Chronic PTSD Research Articles

Treatment of chronic PTSD by cognitive therapy and exposure: 5-year follow-up

Patients who had taken part in a randomized clinical trial of the treatment of chronic PTSD by either cognitive therapy or imaginal exposure were reassessed after 5 years. At 5-year follow-up a clear superiority of cognitive therapy over imaginal exposure emerged, although there had been no difference between the two treatment groups up to 12 months posttreatment. The cognitive therapy group showed significant differences on the primary outcome measures: total PTSD symptoms on the CAPS and percentage of PTSD cases. At 5 years no patients who received cognitive therapy were diagnosed with full PTSD compared to 29% of those who received imaginal exposure. All secondary outcomes showed lower scores for cognitive therapy, of which 3 were significant. Those who were not assessed at 5 years scored significantly higher on assessment measures, especially avoidance, at posttreatment.

Beyond the manual: The insider's guide to Prolonged Exposure therapy for PTSD

Prolonged Exposure therapy (PE; Foa & Rothbaum, 1998) has strong empirical support for its efficacy in reducing trauma-related psychopathology in individuals with chronic PTSD (Rothbaum, Meadows, Resick, & Foy, 2000) . In the process of providing PE to many clients and in training therapists in a variety of settings in its use, we at the Center for the Treatment and Study of Anxiety have amassed extensive experience with this therapy. This article extends the treatment guidelines provided in the PE treatment manual by sharing the knowledge and wisdom that years of experience have brought us. We emphasize the importance of forging a strong therapeutic alliance and providing a thorough rationale for treatment, discuss ways to implement in-vivo and imaginal exposure so as to promote effective emotional engagement with traumatic memories, and conclude with some recommendations for how therapists who conduct PE for PTSD can take care of themselves while delivering a therapy that is very rewarding and, at times, emotionally challenging.

Chronic PTSD and Medical Services Utilization by Asylum Seekers

Chronic PTSD and Medical Services Utilization by Asylum Seekers

Treatment choice for PTSD

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman’s decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, “if this happened to you, what would you do” scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women’s choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.

Mirtazapine for PTSD

Medications most commonly used to treat post-traumatic stress disorder include SSRIs, carbamazepine, and benzodiazepines. In this manufacturer-supported pilot study, 29 patients with DSM-IV chronic PTSD caused by diverse experiences were randomly assigned to receive 45 mg/day of mirtazapine (a 5-HT2 …

Acute stress disorder after burn injury: a predictor of posttraumatic stress disorder?

The principal goals of this study were to determine whether ASD predicted chronic PTSD and whether dissociation is more characteristic of the acute-trauma period than PTSD symptoms. Eighty-three hospitalized adult burn patients were assessed with structured interviews and self-report measures within 2 weeks of injury and again at least 6 months postburn. Nineteen percent had ASD. Dissociative symptoms were not more common or more severe than PTSD symptoms. Thirty-six percent had chronic PTSD. While ASD predicted chronic PTSD, meeting the symptom criteria for PTSD within 2 weeks postburn also predicted chronic PTSD. Our data support the inclusion of an ASD diagnosis in the DSM, which would allow the diagnosis of symptoms in the first month posttrauma as a psychiatric disorder but questions whether dissociation is more characteristic of the acute trauma period than the PTSD symptom clusters.

Pharmacotherapy for survivors of childhood trauma.

Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.

Battlefield functioning and chronic PTSD: associations with perceived self efficacy and causal attribution

This study has two aims: (1) to examine the associations between battlefield functioning and perceived self efficacy (PSE) and attributional style; (2) to examine the unique and cumulative contributions of battlefield functioning, PSE, and attributional style to long term PTSD. The subjects were three groups of Israeli veterans of the 1973 Yom Kippur, who differed in their battlefield functioning: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The subjects filled out a series of questionnaires that assessed PTSD, PCE, attributional style and PTSD, two decades after the war. CSR casualties exhibited the lowest level of PSE, decorated veterans the highest. The three groups also differed in locus of control, with different attribution for failure. Discriminant analysis of PTSD and non-PTSD veterans showed that sociodemographic background, battlefield performance, PSE and attributional style classified 81% of all veterans correctly. The implications of these findings are discussed.

Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout

The present study investigated predictors of treatment outcome and dropout in two samples of PTSD-patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.

A longitudinal study of “intrusion-based reasoning” and posttraumatic stress disorder after exposure to a train disaster

Previously, we found that chronic PTSD relates to “intrusion-based reasoning” (IR), i.e. the tendency to interpret distressing intrusions themselves as evidence that danger is impending, regardless of objective danger information (Engelhard et al., Behav. Res. Ther. 39 (2001) 1139). This study was intended to elucidate the causal status of this relation. Twenty-nine residents of a Belgian town witnessed a train crash and were assessed for IR and PTSD symptoms within 1 month and were re-assessed for PTSD at 3.5 months. Fourteen control residents did not witness the crash and were also tested for IR. The IR paradigm involved rating the danger of brief scenarios in which objective danger and presence of intrusions about the crash were systematically varied. The directly exposed residents showed greater danger ratings to scenarios in which intrusions were included than did the controls. IR was strongly related to both acute and chronic PTSD symptoms. It did not significantly predict chronic PTSD symptoms after controlling for acute symptoms, although the partial correlation ( r=0.26, p=0.09) was in the expected direction. The data suggest that IR is involved in the onset and maintenance of PTSD symptoms, but more clarity about causality awaits future larger and experimental studies.

A controlled evaluation of cognitive behaviorial therapy for posttraumatic stress in motor vehicle accident survivors

Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe sub-syndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior ( p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs ( n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.

Combat-Induced Dissociative Amnesia

Dissociative amnesia following combat trauma in various wars has been extensively documented. In this article, we describe theoretical constructs related to dissociative amnesia, and integrate them with clinical practice through the presentation of a case. Although there is ample documentation of this condition in combat soldiers, in actual clinical practice such dissociative amnesia is probably underdiagnosed and undertreated. This may be detrimental to therapeutic progress, given the fact that ongoing memory deficits constitute one of the core symptoms of chronic PTSD in combat veterans. As illustrated in our case example of combat-induced generalized dissociative amnesia, combat-induced amnesia may also reflect previously existing dissociated traumatic memories that become reactivated during trauma. In this case, intensive treatment using hypnosis within a larger therapeutic milieu involved both the uncovering and processing of recent dissociated traumatic experiences, and, by necessity, other traumas of the past.

Linguistic predictors of trauma pathology and physical health

AbstractThe present study examined how specific linguistic elements in trauma narratives were associated with post‐treatment psychopathology and physical symptoms. We analysed the narratives of 28 female assault victims being treated for chronic PTSD. During exposure therapy, participants were asked to recount their assault ‘as if it was happening now’. These trauma narratives were videotaped, transcribed, and analysed using a linguistic coding program. In particular, narratives containing words about death and dying were associated with worse post‐treatment functioning. This relationship could not be accounted for by assault‐related characteristics. The focus on death and dying in the trauma narrative may reflect the concept of mental defeat, suggesting a possible target for intervention in cognitive‐behavioural treatment of PTSD. Copyright © 2001 John Wiley & Sons, Ltd.

Effective Treatments for PTSD

Foa, Keane, Friedman, Cohen, Introduction. Part I: Assessment and Diagnosis of PTSD. Weathers, Keane, Foa, Assessment and Diagnosis of Adults. Balaban, Assessment of Children. Part II: Early Interventions: Treatment of ASD and Prevention of Chronic PTSD. Bisson, McFarlane, Rose, Ruzek, Watson, Psychological Debriefing for Adults. Brymer, Steinberg, Vernberg, Layne, Watson, Jacobs, Ruzek, Pynoos, Acute Interventions for Children and Adolescents. Litz, Bryant, Early Cognitive-Behavioral Interventions for Adults. Part III: Treatment Approaches for Chronic PTSD. Cahill, Rothbaum, Resick, Follette, Cognitive-Behavioral Therapy for Adults. Cohen, Mannarino, Deblinger, Berliner, Cognitive-Behavioral Therapy for Children and Adolescents. Friedman, Davidson, Stein, Psychopharmacotherapy for Adults. Donnelly, Psychopharmacotherapy for Children and Adolescents. Spates, Koch, Cusack, Pagoto, Waller, Eye Movement Desensitization and Reprocessing. Shea, McDevitt-Murphy, Ready, Schnurr, Group Therapy. Jaycox, Stein, Amaya-Jackson, School-Based Treatment for Children and Adolescents. Kudler, Krupnick, Blank Jr., Herman, Horowitz, Psychodynamic Therapy for Adults. Lieberman, Ippen, Marans, Psychodynamic Therapy for Child Trauma. Glynn, Drebing, Penk, Psychosocial Rehabilitation. Cardena, Maldonado, van der Hart, Spiegel, Hypnosis. Riggs, Monson, Glynn, Canterino, Couple and Family Therapy for Adults. Johnson, Lahad, Gray, Creative Therapies for Adults. Goodman, Chapman, Gantt, Creative Arts Therapies for Children. Najavits, Ryngala, Back, Bolton, Mueser, Brady, Treatment of PTSD and Comorbid Disorders. Part IV: Treatment Guidelines. Psychological Debriefing for Adults. Acute Interventions for Children and Adolescents. Early Cognitive-Behavioral Interventions for Adults. Cognitive-Behavioral Therapy for Adults. Cognitive-Behavioral Therapy for Children and Adolescents. Psychopharmacotherapy for Adults. Psychopharmacotherapy for Children and Adolescents. Eye Movement Desensitization and Reprocessing. Group Therapy. School-Based Treatment for Children and Adolescents. Psychodynamic Therapy for Adults. Psychodynamic Therapy for Child Trauma. Psychosocial Rehabilitation. Hypnosis. Couple and Family Therapy for Adults. Creative Therapies for Adults. Creative Arts Therapies for Children. Treatment of PTSD and Comorbid Disorders. Part V: Conclusion. Friedman, Cohen, Foa, Keane, Integration and Summary.

Cognitive functioning and the early development of PTSD.

Cross-sectional studies of chronic PTSD reveal deficits in verbal memory. We studied cognitive functioning and its relationship to current and subsequent PTSD severity during an early phase of trauma response. Thiry-eight participants with traumatic injuries and only posttrauma incident psychopathology were evaluated shortly after admission to a Level I Trauma Center Neuropsychological measures were obtained at baseline and assessment of PTSD and other psychiatric disorders was conducted at baseline and follow-up, 6 weeks later. Significant negative correlations were found for follow-up PTSD severity with delayed recall and retroactive interference. These relationships were not significant for and were independent of baseline PTSD severity. Relative deficits in select areas of verbal memory after a trauma may confer greater risk for developing PTSD.

Stability of emotions for traumatic memories in acute and chronic PTSD

While memory for central factual information regarding an emotional event is considered to be relatively accurate, memory for emotions seem to be quite inaccurate ( Christianson & Safer, 1995). We extended this line of research to examine memory for the emotional intensity surrounding a traumatic event (e.g., memory for the fear and horror of the event). We conducted a series of two studies. In Study 1, we examined memory for the emotional intensity of the traumatic event in recent sexual or non-sexual assault victims with acute PTSD at 2 and 12 weeks following the assault. In Study 2, we compared memory for emotional intensity in sexual and non-sexual assault victims with either acute or chronic PTSD at initial assessment and 12 weeks later. For both studies, participants were asked to recall general emotional intensity, fear intensity, and dissociative intensity of the traumatic event. Results suggested that memory for the fear of the traumatic event did not fluctuate over time. However, memory for the general emotional and dissociative intensity did fluctuate over time, decreasing for individuals with acute PTSD and increasing for individuals with chronic PTSD.

Posttraumatic stress disorder in rape victims: autonomic habituation to auditory stimuli.

Impaired capacity for physiological habituation may contribute to the persistence of PTSD. Habituation of autonomic responses to auditory tones was examined in 43 women in three groups: 14 adult female rape survivors with chronic PTSD, 11 without PTSD, and a comparison group of 18 who had not been raped. There were no significant differences among the groups in baseline cardiac or electrodermal activity. The PTSD group showed significantly slower electrodermal habituation, as measured by trials to extinction and percentage of nonhabituators, than did the comparison groups. The present study found slower habituation of electrodermal responses for PTSD rape victims to neutral stimuli than for non-PTSD victims and nonvictims.

Olfactory precipitation of PTSD symptoms in combat veterans with chronic PTSD: Preliminary findings of a pet study

Olfactory precipitation of PTSD symptoms in combat veterans with chronic PTSD: Preliminary findings of a pet study

Dysfunctional meaning of posttraumatic intrusions in chronic PTSD

The paper suggests that the negative idiosyncratic meaning of posttraumatic intrusions (e.g., ‘I am going crazy’) and cognitive strategies intended to control the intrusions play a major role in maintaining posttraumatic stress disorder. Two studies of 159 and 138 motor vehicle accidents survivors showed that the dysfunctional meaning of intrusions explained a proportion of the variance of the intrusion-related distress, strategies used to end the intrusions, and PTSD severity that was not explained by intrusion frequency, accident severity, or by general catastrophic thoughts when anxious. Rumination, thought suppression, and distraction when having intrusions showed substantial correlations with PTSD severity, as did avoidance of reminders of the accident. The results have implications for the treatment of chronic PTSD.

Factors associated with outcome of cognitive-behavioural treatment of chronic post-traumatic stress disorder

This study examined factors that were associated with outcome in the treatment of PTSD. A trial of cognitive therapy compared to imaginal exposure of chronic PTSD showed that although clinical improvements were obtained after treatment and at 6 month follow-up one type of treatment was not significantly superior to the other. Characteristics of the patient, the trauma and treatment and of pre-treatment clinical measures were investigated as predictors of PTSD outcome. Eleven variables were significantly associated with the pre- to post-treatment change in CAPS severity scores. Of these, three (duration of therapy, gender and suicide risk) were selected into a step-wise multiple regression equation to explain 36.5% of the outcome. Similarly, nine variables were significant associated with the pre-treatment to follow-up change with three variables (number of missed therapy sessions, residential status and co-morbid GAD) being selected into the equation and explaining 36.9% of the outcome. The best predictor of outcome was inconsistent attendance at therapy.