Effective Treatment For Posttraumatic Stress Disorder Research Articles

MDMA-assisted therapy for PTSD

MDMA is a potential novel treatment for post-traumatic stress disorder (PTSD). Our goal is to review current knowledge on MDMA and its use in MDMA-assisted psychotherapy for PTSD. Literature searches were done on PubMed, Web of Science and Google Scholar and references reviewed in identified articles. MDMA-assisted therapy for PTSD usually consists of a few preparatory sessions before two or three sessions where one or two oral doses of MDMA are given along with supportive psychotherapy. The therapy is delivered in the presence of two therapists for about eight hours each time. In addition, the patient receives up to 9 integrative sessions in due course. This use of MDMA as a part of psychotherapy for PTSD is proposed to lessen the psychological distress that often arises in the processing of traumatic events to facilitate the treatment process and reduce the risk of drop-out. Recent studies indicate that MDMA-assisted psychotherapy reduces PTSD symptoms and is generally well tolerated. These studies are necessary if this MDMA-assisted treatment is to be approved by licensing authorities. There is an urgent need for new effective treatments for PTSD and for comparisons between this MDMA-assisted psychotherapy and currently approved psychotherapies with and without MDMA-use.

Prolonged exposure treatment for post-traumatic stress disorder: Single case studies in a sample of adults with mild intellectual disabilities.

Post-traumatic stress disorder (PTSD) is common in adults with intellectual disabilities. Often there are additional disorders such as substance use, mood and anxiety disorders. The current study focuses on the feasibility and initial efficacy of prolonged exposure (PE) for PTSD in adults with mild intellectual disabilities. The secondary effect of PE on additional mood, anxiety and substance use disorders is also examined. A single case experimental design (N = 12) with an A (baseline)-B (intervention) phase including a follow-up measurement after 3 months was conducted. Time series and single time points measurements were performed. Six participants dropped-out. The results showed a significant decrease in PTSD symptoms and a significant decrease in additional symptoms (social avoidance, anxiety and stress), among participants who completed treatment. PE appears to be a feasible and effective treatment for PTSD in some adults with mild intellectual disabilities. Suggestions emerge from this study to make standard PE treatment more appropriate for adults with mild intellectual disabilities. Further research is needed to reduce drop-out in trauma treatment. Some suggestions for this are made in this study. Treatment of PTSD with PE did not appear to affect comorbid mood disorders. Further research is needed.

Causal Associations between Posttraumatic Stress Disorder and COVID-19.

We aimed to evaluate bidirectional genetic relationships between posttraumatic stress disorder (PTSD) and COVID-19. We investigated potential causal associations between PTSD and two COVID-19 conditions (COVID-19 hospitalization and SARS-CoV-2 infection) via Mendelian randomization (MR) analyses. Three genome-wide association study (GWAS) summary datasets were used in the study, including PTSD (N = 174,659), SARS-CoV-2 infection (N = 2,597,856), and COVID-19 hospitalization (N = 2,095,324). We performed a literature-based analysis to uncover molecular pathways connecting PTSD and COVID-19. We found that PTSD exerts a causal effect on SARS-CoV-2 infection (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.00-1.21, p = 0.048) and hospitalized COVID-19 (OR: 1.34, 95% CI: 1.07-1.67, p = 0.001). However, both SARS-CoV-2 infection and hospitalized COVID-19 were not associated with the risk of PTSD. Pathway analysis revealed that several immunity-related genes may link PTSD to COVID-19. Our study suggests that PTSD was associated with increased risks for COVID-19 susceptibility and severity. Early diagnosis and effective treatment of PTSD in individuals infected with the coronavirus may improve the management of the outcomes of COVID-19.

An Overview of Written Exposure Therapy: A Brief Treatment for PTSD

This article provides an overview of written exposure therapy (WET), which is a brief treatment approach for posttraumatic stress disorder (PTSD). The development of the treatment is described and the research supporting its efficacy and effectiveness is discussed. To date, research has found WET to be an effective treatment approach for PTSD, having treatment outcomes that are noninferior to more time-intensive PTSD treatments. The dropout rates for WET have generally been low. Research has examined WET with a variety of trauma samples delivered in diverse settings and in multiple countries using different language translations without modifications to the protocol. Overall, the rapidly growing literature indicates that WET is an effective brief treatment for PTSD that can be used in many different settings. Recommendations for future research include additional studies examining implementation of treatment as well as dissemination work. [ Psychiatr Ann . 2024;54(3):e70–e74.]

Eye movement desensitization and reprocessing (EMDR) therapy compared to usual treatment for posttraumatic stress disorder in adults with psychosis in forensic settings: Randomized controlled trial.

Little direct evidence supports any particular treatment for posttraumatic stress disorder (PTSD) in people with schizophrenia, forensic histories, and/or multiple comorbidities. This trial assesses the efficacy and risks of eye movement desensitization and reprocessing (EMDR) for people with PTSD and psychotic disorders receiving forensic care, including inpatients and prisoners. Single-blind randomized controlled trial comparing EMDR therapy to wait-list (routine care) in forensic-treated adults with psychotic disorders and PTSD. The primary outcome was clinician-rated PTSD symptoms. Secondary outcomes included participant-rated PTSD symptoms, psychotic symptoms, social functioning, disability level, self-esteem, depressive symptoms, posttraumatic cognitions, complex posttraumatic difficulties, and adverse events. Blinded investigators assessed outcomes at baseline, and after 10 weeks and 6 months. Analysis of the primary outcome was by a mixed linear model. Twenty-four participants were randomized, recruitment being hindered by COVID-19 restrictions. Clinician Administered PTSD Scale mean (SD) scores after 6 months were lower (better) in the EMDR group, 21.3 (13.3), compared with the control group, 31.5 (20.7). The point estimate [95% CI] difference, averaged over two measurement times, was 11.4 [1.3, 21.4], p = .028, favoring EMDR. Self-esteem increased in the EMDR group and depressive symptoms and disability reduced. There were no statistically significant differences in psychotic symptoms or adverse events, although point estimates favored EMDR. This is the first EMDR trial in mental health inpatient, forensic, or custodial settings, where PTSD is common. There were improvements in PTSD and other symptomatology consistent with EMDR being a safe and effective treatment for PTSD in these settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials

Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. None.

Лікування ПТСР та розладів адаптації у учасників та ветеранів бойових дій за допомогою терапії прийняття та відповідальності (ACT): Тези до майбутьного дослiдження

Ukraine faced numerous challenges accompanied by an increased level of psychotraumatic events in society. Historical events, including war, the annexation of Crimea, and other socio-political transformations, have contributed to an increase in the number of individuals who may exhibit symptoms of post-traumatic stress disorder (PTSD) and adjustment disorders. The growing need for qualified psychotherapy services and PTSD treatment programs in the country is urgent. However, the existing services are not yet sufficiently developed to satisfy this need at an adequate level. Increasing awareness and education in mental health issues in society actualizes the need for further scientific research and development of effective and economically justified methods of treatment. ACT (Acceptance and Commitment Therapy) is a progressive approach that helps people with PTSD change their attitudes about their memories and feelings through acceptance rather than avoidance. This method is actively studied and used in countries with developed medical science, for example, in the USA, Canada and Great Britain. In the context of Ukraine, where the topic may be less researched, the need to develop an adapted ACT model, conduct clinical trials, educate professionals, and develop supportive resources for patients and their families is urgent. Such measures will contribute to more effective treatment of PTSD and adjustment disorders in Ukrainian society.

Psychodrama group psychotherapy as an effective treatment for PTSD and depression in inpatient substance use treatment: a mixed methods study

ABSTRACT This mixed-methods study (n = 60) explores the effectiveness of psychodrama in reducing symptoms of Post-Traumatic Stress Disorder (PTSD) and depression in an inpatient drug and alcohol facility. Quantitative findings demonstrate an average decrease in PTSD by 45% and in depression by 69%. Qualitative data from participant surveys support the outcomes and shed additional light on participants’ experience participating in trauma-focused psychodrama. Both quantitative and qualitative outcomes suggest treatment effects were similar regardless of whether participants were the psychodrama protagonist, played a supportive role, or observed. Results add to the evidence-base of psychodrama as an effective group therapy approach for trauma and depression while supporting participants in their recovery from addiction. While there are limitations to this research design, findings contribute to the research base supporting psychodrama’s effectiveness as a group psychotherapy.

Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder

First-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction. To evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions. This multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT. The TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions. Sociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention. Of 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P < .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points. In this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations. ClinicalTrials.gov Identifier: NCT02640690.

Exploration of eye movement desensitization and reprocessing in treating posttraumatic stress-disorder in patients with acquired brain injury: a retrospective case series

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is prevalent in people with acquired brain injury (ABI). Despite the established efficacy of eye movement desensitization and reprocessing (EMDR) for PTSD in general, evaluation studies on EMDR in ABI patients with PTSD are limited. Objective: The aim of this study is to explore clinical features, treatment characteristics, feasibility and first indications of efficacy of EMDR in adult ABI patients with PTSD. Method: This retrospective consecutive case series included ABI patients, who received at least one session of EMDR for PTSD between January 2013 and September 2020. PTSD symptoms were measured using the Impact of Event Scale (IES) pre- and post-treatment. Affective distress was measured using the Subjective Units of Distress (SUD) pre- and post-treatment of the first target. Results: Sixteen ABI patients (median age 46 years, 50% males), with predominantly moderate or severe TBI (50%) or stroke (25%) were included. Treatment duration was a median of seven sessions. Post-treatment IES scores were significantly lower than pre-treatment scores (p < .001). In 81% of the cases there was an individual statistically and clinically relevant change in IES score. Mean SUD scores of the first target were significantly lower at the end of treatment compared to scores at the start of treatment (p < .001). In 88% of the patients full desensitization to a SUD of 0–1 of the first target was accomplished. Only few adjustments to the standard EMDR protocol were necessary. Conclusions: Findings suggest that EMDR is a feasible, well tolerated and potentially effective treatment for PTSD in ABI patients. For clinical practice in working with ABI patients, it is advised to consider EMDR as a treatment option.

POST-TRAUMATIC STRESS DISORDER FOR MILITARY SERVANTS: THEORY, RESEARCH AND TREATMENT

Military service is associated with exposure to traumatic stressors, including war zone hazards, accidents, and other occupational hazards, which may place military personnel at increased risk for the developing post-traumatic stress disorder (PTSD). The overall lifetime prevalence of PTSD among the world’s population varies between 10.0-11.3% for women and 5.0-6.0% for men. Among military veterans, the lifetime prevalence of the disorder is 13.4% and 7.7% for women and men, respectively.&#x0D; The United States Department of Veterans Affairs and the United States Department of Defense recommend a clinical methodology for the treatment of PTSD, which includes the following components: a diagnosis based on the criteria of the “Diagnostic and Statistical Manual of Mental Disorders” of the American Psychiatric Association; the presence of a high risk of harming oneself or others; functional status including duty and level of work responsibility; risk and protective factors; treatment history; medical history of the patient and his family. At the same time, joint decision-making with the patient is assumed, the key components of which are taking into account the patient’s preferences, educating the patient and his relatives with the concept of psychological trauma and the peculiarities of the course of PTSD, joint consideration with the patient of the advantages and disadvantages of available treatment options. The PTSD treatment process necessarily must be trauma-oriented and include the following types of psychotherapy: prolonged exposure, cognitive processing therapy, cognitive-behavioral therapy, brief eclectic psychotherapy, narrative exposure therapy, eye movement desensitization and reprocessing, and written exposure therapy. For situations where clinicians are not trained in trauma-focused psychotherapy or when patients refuse to initiate treatment, pharmacotherapy or non-trauma-focused manualized psychotherapy that includes stress resistance training, life-focused therapy, and interpersonal psychotherapy is recommended.&#x0D; Despite certain successes in the treatment of PTSD, important questions remain unsolved. First of all, there is a lack of clinical research to compare the effectiveness of the many available psychological treatments in general and for active-duty military personnel in particular. It is necessary to continue research in the field of precision medicine, which will make it possible to choose the most effective treatment for PTSD for each serviceman individually. To resolve these and similar issues, further long-term, consistent studies conducted on representative samples are needed.

Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees

BackgroundBurgeoning research suggests that people exposed to the 9/11/2001 terrorist attacks in New York City (NYC) may be at greater risk for cognitive impairment due to a variety of potential exposures. We investigated whether posttraumatic stress disorder (PTSD) history was associated with self-reported confusion or memory loss (CML) among World Trade Center Health Registry enrollees. MethodsThe study sample included enrollees who completed all five wave surveys (W1 in 2003–04 through W5 in 2020–21), were between the ages of 35 and 64 during W3-W5, and had no history of stroke or dementia (N = 11,432). We categorized PTSD history during W1-W3 as chronic-high, increased, decreased, or resilient-low with trajectory analysis. Generalized estimating equations modeling was used for the repeated measures analysis of the outcome, CML. ResultsCompared to those in the resilient-low PTSD group, those in the decreased and increased PTSD groups were at over 52% greater risk of reporting CML; those in the chronic-high PTSD group had between a 1.62 and 1.92 times greater risk of CML than the resilient-low PTSD group, with non-rescue/recovery workers having greater risk on average. PTSD history was also associated with elevated risk of more severe CML-related outcomes in W5 – specifically, experiencing worsening symptoms and functioning in daily life. LimitationsCML symptoms are self-reported, and generalizability of results may be limited. ConclusionsThese findings suggest that survivors with PTSD should be monitored for cognitive issues, including CML. Effective treatment of PTSD may have benefits beyond mitigation of PTSD symptoms.

Live Z-Score Neurofeedback Training for PTSD: A Feasibility and Acceptability Study

Individuals with traumatic experiences may develop symptoms of post-traumatic stress disorder (PTSD) and co-morbid disorders, such as anxiety disorders, major depression, and substance use disorder. Although exposure therapy is considered the “gold standard” for the treatment of PTSD, dropout rates and patient distress are relatively high. One promising approach is live Z-score neurofeedback (ZNF) training, but clinical evidence is sparse. Thus, the current study aimed to evaluate the feasibility and acceptability of ZNF training among individuals with PTSD. After undergoing a diagnostic interview utilizing the MINI Neuropsychiatric Interview, nine patients with PTSD (7 females; mean age = 20.75 [SD = 2.38]) completed ten ZNF sessions, lasting 20 min each, and the PCL-5 at pre- and post-treatment. Over the course of the study, only a few minor study disruptions, adverse events, and patient complaints were reported, and participants rated high on feasibility and acceptability. Results from repeated measures ANOVAs suggest significant improvements in overall PTSD symptoms. Although these findings need to be replicated in larger samples with active control groups, the current study provides support that ZNF is a safe, acceptable, and potentially effective treatment for PTSD.

Neurofeedback Effect on Symptoms of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD's psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback's effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a - 0.74 SMD (95% confidence interval = - 0.9230, - 0.5567), 42% I2, moderate effect size, and - 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.

Experiences of traumatic events, knowledge and attitudes concerning post-traumatic stress disorder, and resilience among nurses and paramedics working in emergency department

Purpose: This study aimed to assess exposure to traumatic events, knowledge and attitudes concerning post-traumatic stress disorder (PTSD) and the level of resilience among nurses and paramedics working in emergency departments. Methods: Data were collected from May 22 to June 12, 2022, using a self-administered survey questionnaire. The participants comprised 135 nurses and 80 paramedics working in emergency departments. The collected data were analyzed with descriptive statistics, a t-test, and an analysis of variance with Scheffé’s test. Results: Compared with emergency room nurses, paramedics were more positive about the government’s spending on job opportunities for people with PTSD. There were no significant differences in attitude regarding government strategies and people with PTSD between nurses and paramedics. Paramedics had higher scores on the effective treatment for PTSD, while emergency room nurses showed higher scores on effective psychotherapy. General knowledge of PTSD differed according to sex (t=-2.33, &lt;i&gt;p&lt;/i&gt;=.021) and education level (F=3.21, &lt;i&gt;p&lt;/i&gt;=.042). Resilience scores differed significantly according to sex (t=2.02, &lt;i&gt;p&lt;/i&gt;=.045), education level (F=4.10, &lt;i&gt;p&lt;/i&gt;=.018), self-reported economic state (F=10.34, &lt;i&gt;p&lt;/i&gt;&lt;.001), and self-reported health (F=11.57, &lt;i&gt;p&lt;/i&gt;&lt;.001). Conclusion: The findings support that emergency department nurses and paramedics are in need of self-care programs to support their mental health and indicate that intervention programs should be developed to enhance resilience in emergency department professionals.

Some observations on remote delivery of eye‐movement desensitisation and reprocessing to people with intellectual disabilities

AbstractIt is increasingly recognised that many people with intellectual disabilities suffer from post‐traumatic stress disorder (PTSD). Eye‐movement desensitisation and reprocessing (EMDR) has been proposed as a potentially helpful intervention that is less reliant on verbal skills than other effective treatments for PTSD and therefore could be more effective than verbal interventions for people with intellectual disabilities. The Trauma‐AID project is a randomised clinical trial (RCT) evaluating the effectiveness of a bespoke EMDR protocol for adults with intellectual disability and PTSD, which incorporates a prolonged phase of Psycho‐Education and Stabilisation (PES) prior to the trauma confrontation phase of EMDR. The COVID‐19 pandemic struck during the feasibility phase of the Trauma‐AID project, necessitating a second feasibility study to evaluate the acceptability and feasibility of remote or hybrid delivery of the PES + EMDR protocol. To this end, we conducted two online surveys of therapists followed by interviews with clients, carers and senior therapists. The surveys were analysed descriptively. Content analysis was used for client and carer interviews, and framework analysis for therapist interviews. All stakeholders reported positive experiences of EMDR; however, some challenges were identified. The majority of clients, carers and therapists interviewed reported that the intervention, whether PES alone or the full PES‐EMDR package, had improved symptoms of PTSD and psychological well‐being, and carers also reported decreases in challenging behaviour. A full account of the data is provided in four Supplementary Digital files. PES‐EMDR therapy appears both feasible and acceptable for clients with intellectual disabilities and therapists, whether delivered face‐to‐face or in a remote or hybrid mode, though remote working appears easier for the PES phase than the EMDR phase of the intervention.

Long-term sevoflurane exposure relieves stress-enhanced fear learning and anxiety in PTSD mice.

Post-traumatic stress disorder (PTSD) is characterized by recurrent episodes of severe anxiety after exposure to traumatic events. It is believed that these episodes are triggered at least in part by environmental stimuli associated with the precipitating trauma through classical conditioning, termed conditioned fear. However, traditional methods of conditioned fear memory extinction are frequently ineffective for PTSD treatment due to the contribution of non-associative sensitization caused by trauma. Anesthetics have shown promise for treating various psychiatric diseases such as depression. In this study, we examined if the inhaled anesthetic sevoflurane can suppress stress-enhanced fear learning (SEFL) in PTSD model mice. Model mice exposed to 2.4% sevoflurane for 6 h exhibited reduced freezing time and behavioral anxiety compared to sham-treated model mice. To explore the underlying mechanisms, we evaluated the regional expression levels of glucocorticoid receptors (GRs), cannabinoid CB1 receptors (CB1Rs), D1 dopamine receptors (D1Rs), and D2 dopamine receptors (D2Rs). We verified that both GR and CB1R were significantly upregulated in the hippocampus, amygdaloid nucleus, and prefrontal cortex (PFC) of model mice, while D1R and D2R were downregulated. All of these expression changes were partially normalized in the PFC by 6 h but not with 2 h sevoflurane exposure. These results showed that sevoflurane exposure following traumatic events may be an effective treatment for PTSD.

Prevention of posttraumatic stress during inpatient rehabilitation post spinal cord injury: Study protocol for a randomized controlled trial of Brief Prolonged Exposure Therapy (Brief PE)

BackgroundScant research has focused on posttraumatic stress disorder (PTSD) in the SCI population, despite high prevalence estimates. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. Our recent clinical trial showed that standard 12-session PE was effective for PTSD treatment among inpatients with SCI. Early intervention with brief PE (3-sessions) delivered in the emergency department has also been effective for PTSD prevention, but has not been tested among people post-SCI. Thus, we aim to conduct the first test of the Brief PE intervention to prevent PTSD among patients with SCI. MethodsAdults who have experienced a SCI (N = 200) will be randomly assigned during inpatient rehabilitation to either: (a) 3 60-min sessions of Brief PE (intervention group) or (b) treatment as usual (control group). ResultsThe primary outcome measure (PTSD symptoms measured by the PSSI-5) and secondary outcome measures (depression, anxiety, pain, quality of life, sleep disturbance, and resilience) will be assessed at baseline, 1-month, 3-months, and 6-months. Hierarchical linear modeling (HLM) will be used to evaluate the effectiveness of the PE intervention on PTSD and secondary outcomes. Descriptive statistics will examine feasibility and will include the number of participants enrolled, the number of sessions completed, fidelity of Brief PE delivery, and average scores for difficulty and helpfulness of the intervention scales for those randomized to intervention. ConclusionsSuccessful completion of this study will provide an evidence-based program to alleviate posttraumatic distress post spinal cord injury and prevent long-term development of PTSD.

MDMA administration attenuates hippocampal IL-β immunoreactivity and subsequent stress-enhanced fear learning: An animal model of PTSD

Post-traumatic stress disorder (PTSD) is a devastating disorder that involves maladaptive changes in immune status. Using the stress-enhanced fear learning (SEFL) paradigm, an animal model of PTSD, our laboratory has demonstrated increased pro-inflammatory cytokine immunoreactivity in the hippocampus following severe stress. Recent clinical trials have demonstrated 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy as an effective novel treatment for PTSD. Interestingly, MDMA has been shown to have an immunosuppressive effect in both pre-clinical and clinical studies. Therefore, we predict MDMA administration may attenuate SEFL, in part, due to an immunosuppressive mechanism. The current studies test the hypothesis that MDMA is capable of attenuating SEFL and inducing alterations in expression of TNF-α, IL-1β, glial fibrillary acidic protein (GFAP), an astrocyte specific marker, and ionized calcium-binding adapter molecule −1 (IBA-1), a microglial specific marker, in the dorsal hippocampus (DH) following a severe stressor in male animals. To this end, experiment 1 determined the effect of MDMA administration 0, 24, and 48 h following a severe foot shock stressor on SEFL. We identified that MDMA administration significantly attenuated SEFL. Subsequently, experiment 2 determined the effect of MDMA administration following a severe stressor on the expression of TNF-α, IL-1β, GFAP, and IBA-1 in the DH. We found that MDMA administration significantly attenuated stress-induced IL-1β and stress-reduced IBA-1 but had no effect on TNF-α or GFAP. Overall, these results support the hypothesis that MDMA blocks SEFL through an immunosuppressive mechanism and supports the use of MDMA as a potential therapeutic agent for those experiencing this disorder. Together, these experiments are the first to examine the effect of MDMA in the SEFL model and these data contribute significantly towards the clinical PTSD findings.

The Redesign and Validation of Multimodal Motion-Assisted Memory Desensitization and Reconsolidation Hardware and Software: Mixed Methods, Modified Delphi-Based Validation Study.

BackgroundIn recent years, the delivery of evidence-based therapies targeting posttraumatic stress disorder (PTSD) has been the focus of the Departments of Defense in countries such as Canada, the Netherlands, and the United States. More than 66% of military members continue to experience symptoms of PTSD that significantly impact their daily functioning and quality of life after completing evidence-based treatments. Innovative, engaging, and effective treatments for PTSD are needed. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) is an exposure-based, virtual reality–supported therapy used to treat military members and veterans with treatment-resistant PTSD. Given the demonstrated efficacy of 3MDR in recently published randomized control trials, there is both an interest in and a need to adapt the intervention to other populations affected by trauma and to improve accessibility to the treatment.ObjectiveWe aimed to further innovate, develop, and validate new and existing hardware and software components of 3MDR to enhance its mobility, accessibility, feasibility, and applicability to other populations affected by trauma, including public safety personnel (PSP), via international collaboration.MethodsThis study used a modified Delphi expert consultation method and mixed methods quasi-experimental validation with the purpose of software validation among PSP (first responders, health care providers) participants (N=35). A team of international experts from the Netherlands, the United States, and Canada met on the web on a weekly basis since September 2020 to discuss the adoption of 3MDR in real-world contexts, hardware and software development, and software validation. The evolution of 3MDR hardware and software was undertaken followed by a mixed methods software validation study with triangulation of results to inform the further development of 3MDR.ResultsThis study resulted in the identification, description, and evolution of hardware and software components and the development of new 3MDR software. Within the software validation, PSP participants widely acknowledged that the newly developed 3MDR software would be applicable and feasible for PSP affected by trauma within their professions. The key themes that emerged from the thematic analysis among the PSP included the desire for occupationally tailored environments, individually tailored immersion, and the applicability of 3MDR beyond military populations.ConclusionsWithin the modified Delphi consultation and software validation study, support for 3MDR as an intervention was communicated. PSP participants perceived that 3MDR was relevant for populations affected by trauma beyond military members and veterans. The resulting hardware and software evolution addressed the recommendations and themes that arose from PSP participants. 3MDR is a novel, structured, exposure-based, virtual reality–supported therapy that is currently used to treat military members and veterans with PTSD. Going forward, it is necessary to innovate and adapt 3MDR, as well as other trauma interventions, to increase effectiveness, accessibility, cost-effectiveness, and efficacy among other populations affected by trauma.