Efficacy Of Prolonged Exposure Therapy Research Articles

Prolonged exposure therapy and its implication through telehealth

Patients with post-traumatic stress disorder (PTSD) usually suffer from avoidance symptoms which might intervene against seeking adequate healthcare and medical consultation for their conditions. As a result of the reduced support to these patients, it has been demonstrated that PTSD symptoms usually persist based on the continuous feeling of avoidance among them. Evidence indicates the efficacy of prolonged exposure therapy for PTSD patients that are usually exposed to traumas as anger issues, comorbid depression, guilt, and alcohol overuse conditions. In the present literature review, we have discussed the concept of conducting prolonged exposure therapy for patients with PTSD and the different implications and effectiveness of telehealth in this field. Evidence indicates the effectiveness of prolonged exposure therapy in managing PTSD regarding symptoms reduction of intensity and improvement. Conducting the therapy through telehealth was also reported with favorable outcomes comparable with the outcomes of the in-person interviews with no adverse events. However, drop-outs have been reported to be high among telehealth-mediated sessions, and therefore, serious approaches should be exerted to overcome these issues. Further considerations should also be provided for patients in certain situations as pandemics to enhance the quality of treatment. Finally, further research is still needed to target areas with poor access to telehealth-related modalities, and introduce the modality to the affected populations and urge local health authorities to provide easy accessibility to these patients.

Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder

ImportanceMeta-analyses of treatments for posttraumatic stress disorder (PTSD) suggest that trauma-focused psychotherapies produce greater benefits than antidepressant medications alone.ObjectiveTo determine the relative efficacy of prolonged exposure therapy plus placebo, prolonged exposure therapy plus sertraline hydrochloride, and sertraline plus enhanced medication management in the treatment of PTSD.Design, Setting, and ParticipantsThe Prolonged Exposure and Sertraline Trial was a randomized, multisite, 24-week clinical trial conducted at the Veterans Affairs Ann Arbor Healthcare System, Veterans Affairs San Diego Healthcare System, Ralph H. Johnson Veterans Affairs Medical Center, and Massachusetts General Hospital Home Base Veterans Program between January 26, 2012, and May 9, 2016. Participants and clinicians were blinded to pill condition, and outcome evaluators were blinded to assignment. Participants completed assessments at weeks 0 (intake), 6, 12, 24, and 52 (follow-up). Participants (N = 223) were service members or veterans of the Iraq and/or Afghanistan wars with combat-related PTSD and significant impairment (Clinician-Administered PTSD Scale score, ≥50) of at least 3 months’ duration. Analyses were on an intent-to-treat basis.InterventionParticipants completed up to thirteen 90-minute sessions of prolonged exposure therapy by week 24. Sertraline dosage was titrated during a 10-week period and continued until week 24; medication management was manualized.Main Outcomes and MeasuresThe primary outcome was symptom severity of PTSD in the past month as assessed by the Clinician-Administered PTSD Scale score at week 24.ResultsOf 223 randomized participants, 149 completed the study at 24 weeks, and 207 (180 men and 27 women; mean [SD] age, 34.5 [8.3 years]) were included in the intent-to-treat analysis. Modified intent-to-treat analysis using a mixed model of repeated measures showed that PTSD symptoms decreased significantly during the 24 weeks (sertraline plus enhanced medication management, 33.8 points; prolonged exposure therapy plus sertraline, 32.7 points; and prolonged exposure therapy plus placebo, 29.4 points; β,–9.39; 95% CI, −11.62 to −7.16; P < .001); however, slopes did not differ by treatment group (prolonged exposure therapy plus placebo group, –9.39; sertraline plus enhanced medication management group, –10.37; and prolonged exposure therapy plus sertraline group, –9.99; P = .81).Conclusions and RelevanceNo difference in change in PTSD symptoms or symptom severity at 24 weeks was found between sertraline plus enhanced medication management, prolonged exposure therapy plus placebo, and prolonged exposure therapy plus sertraline.Trial RegistrationClinicalTrials.gov Identifier: NCT01524133

Sleep-Disordered Breathing Impact on Efficacy of Prolonged Exposure Therapy for Posttraumatic Stress Disorder.

There is growing evidence that sleep disturbances may impede the utility of existing therapeutic interventions for people with posttraumatic stress disorder (PTSD). This retrospective medical record review examined the hypothesis that sleep disturbance affects the outcome of prolonged exposure (PE) therapy for PTSD. We identified 18 combat veterans with PTSD who had completed PE therapy. There were 6 subjects who had sleep-disordered breathing, 5 of whom were documented by sleep polysomnography. All subjects in the sleep-disordered group took part in a minimum of 10 sessions; the mean number of sessions was comparable between the sleep-disordered group and the group without a sleep disorder. Posttreatment PTSD Checklist scores were significantly reduced in those without a sleep disorder (-28.25; 58.0% reduction, F(1, 11) = 59.04, p < .001), but were not reduced in those with sleep-disordered breathing (-7.17; 13.5% reduction, dIGPP = 2.25 [independent groups pretest-posttest design]). These observations supported the hypothesis that the efficacy of PE therapy is affected by sleep quality. If these findings are replicated, treatment algorithms may need to incorporate the presence or absence of sleep disorders as a factor in treatment choice.

Prolonged Exposure Therapy for Combat- and Terror-Related Posttraumatic Stress Disorder

Empirically based studies have demonstrated that prolonged exposure therapy effectively reduces posttraumatic stress disorder (PTSD) symptoms in a vast range of traumas, yet reports of the efficacy of such therapies in combat- and terror-related PTSD are scarce. In this article, we examine the efficacy of prolonged exposure therapy in combat- and terror-related PTSD in comparison to treatment as usual (TAU). Between July 2002 and October 2005, 30 patients of a trauma unit within a psychiatric outpatient clinic were recruited and randomized into prolonged exposure versus TAU therapies. Patients were diagnosed with chronic PTSD (Mini-International Neuropsychiatric Interview criteria) related to combat- (n = 19) or terror-related (n = 11) trauma. Main outcome measures included symptoms of PTSD and depression, as measured by the PTSD Symptom Scale-Interview Version and the Beck Depression Inventory. Posttraumatic stress disorder symptom severity was significantly lower in patients who received prolonged exposure therapy in comparison to patients who received TAU (F(1,24) = 35.3, P < .001). Similar results have emerged in measures of depression and state and trait anxiety. In addition, a significant change from pretreatment to follow-up was found for the prolonged exposure group (F(1,14) = 80.5, P < .0001), but not for the TAU group (F(1,10.3) = 0.6, P = .44). Findings indicate that, similar to PTSD related to other types of trauma, prolonged exposure therapy is beneficial in the amelioration of combat- and terror-related PTSD symptoms. In addition, prolonged exposure was superior to TAU in the short- and long-term reduction of PTSD and depression symptoms. clinicaltrials.gov Identifier: NCT00229372.

Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence

INTRODUCTION: Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are each associated with profound disruptions in psychological, social, and physical functioning, and these disruptions are compounded in individuals with both disorders. Comorbidity between the two disorders is high, with the risk for AD increasing substantially among individuals with PTSD and, conversely, PTSD is highly prevalent among people experiencing AD. AIMS: Given the increased impairment associated with this comorbidity, it is imperative to develop effective treatments for individuals who experience both disorders. METHODS: This paper describes the methodology of a study that examines the efficacy of prolonged exposure therapy alone, naltrexone alone, and their combination compared to pill placebo in reducing the severity of PTSD and alcohol use in individuals with comorbid AD and PTSD. DISCUSSION: Issues related to design, assessment, treatment choice, and challenges posed by the study population are discussed.

The effect of phobic anxiety on plasma β-endorphin: a single-subject experiment

In a single- S experiment, phobic anxiety was observed to produce a substantial elevation in the patient's plasma β-endorphin level, a response which quickly returned to normative parameters upon the cessation of anxiety. This finding supports the hypothesis that one possible mechanism for the efficacy of prolonged exposure therapy to feared stimuli in the treatment of phobias is in the homeostatic endorphinergic response to stress.