) and the global ED score (p = .02) at p < .05, but not at our conservative cut-off. Our findings may further guide how ED-related topics can be integrated in PTSD treatment for women veterans with comorbid PTSD and ED.
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Affiliation(s)
- Sarah E Siegel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA.
| | - Rachel M Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, 4150 Clement St, San Francisco, CA 94121, USA
| | - Robin M Masheb
- VA Connecticut Health System West Haven Campus, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Yale School of Medicine, New Haven, CT, USA
| | - Joy Huggins
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 675 18(th) Street, San Francisco, CA 94107, USA
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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Strelchuk D, Turner K, Smith S, Bisson J, Wiles N, Zammit S. Provision of online eye movement and desensitisation therapy (EMDR) for people with post-traumatic stress disorder (PTSD): a multi-method service evaluation. Eur J Psychotraumatol 2023; 14:2281182. [PMID: 38073540 PMCID: PMC10990439 DOI: 10.1080/20008066.2023.2281182] [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: 03/29/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
Background: The evidence for the effectiveness of online EMDR for PTSD is scarce.Objective: This service evaluation aimed to assess how online EMDR compared to in-person EMDR, in terms of its potential effectiveness and acceptability to therapists and patients.Method: The evaluation was carried out in the Cardiff and Vale University Health Board Traumatic Stress Service. We compared the outcome of therapy (PTSD scores at end of treatment), number of sessions, drop-out rate, and adverse events using linear/logistic regression in those receiving online EMDR over a 12-month period with those who had received in-person therapy in the year previous to that. Interviews with therapists and clients who had provided or undertaken online EMDR explored their views and experiences of treatment. Interviews were analysed thematically.Results: 33 people received in-person EMDR (15.3 sessions, SD = 1.4), and 45 received online EMDR (12.4 sessions, SD = 0.9). 24 individuals completed therapy in-person, and 32 online. There was no evidence of a difference in therapy completion, drop-out rates or adverse events between the two delivery modes. There was weak evidence that those who completed EMDR online and had available data (N = 29), had slightly lower PTSD scores at the end of therapy compared to those who received in-person EMDR (N = 24) (17.1 (SD = 3.2) versus 24.5 (SD = 3.0), mean difference = 7.8, 95% CI -0.3, 15.9, p = .06). However, groups were not randomised and only those who completed treatment were analysed, so estimates may be biased. 11 patients and five therapists were interviewed. Overall, both therapists and clients viewed online EMDR as safe and effective. Benefits mentioned by clients included feeling more in control and not having to travel. Clients' concerns related to lack of privacy and 'transition time/space' between therapy and their daily lives.Conclusion: Results suggest that online EMDR is an acceptable, safe and effective alternative to in-person EMDR for PTSD in this service.
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Affiliation(s)
- Daniela Strelchuk
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Katrina Turner
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sophie Smith
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Hollins Martin CJ, Reid K. A scoping review of therapies used to treat psychological trauma post perinatal bereavement. J Reprod Infant Psychol 2023; 41:582-598. [PMID: 34989287 DOI: 10.1080/02646838.2021.2021477] [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: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. AIM To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. METHOD A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. FINDINGS Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. CONCLUSIONS A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.
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Affiliation(s)
- Caroline J Hollins Martin
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
| | - Katrina Reid
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
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Kindt M, Soeter M. A brief treatment for veterans with PTSD: an open-label case-series study. Front Psychiatry 2023; 14:1260175. [PMID: 37928919 PMCID: PMC10620904 DOI: 10.3389/fpsyt.2023.1260175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Despite the positive outcomes observed in numerous individuals undergoing trauma-focused psychotherapy for PTSD, veterans with this condition experience notably diminished advantages from such therapeutic interventions in comparison to non-military populations. Methods In a preliminary study we investigated the efficacy of an innovative treatment approach in a small sample of veterans (n = 7). Recognizing that accessing and targeting trauma memory in veterans with PTSD may be more challenging compared to other patient populations, we employed unique and personalized retrieval cues that engaged multiple senses and were connected to the context of their trauma. This was followed by a session focused on memory reconsolidation, which incorporated both psychological techniques (i.e., imagery rescripting) and a pharmacological component (i.e., 40 mg of propranolol). Results The findings from this small-scale case series cautiously indicate that this brief intervention, typically consisting of only one or two treatment sessions, shows promise in producing significant effects on symptoms of PTSD, distress and quality of life.This is particularly noteworthy given the complex symptomatology experienced by the veterans in this study. Conclusion To summarize, there are grounds for optimism regarding this brief treatment of combat-related PTSD. It appears that the potential for positive outcomes is far greater than commonly believed, as demonstrated by the encouraging results of this pilot study.
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Affiliation(s)
- Merel Kindt
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke Soeter
- Work Health Technology, The Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
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Sripada RK, Peterson CL, Dziak JJ, Nahum-Shani I, Roberge EM, Martinson AA, Porter K, Grau P, Curtis D, McElroy S, Bryant S, Gracy I, Pryor C, Walters HM, Austin K, Ehlinger C, Sayer N, Wiltsey-Stirman S, Chard K. Using the multiphase optimization strategy to adapt cognitive processing therapy (CPT MOST): study protocol for a randomized controlled factorial experiment. Trials 2023; 24:676. [PMID: 37858262 PMCID: PMC10588087 DOI: 10.1186/s13063-023-07669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Approximately ten percent of US military veterans suffer from posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT) is a highly effective, evidence-based, first-line treatment for PTSD that has been widely adopted by the Department of Veterans Affairs (VA). CPT consists of discrete therapeutic components delivered across 12 sessions, but most veterans (up to 70%) never reach completion, and those who discontinue therapy receive only four sessions on average. Unfortunately, veterans who drop out prematurely may never receive the most effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most effective components of CPT so CPT can be adapted into a briefer format. METHODS The multiphase optimization strategy (MOST) is an innovative, engineering-inspired framework that uses an optimization trial to assess the performance of individual intervention components within a multicomponent intervention such as CPT. Here we use a fractional factorial optimization trial to identify and retain the most effective intervention components to form a refined, abbreviated CPT intervention package. Specifically, we used a 16-condition fractional factorial experiment with 270 veterans (N = 270) at three VA Medical Centers to test the effectiveness of each of the five CPT components and each two-way interaction between components. This factorial design will identify which CPT components contribute meaningfully to a reduction in PTSD symptoms, as measured by PTSD symptom reduction on the Clinician-Administered PTSD Scale for DSM-5, across 6 months of follow-up. It will also identify mediators and moderators of component effectiveness. DISCUSSION There is an urgent need to adapt CPT into a briefer format using empirical approaches to identify its most effective components. A brief format of CPT may reduce attrition and improve efficiency, enabling providers to treat more patients with PTSD. The refined intervention package will be evaluated in a future large-scale, fully-powered effectiveness trial. Pending demonstration of effectiveness, the refined intervention can be disseminated through the VA CPT training program. TRIAL REGISTRATION ClinicalTrials.gov NCT05220137. Registration date: January 21, 2022.
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Affiliation(s)
- Rebecca K Sripada
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA.
| | - Cassaundra L Peterson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - John J Dziak
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, USA
| | - Inbal Nahum-Shani
- University of Michigan Institute for Social Research, Ann Arbor, USA
| | - Erika M Roberge
- VA Salt Lake City Health Care System, University of Utah School of Medicine, Salt Lake City, USA
| | | | | | - Peter Grau
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Diana Curtis
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Sarah Bryant
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Isabel Gracy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Cosette Pryor
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Heather M Walters
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Karen Austin
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Nina Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA
| | | | - Kathleen Chard
- Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, USA
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Shea MT, Krupnick JL, Sautter FJ, Mete M, Green BL, Norman SB, Finley SL, Eaton E. A randomized clinical trial comparing Interpersonal Psychotherapy with Prolonged Exposure for the treatment of PTSD in veterans. J Anxiety Disord 2023; 99:102770. [PMID: 37738685 DOI: 10.1016/j.janxdis.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
Trauma-focused therapies are recommended as first-line treatments for posttraumatic stress disorder (PTSD), but many veterans do not complete or sufficiently respond to these treatments. Interpersonal Therapy (IPT) is a non-trauma focused approach that directly addresses the interpersonal and social impairments associated with PTSD. This two-site randomized controlled equivalence trial compared IPT with Prolonged Exposure (PE) in improving PTSD symptoms and interpersonal functioning in 109 veterans with PTSD. Secondary outcomes included functioning and quality of life. We hypothesized that IPT would be statistically equivalent to PE in reducing PTSD symptoms, and superior to PE in improving interpersonal functioning and secondary outcomes of work and social adjustment and quality of life. PTSD symptom severity decreased significantly in both treatments from pre- to post-treatment. Although IPT improved as much as PE and treatments did not differ significantly, the 95 % confidence interval for the difference between the groups did not fall completely within the margin of equivalence. IPT was not superior to PE in improvement in interpersonal functioning or on secondary outcomes. Findings from multi-level linear mixed models using longitudinal data (posttreatment, three and six month follow up) for the primary outcomes of PTSD and interpersonal functioning were consistent with the post-treatment analyses. Although statistically inconclusive in terms of equivalence, the comparable reduction in PTSD symptoms slightly favoring IPT suggests that IPT is an acceptable alternative to gold-standard trauma-focused treatments for veterans with PTSD.
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Affiliation(s)
- M Tracie Shea
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Janice L Krupnick
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Frederic J Sautter
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States of America; Tulane University Health Sciences Center, New Orleans, LA, United States of America
| | - Mihriye Mete
- MedStar Health Research Institute, Washington, DC, United States of America
| | - Bonnie L Green
- Department of Psychiatry, Georgetown Medical School, Washington, DC, United States of America
| | - Sonya B Norman
- National Center for PTSD, Executive Division, VA Medical Center, White River Junction, VT, United States of America; Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, United States of America
| | - Shauna L Finley
- Brown Medicine Primary Care, Providence, RI, United States of America
| | - Erica Eaton
- Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
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Walter ZC, Carlyle M, Kerswell N, Mefodeva V, Nixon RDV, Cobham VE, Hides L. Study protocol: implementing and evaluating a trauma-informed model of care in residential youth treatment for substance use disorders. Front Psychiatry 2023; 14:1169794. [PMID: 37840800 PMCID: PMC10572352 DOI: 10.3389/fpsyt.2023.1169794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Comorbidity between Substance Use Disorders and trauma/post-traumatic stress disorder (PTSD) is common, particularly within residential treatment services. Comorbidity is associated with poorer treatment retention and treatment outcomes. Integrated treatment approaches are increasingly recommended but are still under examined in residential treatment services. This study will implement and evaluate a novel model of trauma-informed care (TIC) in a youth (18-35 years) residential substance use treatment service. Methods and analysis A single-armed, phase 1 implementation trial will be conducted in one residential treatment service. The model, co-developed with staff, incorporates: (i) workforce development in TIC through staff training and clinical supervision; adaptions to the service (ii) policies, procedures, and physical settings and (iii) treatment program adaptions (in delivery style and content) to be more trauma-informed; (iv) client screening and feedback for trauma and PTSD at service entry; and (v) the provision of support, referral and/or trauma-focused therapy to those with PTSD. Service outcomes will include adherence to the TIC model and client treatment completion. Client substance use and mental health measures will be collected at service entry, and 1-, 3-, 6- and 12-months follow up. Staff outcomes, including workplace satisfaction, burnout, and fatigue, as well as perceptions and confidence in delivering TIC will be collected at baseline, and at 3-, 6-, 12- and 18-months following training in the model. The sustainability of the delivery of the TIC model of care will be evaluated for 12 months using service and staff outcomes. Ethics and dissemination The study has received ethical approval by the University of Queensland (Approval number: 2020000949). The results will be disseminated through publication in a peer-reviewed scientific journal, presentations at scientific conferences, and distributed via a report and presentations to the partner organization.Clinical trial registration: ACTRN12621000492853.
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Affiliation(s)
- Zoe C. Walter
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Molly Carlyle
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Nick Kerswell
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Valeriya Mefodeva
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Reg D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Vanessa E. Cobham
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Children’s Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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Davis AK, Xin Y, Sepeda N, Averill LA. Open-label study of consecutive ibogaine and 5-MeO-DMT assisted-therapy for trauma-exposed male Special Operations Forces Veterans: prospective data from a clinical program in Mexico. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:587-596. [PMID: 37734158 DOI: 10.1080/00952990.2023.2220874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/28/2023] [Indexed: 09/23/2023]
Abstract
Background: Research in psychedelic medicine has focused primarily on civilian populations. Further study is needed to understand whether these treatments are effective for Veteran populations.Objectives: Here, we examine the effectiveness of psychedelic-assisted therapy among trauma-exposed Special Operations Forces Veterans (SOFV) seeking treatment for cognitive and mental health problems in Mexico.Methods: Data were collected from an ibogaine and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) clinical treatment program for SOFV with a history of trauma exposure. This clinical program collects prospective clinical program evaluation data, such as background characteristics, symptom severity, functioning (e.g., satisfaction with life, posttraumatic stress disorder symptoms, depression symptoms, anxiety symptoms, sleep disturbance, psychological flexibility, disability in functioning, cognitive functioning, neurobehavioral symptoms, anger, suicidal ideation), and substance persisting/enduring effects through online surveys at four timepoints (baseline/pre-treatment, one-, three-, and six-months after treatment).Results: The majority of the sample (n = 86; Mean Age = 42.88, SD = 7.88) were Caucasian (87.2%), non-Hispanic (89.5%), and males (100%). There were significant and large improvements in self-reported PTSD symptoms (p < .001, d = .414), depression (p < .001, d = .275), anxiety (p < .001, d = .276), insomnia severity (p < .001, d = .351), and post-concussive symptoms (p < .001, d = .389) as well as self-reported satisfaction with life (p < .001, d = .371), psychological flexibility (p < .001, d = .313) and cognitive functioning (p < .001, d = .265) from baseline to one-month follow-up.Conclusions: Data suggest combined ibogaine and 5-MeO-DMT assisted therapy has potential to provide rapid and robust changes in mental health functioning with a signal of durable therapeutic effects up to 6-months. Future research in controlled settings is warranted.
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Affiliation(s)
- Alan Kooi Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Nathan Sepeda
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| | - Lynnette A Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, US Department of Veteran Affairs, Houston, TX, USA
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Nihei M, Hojo D, Tanaka T, Sawa K. A model for recovery-from-extinction effects in Pavlovian conditioning and exposure therapy. Learn Behav 2023; 51:332-345. [PMID: 36869186 DOI: 10.3758/s13420-023-00578-0] [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] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
Exposure therapy is an effective intervention for anxiety-related problems. The mechanism of this intervention has been the extinction procedure in Pavlovian conditioning, and this application has provided many successful instances for the prevention of relapse. However, traditional associative theories cannot comprehensively explain many findings. In particular, it is difficult to explain the recovery-from-extinction effects, which is the reappearance of the conditioned response following extinction. In this paper, we propose an associative model that is a mathematical extension of Bouton's (1993, Psychological Bulletin, 114, 80-99) model for the extinction procedure. The core of our model is that the asymptotic strength of the inhibitory association depends on the degree of excitatory association retrieved in a context in which a conditioned stimulus (CS) is presented and that the retrieval is determined by the similarity between contexts during both reinforcement and non-reinforcement and the retrieval context. Our model provides an explanation of the recovery-from-extinction effects, and implications for exposure therapy.
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Affiliation(s)
- Masato Nihei
- Graduate School of the Humanities, Senshu University, 2-1-1, Higashimita, Tama-ku, Kawasaki-shi, Kanagawa, 214-8580, Japan.
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
| | - Daiki Hojo
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 133-0033, Japan
| | - Tsunehiko Tanaka
- Faculty of Education, Niigata University, 8050 Ikarashi-2-no-Cho, Nishi-ku, Niigata, 950-2181, Japan
| | - Kosuke Sawa
- School of Human Sciences, Senshu University, 2-1-1, Higashimita, Tama-ku, Kawasaki-shi, Kanagawa, 214-8580, Japan
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Mortimer AR, Mortimer RB. Psychological First Aid for Wilderness Trauma: Interventions for Expedition or Search and Rescue Team Members. Wilderness Environ Med 2023; 34:346-353. [PMID: 37105845 DOI: 10.1016/j.wem.2023.02.009] [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: 10/03/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 04/29/2023]
Abstract
When exposed to actual or threatened death or serious injury in austere settings, expedition members are at risk of acute stress reactions, as are search and rescue members involved with extricating the patient. Acute stress reactions are a normal response to significant trauma and commonly resolve on their own. If they do not, they can lead to post-traumatic stress disorder (PTSD), a set of persistent symptoms that cause significant effects on the person's life. Medication has a limited preventive role in the field for treatment of stress partly because so few are trained to administer it. Contrastingly, psychological first aid can be performed by lay team members with minimal training. Psychological first aid consists of interventions attempting to encourage feelings of safety, calm, self-efficacy, connection, and hope. These are interventions that provide guidance to not make the situation emotionally worse and might have a preventive effect on later development of PTSD. They are valuable in the field not only for the patient but also for affected team members as well as for search and rescue team members who may be indirectly affected by the trauma and experience repercussions later.
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Affiliation(s)
- Amanda R Mortimer
- Department of Psychology, California State University, Fresno, Fresno, CA
| | - Roger B Mortimer
- Fresno Medical Education Program, Department of Family Medicine, University of California, San Francisco, San Francisco, CA.
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Tillman GD, Morris EE, Bass C, Turner M, Watson K, Brooks JT, Rawlinson T, Kozel FA, Kraut MA, Motes MA, Hart J. P3a amplitude to trauma-related stimuli reduced after successful trauma-focused PTSD treatment. Biol Psychol 2023; 182:108648. [PMID: 37482132 DOI: 10.1016/j.biopsycho.2023.108648] [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: 02/24/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
An elevated P3a amplitude to trauma-related stimuli is strongly associated with posttraumatic stress disorder (PTSD), yet little is known about whether this response to trauma-related stimuli is affected by treatment that decreases PTSD symptoms. As an analysis of secondary outcome measures from a randomized controlled trial, we investigated the latency and amplitude changes of the P3a in responses in a three-condition oddball visual task that included trauma-related (combat scenes) and trauma-unrelated (threatening animals) distractors. Fifty-five U.S. veterans diagnosed with combat-related PTSD were randomized to receive either active or sham repetitive transcranial magnetic stimulation (rTMS). All received cognitive processing therapy, CPT+A, which requires a written account of the index trauma. They were tested before and 6 months after protocol completion. P3a amplitude and response time decreases were driven largely by the changes in the responses to the trauma-related stimuli, and this decrease correlated to the decrease in PTSD symptoms. The amplitude changes were greater in those who received rTMS + CPT than in those who received sham rTMS + CPT, suggesting that rTMS plays beneficial role in reducing arousal and threat bias, which may allow for more effective engagement in trauma-focused PTSD treatment.
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Affiliation(s)
- Gail D Tillman
- Callier Center, University of Texas at Dallas, Dallas, TX, USA.
| | | | - Christina Bass
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Mary Turner
- Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelsey Watson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Jared T Brooks
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - Tyler Rawlinson
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Michael A Kraut
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Motes
- Callier Center, University of Texas at Dallas, Dallas, TX, USA
| | - John Hart
- Callier Center, University of Texas at Dallas, Dallas, TX, USA; Departments of Psychiatry University of Texas Southwestern Medical Center, Dallas, TX, USA; Departments of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cameron D, Shiner B, O'Neill A, O'Neil M. Factors Associated with Engaging in Evidence-Based Psychotherapy During the First Year of Posttraumatic Stress Disorder Treatment Between 2017 and 2019. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:813-823. [PMID: 37338657 DOI: 10.1007/s10488-023-01280-z] [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] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
To address the burden of posttraumatic stress disorder (PTSD), the Veterans Health Administration (VHA) implemented evidence-based psychotherapies (EBPs) for PTSD at all VHA medical centers. Prior investigations show EBP utilization has increased following the initial nationwide implementation. However, most patients still do not engage in EBPs and those who do often have substantial delays between diagnosis and treatment which is associated with poorer treatment outcomes. The goal of the current study is to identify patient and clinical factors associated with initiating EBP and completing a minimally adequate dose of treatment within the first year of a new PTSD diagnosis. Overall, 263,018 patients started PTSD treatment between 2017 and 2019 and 11.6% (n = 30,462) initiated EBP during their first year of treatment. Of those who initiated EBP, 32.9% (n = 10,030) received a minimally adequate dose. Older patients were less likely to initiate EBP, but more likely to receive an adequate dose when they did initiate. Black, Hispanic/Latino/a, and Pacific Islander patients' likelihood of initiating EBP was not significantly different than White patients, but these patients were less likely to receive an adequate dose. Patients with comorbid depressive disorders, bipolar disorder, psychotic disorders, or substance use disorders were less likely to initiate EBP, while patients reporting MST were more likely to initiate EBP. This study identifies several patient-level disparities that could be prioritized to increase EBP utilization. In our evaluation, most patients did not engage in EBP during their first year of PTSD treatment, which is consistent with previous evaluations of EBP utilization. Future research should focus on understanding the flow of patients from PTSD diagnosis to treatment to support effective PTSD care delivery.
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Affiliation(s)
- David Cameron
- VA Portland Health Care System, (R&D 66), 3710, SW US Veterans Hospital Rd, Portland, OR, 97239, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Brian Shiner
- White River Junction VA Medical Center, Hartford, VT, USA
- National Center for PTSD, Hartford, VT, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Allison O'Neill
- VA Portland Health Care System, (R&D 66), 3710, SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Maya O'Neil
- VA Portland Health Care System, (R&D 66), 3710, SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
- Oregon Health & Science University, Portland, OR, USA.
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50
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Lu W, Mueser KT, Yanos PT, Siriram A, Jia Y, Leong A, Silverstein SM, Gottlieb J, Jankowski MK. Post-Traumatic Cognitions Inventory (PTCI): psychometric properties in clients with serious mental illness and co-occurring PTSD. Behav Cogn Psychother 2023; 51:459-474. [PMID: 37212149 DOI: 10.1017/s1352465823000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND People with post-traumatic stress disorder (PTSD) exhibit negative cognitions, predictive of PTSD severity. The Post-Traumatic Cognitions Inventory (PTCI) is a widely used instrument measuring trauma-related cognitions and beliefs with three subscales: negative thoughts of self (SELF), negative cognitions about the world (WORLD), and self-blame (BLAME). AIMS The current study attempted to validate the use of the PTCI in people with serious mental illness (SMI), who have greater exposure to trauma and elevated rates of PTSD, using confirmatory factor analysis (CFA) and examining convergent and divergent correlations with relevant constructs. METHOD Participants were 432 individuals with SMI and co-occurring PTSD diagnosis based on the Clinician Administered PTSD Scale, who completed PTCI and other clinical ratings. RESULTS CFAs provided adequate support for Foa's three-factor model (SELF, WORLD, BLAME), and adequate support for Sexton's four-factor model that also included a COPE subscale. Both models achieved measurement invariance at configural, metric and scalar levels for three diagnostic groups: schizophrenia, bipolar and major depression, as well as for ethnicity (White vs Black), and gender (male vs female). Validity of both models was supported by significant correlations between PTCI subscales, and self-reported and clinician assessed PTSD symptoms and associated symptoms. CONCLUSIONS Findings provide support for the psychometric properties of the PTCI and the conceptualization of Sexton's four-factor and Foa's three-factor models of PTCI among individuals diagnosed with SMI (Foa et al., ).
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Affiliation(s)
- Weili Lu
- Rutgers University, New Brunswick, USA
| | | | | | | | - Yuane Jia
- Rutgers University, New Brunswick, USA
| | | | | | | | - Mary K Jankowski
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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