Transcranial Magnetic Stimulation In PTSD And Complex PTSD: Contemporary Stimulation Protocols And Integration With Psychotherapy—A Hybrid Review

There is concern that exposure therapy, an evidence-based cognitive-behavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate because of risk of relapse for patients with co-occurring substance dependence. To determine whether an integrated treatment for PTSD and substance dependence, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and substance dependence symptom severity compared with usual treatment for substance dependence. Randomized controlled trial enrolling 103 participants who met DSM-IV-TR criteria for both PTSD and substance dependence. Participants were recruited from 2007-2009 in Sydney, Australia; outcomes were assessed at 9 months postbaseline, with interim measures collected at 6 weeks and 3 months postbaseline. Participants were randomized to receive COPE plus usual treatment (n = 55) or usual treatment alone (control) (n = 48). COPE consists of 13 individual 90-minute sessions (ie, 19.5 hours) with a clinical psychologist. Change in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS; scale range, 0-240) and change in severity of substance dependence as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range, 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criterion on the CIDI were considered clinically significant. From baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment group (mean difference, -38.24 [95% CI, -47.93 to -28.54]) and the control group (mean difference, -22.14 [95% CI, -30.33 to -13.95]); however, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity (mean difference, -16.09 [95% CI, -29.00 to -3.19]). No significant between-group difference was found in relation to improvement in severity of substance dependence (0.43 vs 0.52; incidence rate ratio, 0.85 [95% CI, 0.60 to 1.21), nor were there any significant between-group differences in relation to changes in substance use, depression, or anxiety. Among patients with PTSD and substance dependence, the combined use of COPE plus usual treatment, compared with usual treatment alone, resulted in improvement in PTSD symptom severity without an increase in severity of substance dependence. isrctn.org Identifier: ISRCTN12908171.

Post-Traumatic Stress Disorder (PTSD) affects approximately 7% of the United States population and can have significant psychiatric and functional impairments. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential treatment, though its efficacy remains inadequately explored. This study evaluates the impact of rTMS on PTSD symptom severity, utilizing the PTSD Checklist for DSM-5 (PCL-5) as a validated outcome measure. A retrospective analysis was conducted on 127 patients meeting PTSD criteria (PCL-5 score≥31) who underwent a standardized rTMS protocol between December 2021 and December 2023. Treatment parameters included dorsolateral prefrontal cortex stimulation with individualized motor threshold mapping. PCL-5 scores were assessed pre- and post-treatment using paired t-tests to quantify response to rTMS. The mean pre-treatment PCL-5 score was 49.55, which decreased to 29.07 post-treatment (p<0.0001). Clinically meaningful response (≥30% reduction in PCL-5 score) was observed in 65.4% of patients, with 42.5% achieving a≥50% reduction. Female patients demonstrated a greater reduction in PTSD symptom severity compared to males (41.57% versus 36.64% reduction). No severe adverse events, including seizures, were reported. rTMS significantly reduces PTSD symptom severity, with a clinically meaningful response observed in the majority of patients. These findings support the utility of rTMS as an effective, well-tolerated intervention for PTSD. Future studies should investigate long-term symptom stability and optimal stimulation parameters to refine treatment efficacy.

Trauma-focused treatments are effective for posttraumatic stress disorder (PTSD) but are rarely offered to patients with comorbid substance use disorder. Research suggests gender-based differences in prevalence and treatment needs for these patients, but treatment trials have mainly included men. To evaluate whether integrated trauma-focused psychological treatment (ie, integrated treatment) leads to greater reduction in PTSD symptom severity and weekly alcohol use than usual treatment (ie, relapse prevention) for alcohol use disorder (AUD) in women. This randomized clinical trial was conducted at 3 outpatient addiction services in Sweden. Data were collected from 2016 to 2021, and participants were followed up for 9 months after treatment initiation. Data were analyzed from October 2024 to April 2025. Participants were women older than 18 years with current PTSD and moderate-to-severe AUD diagnoses meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Participants were randomly assigned to either the integrated treatment or relapse prevention arm. Intention-to-treat analyses were carried out using linear mixed models. Twelve sessions, typically weekly, of integrated treatment (ie, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE]) or relapse prevention were delivered by trained and experienced staff (including registered nurses, licensed psychologists, and social workers). Prespecified co-primary outcomes were PTSD symptom severity (assessed by blinded raters using Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) and weekly alcohol use (self-assessed using Timeline Followback) from baseline to the 9-month follow-up. Secondary outcomes included self-reported PTSD symptom severity, clinician-rated PTSD remission, and an objective biomarker of alcohol use (phosphatidylethanol level). Ninety women (mean [SD] age, 44.7 [12.5] years) were included and randomly assigned to integrated treatment (n = 45) or relapse prevention (n = 45). In both arms, PTSD symptom severity decreased from baseline to 9-month follow-up (mean CAPS-5 score for integrated treatment: 37.40 [95% CI, 33.84-40.96] to 13.18 [95% CI, 8.95-17.41]; relapse prevention: 39.09 [95% CI, 35.53-42.65] to 23.68 [95% CI, 19.47-27.88]), with a significantly greater decrease in the integrated treatment arm than the relapse prevention arm (treatment-by-time interaction: F4,155 = 3.0; P = .02). Self-reported alcohol use decreased significantly over time (F14,581 = 3.0; P < .001) in both arms (integrated treatment: 144.41 [95% CI, 104.66-184.15] g/week to 92.65 [95% CI, 48.81-136.48] g/week; relapse prevention: 133.45 [95% CI, 93.71-173.19] g/week to 77.80 [95% CI, 31.65-123.95] g/week), but there was no detectable difference between treatments. In this trial of integrated treatment vs relapse prevention, integrated treatment led to a greater reduction in PTSD symptom severity and no detectable difference in alcohol use decrease compared with relapse prevention. These results support that integrated treatment can safely and effectively treat PTSD in women with AUD and ongoing alcohol use. ISRCTN.org Identifier: ISRCTN61391164.

This paper examines factors associated with change in PTSD symptom severity among individuals randomised to receive an integrated exposure-based psychotherapy for PTSD and substance dependence–Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Outcomes examined include change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS), and the reliability and clinical significance of change in PTSD symptom severity. Factors examined include patient baseline characteristics, treatment characteristics, and events over follow-up. The mean difference in CAPS score was 38.24 (SE 4.81). Approximately half (49.1%) demonstrated a reliable and clinically significant improvement in PTSD symptom severity. No one was classified as having demonstrated clinically significant worsening of symptoms. Three independent predictors of reductions in PTSD symptom severity were identified: baseline PTSD symptom severity (β 0.77, SE 0.23, p = 0.001), number of traumas experienced prior to baseline (β −0.30, SE 0.15, p = 0.049), and number of sessions attended (β 2.05, SE 0.87, p = 0.024). The present study provides further evidence regarding the safety of the COPE treatment and factors associated with improvement in PTSD symptom severity. The identification of only a small number of predictors of the outcome points to the broad applicability of the COPE treatment to PTSD and substance use disorder (SUD) patients.

Successful treatment of the Meige's syndrome with navigated repetitive transcranial magnetic stimulation: A case report

&lt;p dir="ltr"&gt;Background: Most people experience traumatic events, for instance a natural disaster or the unexpected death of a loved one.&lt;/p&gt;&lt;p dir="ltr"&gt;Some people then develop posttraumatic stress disorder (PTSD), a debilitating disorder characterized by intrusion symptoms, e.g. intense distress and nightmares, avoidance, negative changes in cognitions and mood as well as changes in arousal and reactivity, e.g. startling easily and finding it difficult to concentrate. PTSD is approximately twice as common among women as among men.&lt;/p&gt;&lt;p dir="ltr"&gt;Some people find that alcohol provides short-term relief from their PTSD symptoms, for example by reducing intense distress or being able to sleep and wake without remembering one's nightmares. Over time alcohol use can lead to alcohol use disorder (AUD), which is characterized by problematic alcohol use. There are other trajectories to comorbid PTSD and AUD, but this is the most supported by research to date. PTSD and AUD often occur together.&lt;/p&gt;&lt;p dir="ltr"&gt;PTSD and AUD are associated with negative outcomes, e.g. other mental disorders, suicidality and ill physical health. Similarly, PTSD and alcohol use during pregnancy are associated with adverse outcomes for those pregnant as well as their expected children, including antepartum complications and fetal alcohol spectrum disorders (FASD).&lt;/p&gt;&lt;p dir="ltr"&gt;Comorbid PTSD and AUD tend to be more severe and more impairing than either disorder on its own. For instance, higher rates of comorbid mental disorders, suicidality and homelessness have been found among people with comorbid PTSD and AUD than among individuals with either PTSD or AUD.&lt;/p&gt;&lt;p dir="ltr"&gt;Comorbid PTSD and AUD are regarded as difficult to treat. Traditionally, sequential treatment, where AUD was treated first, then PTSD, was suggested. Patients were typically required to achieve and maintain abstinence before PTSD treatment was initiated, something which potentially is a great barrier to PTSD treatment for those with comorbid PTSD and AUD.&lt;/p&gt;&lt;p dir="ltr"&gt;Great strides have been made in developing treatment of comorbid PTSD and AUD, but the evidence on how to treat comorbid PTSD and AUD is not yet robust. Women are overrepresented among those with comorbid PTSD and AUD, yet, underrepresented in the extant treatment research. Trials of treatment of comorbid PTSD and AUD have included mainly men. Women and men may have different treatment needs and may also respond differently to treatment. So, we need to know more about treatment of comorbid PTSD and AUD in women.&lt;/p&gt;&lt;p dir="ltr"&gt;Objectives: The present thesis sought to estimate the current prevalence of PTSD and alcohol use during pregnancy in Stockholm, Sweden, and to investigate the safety, feasibility, and efficacy of concurrent treatment of comorbid PTSD and AUD, which does not require abstinence, in treatment- seeking women with comorbid PTSD and AUD in Swedish healthcare.&lt;/p&gt;&lt;p dir="ltr"&gt;Methods: Cross-sectional studies were conducted to estimate the current prevalence of PTSD and alcohol use during pregnancy. A pilot study was undertaken to investigate the safety and feasibility of concurrent treatment of PTSD and AUD in treatment-seeking women in Swedish healthcare. A randomized clinical trial was conducted to investigate whether concurrent treatment of PTSD and AUD reduces PTSD symptom severity and alcohol use more than AUD treatment in treatment-seeking women with comorbid PTSD and AUD in Swedish healthcare.&lt;/p&gt;&lt;p dir="ltr"&gt;Results: Approximately 4.1 percent of pregnant people are estimated to have current PTSD and approximately 4.2 percent estimated to use alcohol during pregnancy in Stockholm, Sweden. Concurrent treatment of PTSD and AUD in women was safe and feasible. In the randomized clinical trial, PTSD symptom severity and alcohol use decreased from baseline to 9-month follow-up for both treatments. There was a significantly greater reduction in PTSD symptom severity in the concurrent treatment arm than in the AUD treatment arm. There was no detectable difference in alcohol use between treatments.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions: Further efforts to spread information about alcohol use during pregnancy may be needed, continued screening for alcohol use during pregnancy is warranted as well as treatment of risky alcohol use and AUD, when necessary, to reduce the risk of adverse outcomes for those pregnant as well as their expected children. It may be useful to investigate screening for PTSD in antenatal care further, to evaluate whether systematic screening for PTSD should be introduced in antenatal care. The present findings indicate that concurrent treatment of PTSD and AUD is feasible, safe, and efficacious for treatment-seeking women with comorbid PTSD and AUD in Swedish healthcare, and that abstinence is not required before or during treatment.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. &lt;b&gt;Persson, A;&lt;/b&gt; Lindmark, S; Petersson, K; Gabriel, E; Thorsell, M; Lindström, K; Göransson, M; Cardell, G; Magnusson, Å. Fear of childbirth, potentially traumatic events and posttraumatic stress disorder during pregnancy in Stockholm, Sweden: A cross-sectional study. Sexual &amp; Reproductive Healthcare, 2020, Vol. 25, p. 100516. &lt;a href="https://doi.org/10.1016/j.srhc.2020.100516" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.srhc.2020.100516&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Persson, A;&lt;/b&gt; Lindmark, S; Petersson, K; Gabriel, E; Thorsell, M; Lindström, K; Göransson, M; Cardell, G; Magnusson, Å. Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study. Sexual &amp; Reproductive Healthcare, 2021, Vol. 29, p. 100622. &lt;a href="https://doi.org/10.1016/j.srhc.2021.100622" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.srhc.2021.100622&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Persson, A;&lt;/b&gt; Back, S E; Killeen, T K; Brady, K T; Schwandt, M L; Heilig, M; Magnusson, A. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A pilot study in alcohol-dependent women. Journal of Addiction Medicine, 2017, Vol. 11(2), p. 119-125. &lt;a href="https://doi.org/10.1097/ADM.0000000000000286" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1097/ADM.0000000000000286&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;IV. &lt;b&gt;Persson, A;&lt;/b&gt; Axén, Å; Capusan, A J; Magnusson, Å; Heilig, M. Concurrent Treatment of Posttraumatic Stress Disorder and Alcohol Use Disorder in Women: A Randomized Clinical Trial. JAMA Network Open, 2025, Vol. 8(7), p. e2521087. &lt;a href="https://doi.org/10.1001/jamanetworkopen.2025.21087" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1001/jamanetworkopen.2025.21087&lt;/a&gt;&lt;/p&gt;

Women's experiences of negative social reactions to disclosure of intimate partner violence (IPV) victimization have been linked to greater posttraumatic stress disorder (PTSD) symptom severity. However, research has not identified factors that may explain this association. The goal of the current study was to extend research in this area by elucidating the potential mediating role of avoidant coping in the relations among negative and positive social reactions to IPV disclosure and PTSD symptom severity. Participants were 173 community women currently experiencing IPV who disclosed their victimization to another individual (M age = 36.31, 65.9% African American). Findings revealed that IPV-victimized women who experienced greater negative social reactions to IPV endorsed higher levels of avoidant coping and greater PTSD symptom severity. Moreover, avoidant coping was found to mediate the negative social reactions-PTSD symptom severity association. Results highlight the relevance of avoidant coping to the link between negative social reactions to IPV disclosure and PTSD symptom severity, and suggest that prevention and intervention efforts targeting avoidant coping may be useful in reducing PTSD symptom severity among IPV-exposed women who experience negative social reactions to IPV disclosure.

Background: Animal-assisted interventions (AAI) are increasingly applied for people with post-traumatic stress disorder (PTSD) symptoms albeit its effectiveness is unclear.Objectives: To examine the effectiveness of AAI for treating PTSD symptoms.Method: We searched 11 major electronic databases for studies reporting quantitative data on effects of AAI for children and adults with PTSD symptoms. Of 22ʹ211 records identified, we included 41 studies with 1111 participants in the systematic review comprising eight controlled studies with 469 participants in the meta-analysis. We conducted random-effects meta-analyses with all controlled studies based on standardized mean differences (SMD), and calculated standardized mean change (SMC) as effect sizes for studies with a pre-post one-group design. Two independent researchers assessed the quality of the included studies using the NIH Study Quality Assessment Tools. The primary outcome was PTSD or depression symptom severity measured via a standardized measurement at pre- and post-intervention assessments.Results: There was a small but not statistically significant superiority of AAI over standard PTSD psychotherapy (SMD = −0.26, 95% CI: −0.56 to 0.04) in reducing PTSD symptom severity while AAI was superior to waitlist (SMD = −0.82, 95% CI: −1.56 to 0.08). Getting a service dog was superior to waiting for a service dog (SMD = −0.58, 95% CI: −0.88 to −0.28). AAI led to comparable effects in reducing depression as standard PTSD psychotherapy (SMD = −0.03, CI: −0.88 to 0.83). Pre-post comparisons showed large variation for the reduction in PTSD symptom severity, with SMCs ranging from −0.38 to −1.64, and for depression symptom severity, ranging from 0.01 to −2.76. Getting a service dog lowered PTSD symptoms between −0.43 and −1.10 and depression with medium effect size of −0.74.Conclusions: The results indicate that AAI are efficacious in reducing PTSD symptomatology and depression. Future studies with robust study designs and large samples are needed for valid conclusions.

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population. Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness. Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03]. This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

DNA methylation and psychotherapy response in trauma-exposed men with appetitive aggression

Sleep disturbances are common among veterans with chronic military-related posttraumatic stress disorder (PTSD). This article reports the results of a multicenter clinical trial that explored the clinical correlates of reported sleep impairment in these veterans and tested the impact of the second-generation antipsychotic risperidone upon these symptoms. This article reports secondary analyses of a 24-week multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD symptoms (n = 267, 97% male) who were symptomatic despite treatment with antidepressants and other medications. The study was conducted between February 2007 and February 2010. DSM-IV PTSD diagnoses were made by using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Nonpatient Edition. Sleep disturbances were assessed principally by using the Pittsburgh Sleep Quality Index (PSQI) (primary outcome measure). Analyses were conducted using bivariate correlations and longitudinal mixed model regressions. Eighty-eight percent of the patients in this study had clinically significantly impaired sleep on the PSQI. Severity of sleep disturbances correlated with PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS) and reductions in multiple measures of quality of life (Veterans RAND 36-item Health Survey [SF-36 V] subscales, Boston Life Satisfaction Index). Risperidone produced small but statistically significant effects on total PSQI scores (main effect of drug: F1,228 = 4.57, P = .034; drug-by-time interaction: F2,421 = 4.32, P = .014) and severity of nightmares as assessed by the CAPS (main effect of drug: F1,248 = 4.60, P = .033). The improvements in sleep quality produced by risperidone correlated with reductions in PTSD symptom severity and improvement in the mental health subscale of the SF-36 V. This study highlighted the near universality and significant negative impact of severe disturbances in sleep quality in veterans with chronic military-related PTSD who were partial responders to standard pharmacotherapies. The modest improvements in sleep quality produced by adjunctive risperidone were correlated with limited reductions in PTSD severity and improvements in quality of life. ClinicalTrials.gov identifier: NCT00099983.

Effective and efficient treatment is needed for posttraumatic stress disorder (PTSD) in active duty military personnel. To examine the effects of massed prolonged exposure therapy (massed therapy), spaced prolonged exposure therapy (spaced therapy), present-centered therapy (PCT), and a minimal-contact control (MCC) on PTSD severity. Randomized clinical trial conducted at Fort Hood, Texas, from January 2011 through July 2016 and enrolling 370 military personnel with PTSD who had returned from Iraq, Afghanistan, or both. Final follow-up was July 11, 2016. Prolonged exposure therapy, cognitive behavioral therapy involving exposure to trauma memories/reminders, administered as massed therapy (n = 110; 10 sessions over 2 weeks) or spaced therapy (n = 109; 10 sessions over 8 weeks); PCT, a non-trauma-focused therapy involving identifying/discussing daily stressors (n = 107; 10 sessions over 8 weeks); or MCC, telephone calls from therapists (n = 40; once weekly for 4 weeks). Outcomes were assessed before and after treatment and at 2-week, 12-week, and 6-month follow-up. Primary outcome was interviewer-assessed PTSD symptom severity, measured by the PTSD Symptom Scale-Interview (PSS-I; range, 0-51; higher scores indicate greater PTSD severity; MCID, 3.18), used to assess efficacy of massed therapy at 2 weeks posttreatment vs MCC at week 4; noninferiority of massed therapy vs spaced therapy at 2 weeks and 12 weeks posttreatment (noninferiority margin, 50% [2.3 points on PSS-I, with 1-sided α = .05]); and efficacy of spaced therapy vs PCT at posttreatment. Among 370 randomized participants, data were analyzed for 366 (mean age, 32.7 [SD, 7.3] years; 44 women [12.0%]; mean baseline PSS-I score, 25.49 [6.36]), and 216 (59.0%) completed the study. At 2 weeks posttreatment, mean PSS-I score was 17.62 (mean decrease from baseline, 7.13) for massed therapy and 21.41 (mean decrease, 3.43) for MCC (difference in decrease, 3.70 [95% CI,0.72 to 6.68]; P = .02). At 2 weeks posttreatment, mean PSS-I score was 18.03 for spaced therapy (decrease, 7.29; difference in means vs massed therapy, 0.79 [1-sided 95% CI, -∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment was 18.88 for massed therapy (decrease, 6.32) and 18.34 for spaced therapy (decrease, 6.97; difference, 0.55 [1-sided 95% CI, -∞ to 2.05; P = .03 for noninferiority]). At posttreatment, PSS-I scores for PCT were 18.65 (decrease, 7.31; difference in decrease vs spaced therapy, 0.10 [95% CI, -2.48 to 2.27]; P = .93). Among active duty military personnel with PTSD, massed therapy (10 sessions over 2 weeks) reduced PTSD symptom severity more than MCC at 2-week follow-up and was noninferior to spaced therapy (10 sessions over 8 weeks), and there was no significant difference between spaced therapy and PCT. The reductions in PTSD symptom severity with all treatments were relatively modest, suggesting that further research is needed to determine the clinical importance of these findings. clinicaltrials.gov Identifier: NCT01049516.

Posttraumatic stress disorder (PTSD) is a debilitating condition that disproportionately impacts service members (SMs). Interoception interventions that target malleable, transdiagnostic risk factors for PTSD, such as the acceptance of uncomfortable internal sensations, may serve as potential options for military providers. The current study evaluated the efficacy of Reconnecting to Internal Sensations and Experiences (RISE)-an empirically supported interoception training focused on accepting and managing internal sensations-in reducing PTSD symptom severity. Active-duty SMs and veterans (N = 100) with probable PTSD were randomized to receive RISE or Healthy Habits (active control). Participants completed four weekly 30-min training modules, as well as survey assessments (PTSD symptom severity, not worrying/acceptance of uncomfortable internal sensations) at baseline, posttreatment, and 1-month follow-up. Mediation analysis evidenced a significant direct effect of RISE on improvements in not worrying/acceptance at posttreatment, B = 0.51, and not worrying/acceptance on reductions in PTSD symptom severity at follow-up, B = -3.76. Despite no direct effect of condition on PTSD symptoms, B = 2.66, a significant indirect effect was observed through improvements in not worrying/acceptance, B = -1.91, such that RISE led to increased not worrying/acceptance, which, in turn, was associated with decreases in PTSD symptom severity. These findings support acceptance of internal sensations as a key mechanism of change for improving PTSD. Further, the results provide preliminary evidence for RISE as a viable PTSD treatment supplement for SMs and provide preliminary support for the use of transdiagnostic tools developed with considerations for military cultural stigma and logistical concerns.

Understanding the relationship of perceived social support to post-trauma cognitions and posttraumatic stress disorder