Imaginal Exposure Research Articles

Relationship between change in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers

ObjectiveThe current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. MethodsActive duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. The relationships between in-vivo exposure distress, imaginal exposure distress, and PTSD symptoms, were examined in a factor of curves model for participants in the treatment conditions. ResultsAnalyses revealed that, when controlling for one another, changes in in-vivo exposure distress were significantly associated with changes in PTSD symptoms (β = 0.75, 95% CI [0.60, 0.90]), while changes in imaginal exposure distress were not (β = 0.03, 95% CI [-0.27, 0.33]). The model also revealed that after accounting for the shared variation in trajectories of change, symptom clusters did not have unique variation, meaning that symptom clusters did not change independently. ConclusionResults suggest the possibility that in-vivo exposures are more closely tied to changes in overall PTSD symptoms than imaginal exposures during exposure therapy. Furture research should incorporate more frequent measurement of in-vivo exposure distress to better elucidate these relations over the course of treatment.

The temporal dynamics of symptoms during exposure therapies of PTSD: a network approach

ABSTRACT Background: Analysis of dynamic (temporal) networks allows an identification of important targets of treatment. Objective: This study examined the dynamic network of symptoms in patients diagnosed with post-traumatic stress disorder (PTSD) during exposure therapy. Method: Patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure to the traumatic memory, or modified prolonged exposure, where imagery re-scripting of the memory replaced imaginal exposure, in a 10-week residential program. They completed a measure of DSM-IV PTSD symptoms weekly. The multilevel vector autoregressive (mlVAR) model was used to analyse the data, producing a temporal (dynamic), contemporaneous, and between-person network. Results: Physiological reactivity to reminders in a given week was positively related to distress reactivity and to flashbacks the subsequent week. Hypervigilance one week was positively related to startle response and external avoidance the subsequent week. In addition, sleep problems were positively predicted by previous week internal avoidance and negatively predicted by previous week flashbacks. Hypervigilance and physiological reactivation had the highest out-strength, indicating that they were the most predictive of other symptoms. Conclusions: The present within-person results make a preliminaryrect basis for the recommendation to monitor and facilitate change in physiological reactivation and hypervigilance in the treatment of PTSD. Future studies should examine the replicability of our temporal PTSD network and also include causal variables beyond symptoms.

Neural Activations During Imaginal Exposure in Individuals Fearful of Spiders

Neural Activations During Imaginal Exposure in Individuals Fearful of Spiders

The efficacy of a single imaginal exposure-writing assignment in reducing posttraumatic stress and depressive symptoms: A pilot study.

This online study examined the effects of a single imaginal exposure-writing assignment on posttraumatic stress (PTS) and comorbid depressive symptoms. Forty-six participants with PTS were allocated to either a single imaginal exposure-writing assignment, a nontrauma writing assignment, or to a nonwriting control condition, and were reassessed 2 and 5 weeks after baseline. Of the 49 participants, 36 were female, with an average age of 23. Participation was conducted through Qualtrics. Effects were assessed with the Posttraumatic Diagnostic Scale (PDS) and the Beck Depression Inventory-II (BDI-II). PTS and depressive symptoms decreased over time regardless of the study condition. We found no support for the efficacy of a single imaginal exposure-writing assignment in reducing PTS or comorbid depressive symptoms. Suggestions are given for future studies that attempt to identify a minimal dose of imaginal exposure writing for PTS.

Using Virtual Reality Environments to Augment Cognitive Behavioral Therapy for Fears and Phobias in Autistic Adults.

Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposure can be too anxiety-provoking to allow treatment to take place, and imaginal exposure can be problematic. To address this, we developed an intervention that combines cognitive behavioral therapy (CBT) with immersive virtual reality (VR) exposure to reduce anxiety. Following successful trials of this intervention with young people on the autism spectrum, we report a pilot study using the same intervention with autistic adults. Eight adults (aged 18–57 years) received one psychoeducation session and then four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant completed all sessions showing that the intervention is feasible and acceptable. Outcomes were monitored at 6 weeks and 6 months postintervention. Five of the eight participants were classified as intervention responders and at 6 months after the end of intervention were experiencing real-life functional improvements. These preliminary findings show that VR-graded exposure alongside CBT may be an effective treatment for autistic people with phobias.Lay SummaryWhy was this study done?Anxiety is common in autistic adults. For some people, fears and phobias regarding everyday objects and situations occur frequently affecting everyday life. The main method to treat fears and phobias for people without autism is gradual exposure to the situation that causes anxiety. However, this method may be challenging for people on the autism spectrum. We wanted to test a new method of treatment that uses cognitive behavioral therapy (CBT) delivered with gradual exposure in a fully immersive virtual reality (VR) environment.What was the purpose of this study?We have already delivered this treatment successfully with autistic children. We wanted to test if this treatment would work for autistic adults. Changing traditional psychological treatments, such as CBT, to make it more suitable for autistic people is recommended by the National Institute for Health and Care Excellence.What did the researchers do?We recruited eight autistic adults (aged 18–57 years) with a fear/phobia and their supporter (parent/friend/support worker). Each adult had one session with a therapist to learn anxiety management techniques. They then had four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant had a computer-generated scene designed for their specific anxiety-provoking situation. After four sessions, the participant tried real-life exposure with their supporter. We measured progress at 6 weeks and 6 months after the last VR session.What were the results of this study?Each participant completed all four sessions. This shows that the intervention was possible to deliver and acceptable to autistic people and therapists. Participants completed assessments at 6 weeks and 6 months after the VR sessions. Five of the eight participants were “responders” to the intervention. This means that 6 months after the last VR session, they still had real-life day-to-day improvements in relation to their phobia.What do these findings add to what was already known?We had not delivered this intervention to autistic adults previously. The findings show that this VR intervention has the potential to be an effective treatment for anxiety in autistic adults.What are the potential weaknesses in the study?This is a small study and future work will be a larger trial of this treatment—comparing results from people who get the intervention with people who do not. We would also want to have an outcome assessor who did not know whether people had received the intervention or not.How will these findings help autistic adults now or in the future?This new intervention has the potential to help autistic adults manage their anxiety in stressful situations and therefore may improve their quality of life.

Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches

Introduction Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. Methods Data were drawn from veterans (N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. Results FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. Discussion Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

Investigating the effects of imagery rescripting on emotional memory: A series of analogue studies

Imagery rescripting (IR) is a promising treatment for a variety of disorders, but its working mechanisms remain largely unknown. To elucidate the associative and evaluative learning processes underlying IR, we exposed participants to an aversive film clip followed by an instructed fear-conditioning procedure. The acquired fear memory was subsequently manipulated by either rescripting- (IR) or exposure-based (imaginal exposure; IE) interventions and their effects were examined on subjective and psychophysiological fear responses in three successive studies. Though the interpretation of the results was challenged with respect to the employed analogue IR intervention (Exp 1) and unexpected findings in the control condition (Exp 3), the present results establish preliminary evidence for the hypothesis that IR produces differential effects on fear responding when compared to IE. For example, in line with stimulus devaluation theory, IR effectively reduced subjective distress to the conditioned stimulus (Exp 2). Also, IR resulted in decreased physiological fear responses after fear reinstatement (Exp 3). The findings advance our general understanding of the processes involved in IR and they tentatively indicate that rescripting- and exposure-based treatments may work through different mechanisms. Moreover, this line of research demonstrates the challenges encountered when working with analogue models to test mechanisms of therapeutic change.

Mediators of Change in Imagery Rescripting and Imaginal Exposure for Nightmares: Evidence From a Randomized Wait-List Controlled Trial

Imagery rescripting (IR) and imaginal exposure (IE) are two efficacious treatments for nightmare disorder, but their discrete underlying mechanism(s) remain largely unknown. We therefore examined mediators of the treatment effects of IR and IE in a randomized wait-list controlled trial (N = 104). Therapeutic outcomes were assessed at pre- and post-assessment, and mediator assessment took place in between treatment sessions to establish a temporal relationship between mediators and nightmare symptoms (i.e., frequency and distress). In line with the hypothesis, enhanced mastery (or self-efficacy) of the nightmare content mediated the therapeutic efficacy of IR. Furthermore, the treatment effects of IE were mediated by increased tolerability of the negative emotions elicited by nightmares. Even though IR and IE for nightmares seem to produce similar therapeutic effects, the results of this study suggest that IR and IE tap into different underlying processes.

Making eye movements during imaginal exposure leads to short-lived memory effects compared to imaginal exposure alone

Background and objectivesA plethora of eye movement desensitization and reprocessing (EMDR) analogue studies has shown that, in the short term, making eye movements (EM) during brief imaginal exposure (“recall + EM”) blurs memories more than just imaginal exposure (“recall only”). Yet, results of the few studies that included a follow-up test are inconsistent. We improved this paradigm's ecological validity by including an extended intervention phase and multiple assessments per phase. We hypothesized that recall + EM results in larger immediate and 24 h reductions in memory vividness, negative valence, and distress than recall alone. We explored the persistence of the effects, as well as the predictive value of memory characteristics and individual differences. MethodsStudents (N = 100) selected a negative autobiographical memory and were randomized to recall + EM or recall alone; both interventions lasted 32 intervals of 24s. During the interventions they rated the memory after every four intervals. ResultsAfter 4 × 24s intervention, recall + EM resulted in memory deflation, while recall only caused memory inflation. After the full intervention (i.e., 32 × 24s), both conditions resulted in immediate and 24 h reductions on all outcome measures. Crucially, memory effects in the recall + EM condition partially relapsed 24 h later, while the effects in the recall only condition persisted. Change patterns were hardly explained by predictive variables. LimitationsWe used a non-clinical sample; replication in clinical samples is warranted. ConclusionMaking EM during imaginal exposure leads to short-lived effects compared to imaginal exposure alone. However, EM may offer a response aid for those who avoid imaginal exposure.

Written Exposure Therapy: The Case for Latinos

Despite the substantial impact of trauma and subsequent posttraumatic stress in the Latino population, Latinos often underutilize services to address symptoms. Furthermore, research is still lacking regarding the effectiveness of evidence-based treatments, specifically for Latinos. We review the case of a 29-year-old Latina diagnosed with posttraumatic stress disorder (PTSD) who presented with intrusive memories, nightmares, and negative affect. The client’s progress in treatment was hindered by extreme emotion dysregulation when asked to engage in imaginal exposure, leading her to contemplate premature termination of therapy. Thus, prolonged exposure therapy (PET) was modified based on written exposure therapy to successfully treat the client. Treatment success was reflected in both the client’s self-report and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (PCL-5) scores at pre- and posttreatment. From this case study, we can conclude that (a) PET can be effectively modified during treatment to include written exposures if the client cannot participate in imaginal exposure; (b) such treatment may be effective for Latinos experiencing posttraumatic stress; and (c) cultural and logistical factors affecting client participation and utilization of services should be addressed in treatment.

The efficacy of 90-minute versus 60-minute sessions of prolonged exposure for posttraumatic stress disorder: Design of a randomized controlled trial in active duty military personnel.

Posttraumatic stress disorder (PTSD) can have devastating effects on multiple aspects of functioning. Thus, it is imperative to increase access to evidence-based treatment for PTSD. Prolonged Exposure therapy (PE) has extensive empirical support and is one of the first-line PTSD treatments included in civilian, veteran, and military clinical practice guidelines. However, the standard 90-min PE session format can constitute a significant barrier to its adoption in routine clinical care settings, which typically schedule 60-min appointment sessions. If the length of PE sessions could be reduced from 90 to 60 min without compromising treatment efficacy and efficiency, this would remove a major barrier to PE adoption. This paper describes the rationale and methods of a randomized controlled noninferiority trial comparing 90-min versus 60-min PE sessions (including 40- vs. 20-min imaginal exposures, respectively) among 160 active duty military personnel with PTSD. The aims of this study are to: (1) examine the efficacy and efficiency (i.e., rate of symptom improvement) of 90- versus 60-min PE; (2) assess change in psychophysiological markers of treatment response across conditions; and (3) test mechanisms of change underlying the efficacy of PE. The results of this study will inform dissemination efforts in military, veteran, and civilian sectors. Further, identifying mechanisms of therapeutic change will answer important theoretical questions about how PE works, in order to refine and increase the efficacy and efficiency of PE to better meet the needs of individuals with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An intervention for fears and phobias in young people with autism spectrum disorders using flat screen computer-delivered virtual reality and cognitive behaviour therapy

BackgroundSpecific fears and phobias are common in young people with autism spectrum disorder (ASD) and can impact greatly on daily functioning. Traditional treatment methods, such as real-life or imaginal exposure, may not be suitable for this population without adaptation and alternative interventions are needed. In previous studies, we established that delivering graded exposure through computer generated scenes in a fully immersive virtual reality environment (the Blue Room) is an effective intervention for some young people with ASD and specific fears/phobias. In this study, we explored the same intervention delivered using flat screen, computer-delivered virtual reality graded exposure with cognitive behavioural therapy. MethodsEight young people with ASD received one psychoeducation session followed by four 20 minute sessions of flat screen, computer–delivered virtual reality graded exposure with cognitive behaviour therapy (CBT) sessions with a psychologist. Follow up measures, including Target Behaviour change ratings, were taken at 6 weeks, 6 months and 12 months after intervention. ResultsFour of the participants were classed as responders to the intervention and were able to function without the fear/phobia impacting their life. These improvements were maintained 12 months post-intervention. One participant was lost to follow-up and three participants were classed as non-responders to the intervention. ConclusionsFindings show that flat screen computer-delivered virtual reality with cognitive behaviour therapy can be an effective intervention for specific fears and phobias for some young people with ASD.

Using Prolonged Exposure With an Older Male U.S. Veteran With Childhood Sexual Abuse-Related PTSD

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.

Heterogeneity of treatment dropout: PTSD, depression, and alcohol use disorder reductions in PTSD and AUD/SUD treatment noncompleters.

Treatment dropout is often assumed to be due to worsening or lack of symptom improvement, despite minimal research examining symptom change among treatment dropouts. Thus, the present study examined symptom change in veterans who discontinued evidence-based treatment for comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Participants were veterans who completed at least one session of a 12-session Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) for comorbid PTSD/AUD. The study analyses investigated the 43% of the sample (n=22) that did not complete the full 12-session protocol and were therefore considered treatment dropouts. Symptom changes in PTSD, AUD, and depression were examined among dropouts using two methods: (a) clinically significant change criteria and (b) good end-state criteria. Results indicated that a significant proportion of treatment dropouts displayed clinically significant improvement and/or met good end-state criteria for PTSD (40-59%), AUD (66%), and depression (45-68%) prior to dropping out. The results revealed that participants who displayed symptom improvement attended more treatment sessions and completed more imaginal exposures than participants who did not experience significant improvement. Together, the findings add to a growing body of literature suggesting that a large proportion of treatment dropouts may actually improve. Although preliminary, the findings challenge the notion that treatment dropout is always associated with negative outcomes.

Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review.

BackgroundAlthough traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues with these therapies that largely center around the costs and risks associated with the components comprising the therapeutic process. To treat certain types of specific phobias, sessions may need to be held in public, therefore risking patient confidentiality and the occurrence of uncontrollable circumstances (eg, weather and bystander behavior) or additional expenses such as travel to reach a destination. To address these issues, past studies have implemented virtual reality (VR) technologies for virtual reality exposure therapy (VRET) to provide an immersive, interactive experience that can be conducted privately and inexpensively. The versatility of VR allows various environments and scenarios to be generated while giving therapists control over variables that would otherwise be impossible in a natural setting. Although the outcomes from these studies have been generally positive despite the limitations of legacy VR systems, it is necessary to review these studies to identify how modern VR systems can and should improve to treat disorders in which anxiety is a key symptom, including specific phobias, posttraumatic stress disorder and acute stress disorder, generalized anxiety disorder, and paranoid ideations.ObjectiveThe aim of this review was to establish the efficacy of VR-based treatment for anxiety-related disorders as well as to outline how modern VR systems need to address the shortcomings of legacy VR systems.MethodsA systematic search was conducted for any VR-related, peer-reviewed articles focused on the treatment or assessment of anxiety-based disorders published before August 31, 2017, within the ProQuest Central, PsycINFO, and PsycARTICLES databases. References from these articles were also evaluated.ResultsA total of 49 studies met the inclusion criteria from an initial pool of 2419 studies. These studies were a mix of case studies focused solely on VRET, experimental studies comparing the efficacy of VRET with various forms of CBT (eg, in vivo exposure, imaginal exposure, and exposure group therapy), and studies evaluating the usefulness of VR technology as a diagnostic tool for paranoid ideations. The majority of studies reported positive findings in favor of VRET despite the VR technology’s limitations.ConclusionsAlthough past studies have demonstrated promising and emerging efficacy for the use of VR as a treatment and diagnostic tool for anxiety-related disorders, it is clear that VR technology as a whole needs to improve to provide a completely immersive and interactive experience that is capable of blurring the lines between the real and virtual world.

When translational neuroscience fails in the clinic: Dexamethasone prior to virtual reality exposure therapy increases drop-out rates

Posttraumatic stress disorder (PTSD) is characterized by exaggerated expression of fear responses to danger and safety cues. Translational research suggests that dexamethasone facilitates fear extinction in animal and human fear conditioning models. For this randomized, placebo-controlled trial (N = 27), we aimed to translate these findings to the clinic by using virtual reality exposure (VRE) therapy for OEF/OIF/OND veterans with PTSD to determine whether dexamethasone will increase the efficacy of exposure therapy for VRE relative to placebo. VRE sessions involved imaginal exposure to the most traumatic war memories while viewing a computer-generated view of virtual Iraq or Afghanistan with multisensory stimulus options used to match patient’s description of the trauma. VRE was effective in reducing PTSD symptoms but there was no interaction with dexamethasone. Drop-out rate was significantly higher in the dexamethasone group, with 10 of 13 (76.9%) participants in this group discontinuing, compared to only 4 of 14 (28.5%) in the placebo group, χ2 = 6.31, p = 0.02. Results indicate that the dexamethasone group may have experienced an increase in PTSD symptoms, particularly re-experiencing, at session 2 following first drug administration. Contrary to study hypotheses, dexamethasone did not enhance exposure therapy outcomes and was associated with increased drop-out. This demonstrates potential pitfalls in translating neuroscience models to the clinic; future research carefully examining glucocorticoid mechanisms involved in therapy augmentation is warranted.

Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure

Integrated exposure-based interventions to treat substance use disorders (SUD) and posttraumatic stress disorder (PTSD) may not be widely utilized, in part, because of clinician concerns that such interventions will worsen symptomatology and lead to treatment dropout. In order to address this question, the current pilot study examined whether participants' ratings of craving and distress following imaginal exposure predicted increased substance use, PTSD severity, and treatment dropout. Participants (N = 46) were U.S. military Veterans who met criteria for current SUD and PTSD. Subjective ratings of craving and distress, and past-week substance use and PTSD symptom severity were assessed at each treatment session. Multilevel modeling tested whether lagged ratings of craving and distress predicted the following week's frequency of substance use and PTSD severity. Discrete time survival analysis, using proportional odds Cox ratio, examined whether craving and distress ratings predicted treatment dropout. The findings revealed that neither craving nor distress following imaginal exposure were associated with the following week's substance use or PTSD severity. However, participants with higher craving and distress were more likely to drop out before completing treatment. Future research is needed to develop strategies to increase treatment retention for individuals at-risk for treatment dropout and identify mechanisms that account for the association between in-session ratings of craving and distress and dropout.

Hyperactivation of the Frontal Control Network Revealed by Symptom Provocation in Obsessive-Compulsive Disorder Using EEG Microstate and sLORETA Analyses

The aim of this study was to investigate the changes of brain electric field induced by symptom provocation in patients with obsessive-compulsive disorder (OCD) in comparison to healthy controls in the resting state. For this purpose, EEG recordings in conditions of initial rest, clean control, symptom provocation by imaginal exposure, and final rest were used for computing spatiotemporal activity characteristics based on microstate segmentation. Within-group comparisons were significant for the symptom provocation condition: OCD showed high global field power (GFP) and transition rates into a medial frontal microstate, whereas healthy controls showed high frequency of occurrence and high percent of dwelling time for a medial occipitoparietal microstate. Between-group comparisons demonstrated significantly lower GFP and dwelling time for the medial occipitoparietal microstate in OCD in several conditions including initial rest and symptom provocation. In addition, OCD compared to healthy controls showed significant instability of the medial occipitoparietal microstate, with high preference for transitions into the medial frontal microstate. In conclusion, during rest and symptom provocation, OCD patients make preferential use of a medial frontal brain network, with concomitant reduction of use of a medial occipitoparietal network, as shown by dwelling times, explained variance, and dynamic transition rates. These findings support the idea of a possible biological marker for OCD, which might correspond to pathological hyperactivation of the frontal control network.

Exposure-based therapy changes amygdala and hippocampus resting-state functional connectivity in patients with posttraumatic stress disorder.

Recent research suggests that posttraumatic stress disorder (PTSD) is associated with altered amygdala and hippocampal resting-state functional connectivity (rsFC). However, less research has examined whether Prolonged Exposure (PE), a first line exposure-based treatment for PTSD, has the potential to alter resting state neural networks. A total of 24 patients with PTSD and 26 matched trauma-exposed healthy controls (TEHCs) underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. PTSD patients were scanned a second time after completing 10-session PE in which patients narrated a detailed trauma account (imaginal exposure) and confronted trauma reminders (in vivo exposure) to extinguish trauma-related fear responses. TEHC were scanned again following a 10-week waiting period. Seed regions of interest (ROIs) included centromedial amygdala (CMA), basolateral amygdala (BLA), and the hippocampus. Post- versus pretreatment comparisons indicated increased rsFC of the BLA and CMA with the orbitofrontal cortex (OFC), and hippocampus-medial prefrontal cortex (mPFC) among patients with PTSD, but not among TEHC participants. Enhanced amygdala and hippocampus rsFC with prefrontal cortical regions following PE could underlie improved capacity for inhibition and re-evaluation of threat, and heightened memory encoding and retrieval ability, respectively. These findings encourage further investigation of this circuitry as a therapeutic target in PTSD.

Muss’ Rewind treatment for trauma: description and multi-site pilot study

Background: Rewind is a brief trauma-focussed imaginal exposure treatment for posttraumatic stress disorder (PTSD), however evidence for this treatment is limited.Aim: The aim of this paper was to provide preliminary evidence of its efficacy in the treatment of PTSD symptoms.Method: A practice-based pre-post treatment design with an intention-to-treat analysis was used. Sixty three people were treated with Rewind in three separate services. Participants were assessed using the Impact of Events Scale (IES) prior to treatment and were re-assessed at a two-week follow-up. All participants who scored above 25 on the IES were included and there were no other exclusion criteria.Results: There was an overall data capture rate of 95%. After treatment, 55 (87%) participants were below the IES clinical cut-off and, other than three participants with missing data, all participants showed reliable improvement using the IES Reliable Change Index.Conclusion: These preliminary findings suggest that Muss’ Rewind may offer a useful treatment for PTSD symptoms. Rewind may be cost-effective, given the number of sessions that were required and the relative effectiveness of newly trained therapists in delivering the therapy. Despite methodological limitations, these results suggest that a randomised controlled trial is warranted.