PTSD Symptom Scale-Self Report Research Articles

Investigating traumatic memory integration in people with and without post-traumatic stress disorder using the event-cueing paradigm

ABSTRACT Poor integration and landmark views make opposing claims regarding the relationship between post-traumatic stress symptoms and trauma memory integration. This study tested these approaches using an event cluster paradigm. In total, 126 participants (N ptsd = 61; N non-ptsd = 65) remembered memories from the same story as trauma, positive and neutral memories and reported whether each memory was directly retrieved or generated. Moreover, the retrieval time (RT) was recorded. Finally, the participants completed the Centrality of Event Scale (CES) and Post-traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR). The results demonstrated that participants with post-traumatic stress disorder (PTSD) recalled their clusters of memories more slowly and less directly than those without PTSD. However, the CES predicted PTSD severity more strongly than RT and retrieval strategy. These results suggest that traumatic memories are more disorganised but perceived as more central in PTSD.

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning.

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.

Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders

Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD. ClinicalTrials.gov # NCT02755103

The feasibility of eye movement desensitization and reprocessing (EMDR) for older adults with posttraumatic stress disorder (PTSD) and comorbid psychiatric and somatic disorders.

The aim of this study is to investigate the feasibility of eye movement desensitization and reprocessing (EMDR) therapy in older adults with posttraumatic stress disorder (PTSD), and to explicitly include information about presence of the comorbid psychiatric and somatic disorders as well as a history of traumatic events at treatment start. A nonrandomized feasibility study in a multicenter design was conducted with 25 older PTSD patients (60-84 years). Treatment consisted of weekly 1-hour EMDR sessions for PTSD during 3, 6, or maximum 9 months. PTSD diagnosis was assessed with Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Symptom Scale-Self Report (PSS-SR). We also operationalized PTSD symptom change on CAPS-5 and PSS-SR in loss of diagnosis according to DSM-5 and remission. Remission was defined as loss of diagnosis and no longer having any PTSD symptoms according to minimum severity scores on CAPS-5 (< 12) and PSS-SR (≤ 10). Comorbid psychiatric disorders were assessed pre- (and post-)treatment and somatic disorders and presence of traumatic (childhood) events were assessed pretreatment. Comorbidity rates of depressive (64%), anxiety (56%), other psychiatric (32%), personality (60%), and somatic disorders (96%) were high in our sample of older adults. A linear mixed model approach showed a significant decrease in CAPS-5 scores from pre- to posttreatment for the total sample [F(1, 24) = 150.304, p < .001; Cohen's d = 2.59]. No significant main effects of therapy duration (3, 6, or 9 months), pretreatment intensity of psychopathology (BSI), or their interaction was found (all p > .05). Eighty percent lost their PTSD diagnosis and remission rate was 52% for CAPS-5 and 37.5% for PSS-SR. Remission (not loss of PTSD-diagnosis) showed a negative correlation with the number of experienced traumatic childhood events. EMDR therapy showed large treatment effect on PTSD symptom severity in older adults and this was unrelated to therapy duration and presence of comorbid psychiatric and somatic disorders pretreatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and associated factors of post-traumatic stress disorder (PTSD) among a cohort of Srilankan post-partum mothers: a cross-sectional study

BackgroundPost-Traumatic Stress Disorder (PTSD) usually follows a catastrophic event. However, the experience of child birth can be severe enough to cause PTSD in some women. The aim of this study is to highlight the prevalence of Post Traumatic Stress Disorder among a cohort of postpartum mothers.MethodsA cross-sectional study was conducted in field clinics of a semi-urban area in Sri Lanka. A pre-tested interviewer administered checklist was used to collect socio-demographic and pregnancy related data. Pre-existing self-administered, validated Sinhalese versions of the Edinburgh Postnatal Depression Scale (EPDS) and PTSD Symptom Scale-Self Report (PSS-SR) were used to assess the presence of Post-Partum Depression (PPD) and PTSD, respectively. Each participant was assessed for PTSD and PPD after one, two and six months following delivery. Scores of PPD > 9 and PSS-SR > 13 were taken as screening positive for the two conditions, respectively.ResultsTwo hundred and twenty-five mothers at the end of postpartum one month were recruited for the study. The response rate at their follow-up visits at the second and sixth months were 95 % (n = 214) and 93 % (n = 211). The prevalence of postpartum PTSD was 2.7 % (n = 6), 0.9 % (n = 2) and 0.5 % (n = 1) after one, two and sixth months respectively. Prevalence of postpartum PTSD was 3.6 % over 6 months. Verbal abuse during labour (p = 0.04) and the presence of postpartum depression (P ≤ 0.001) were significantly associated with postpartum PTSD. There were no significant associations between PTSD and gestational age at delivery, index pregnancy being a planned pregnancy, a history of subfertility, family history of psychiatric disorders, intimate partner violence, receiving antenatal counseling, type and mode of delivery, duration of labour, presence of a labour companion, post-partum hemorrhage, manual removal of placenta, negative birth experience, low APGAR score of the baby at delivery, receiving neonatal and maternal intensive care, birth defects, problems with breast feeding or opportunity to discuss with a health care worker.ConclusionsPrevalence of postpartum PTSD in this community-based study is 3.6 %; which is comparable with the overall global prevalence. PTSD was significantly associated with verbal abuse during labour and postpartum depression.

Prevalence of Childhood Maltreatment and Posttraumatic Stress Symptoms Among Male Inmates in Iceland.

Childhood maltreatment is highly correlated with adult criminal behavior, and the prevalence of childhood maltreatment within prison populations is high. Furthermore, studies have repeatedly shown a higher prevalence of posttraumatic stress disorder (PTSD) symptoms in samples of prisoners compared with the general public. The aims of the current study were to determine the frequency of childhood maltreatment among male inmates in Iceland and the percentage of male inmates meeting screening criteria for PTSD. The Icelandic versions of the Childhood Trauma Questionnaire-Short Form and the PTSD Symptom Scale-Self-Report (PSS-SR) were used in the study. Results show a high prevalence of childhood maltreatment among the sample (N = 48), where 87% of participants reported having experienced at least one of the five categories listed (M = 2.33, SD = 1.68). Approximately 52% had experienced emotional abuse, 27% had experienced physical abuse, 48% had experienced sexual abuse, and over half reported experiencing neglect in their childhood. Two thirds of the participants were above the cutoff score for PTSD on the PTSD Symptom Scale-Self-Report, all of whom expressed a reduced quality of life and/or functional impairment because of their symptoms. The results indicate that most male inmates in Icelandic prisons were maltreated during their childhood and that many of them report severe posttraumatic stress symptoms. By integrating trauma-focused interventions into Iceland's Prison Service, mental health nurses and other mental health professionals have an opportunity to profoundly affect prisoners' functioning and quality of life, thereby potentially reducing the likelihood of recidivism for a large part of this population in the future.

Post-traumatic stress disorder after first-episode psychosis

IntroductionA psychotic episode may be sufficiently traumatic to induce symptoms of post-traumatic stress disorder (PTSD), which could impact outcomes in first-episode psychosis (FEP). Yet, post-traumatic stress disorder is often left untreated and undiagnosed in the presence of psychosis.ObjectivesTo conduct a short review of literature on the prevalence and impact of PTSD after FEP.MethodsWe performed a literature search on PUBMED, using the query: “Stress Disorders, Post-Traumatic” [Mesh] AND “first episode” AND “psychosis”. We focused on data from systematic reviews, clinical trials and meta-analysis published on last 10 years, either in English or Portuguese.ResultsApproximately one in two people experience PTSD symptoms and one in three experience full PTSD, following a FEP. Prevalence may be higher in affective psychosis, inpatient samples and patients previously suffering from depression and anxiety. PTSD Symptom Scale – Self-Report (PSS-SR) can be a useful screening instrument, but there is no established evidence-based intervention for PTSD in people with FEP. Coercive intervention such as involuntary hospitalization, seclusion, restraint or being forced to take medication, as well as being around sick or anxious patients, can be upsetting and traumatizing.ConclusionsOur data showed high rates of psychosis-related PTSD. To prevent PTSD, conditions of hospitalization should be optimized and the use of coercive treatments should be limited. Subjects with recent-onset psychosis should be screened for PTSD symptoms. Evidence-based interventions to treat PTSD symptoms in the context of FEP are needed to address this burden and improve outcomes.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Background: A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective: This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods: This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results: 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion: Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.

Treating patients with driving phobia by virtual reality exposure therapy – a pilot study

ObjectivesVirtual reality exposure therapy (VRET) is a promising treatment for patients with fear of driving. The present pilot study is the first one focusing on behavioral effects of VRET on patients with fear of driving as measured by a post-treatment driving test in real traffic.MethodsThe therapy followed a standardized manual including psychotherapeutic and medical examination, two preparative psychotherapy sessions, five virtual reality exposure sessions, a final behavioral avoidance test (BAT) in real traffic, a closing session, and two follow-up phone assessments after six and twelve weeks. VRE was conducted in a driving simulator with a fully equipped mockup. The exposure scenarios were individually tailored to the patients’ anxiety hierarchy. A total of 14 patients were treated. Parameters on the verbal, behavioral and physiological level were assessed.ResultsThe treatment was helpful to overcome driving fear and avoidance. In the final BAT, all patients mastered driving tasks they had avoided before, 71% showed an adequate driving behavior as assessed by the driving instructor, and 93% could maintain their treatment success until the second follow-up phone call. Further analyses suggest that treatment reduces avoidance behavior as well as symptoms of posttraumatic stress disorder as measured by standardized questionnaires (Avoidance and Fusion Questionnaire: p < .10, PTSD Symptom Scale–Self Report: p < .05).ConclusionsVRET in driving simulation is very promising to treat driving fear. Further research with randomized controlled trials is needed to verify efficacy. Moreover, simulators with lower configuration stages should be tested for a broad availability in psychotherapy.

Event centrality, transitional impact and symptoms of posttraumatic stress in a clinical sample

ABSTRACTBackground and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one’s life story. One reason a traumatic memory becomes a reference point for one’s life story is that it brings about significant changes in one’s life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity.Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI).Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.

Improvements in cardiorespiratory fitness are not significantly associated with post-traumatic stress disorder symptom reduction in intensive treatment

ABSTRACT Background: Physical activity has been found to have positive effects on symptoms of post-traumatic stress disorder (PTSD). However, the importance and role of cardiorespiratory fitness (CRF) in relation to PTSD treatment outcome is not yet clear. Objective: The purpose of the present study was to test the hypothesis that CRF would increase following intensive trauma-focused treatment (TFT) of PTSD augmented with physical activity, and that improved CRF would be associated with a significant decline in PTSD symptoms. Method: One hundred-eight individuals with severe PTSD (72% women; mean age = 40.44, SD = 11.55) were enrolled in an intensive TFT programme of 8 days within 2 consecutive weeks that consisted of daily prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR) therapy and 6 hours of physical activity each day. CRF levels were assessed at baseline and post-treatment with a 6-Minute Walk Test (6MWT) and, in a subsample, with a submaximal ergometer test (PWC75%/kg). Severity of PTSD symptoms was measured with the PTSD Symptom Scale-Self Report (PSS-SR). Results: A significant increase in CRF from pre- to post-treatment and a significant decrease of PTSD-symptoms was found. However, CRF difference scores were not associated with treatment outcome. Conclusions: Although individuals with PTSD may show an increase in CRF following an intensive TFT programme augmented with physical activity and a decrease of PTSD-symptoms, the current findings do not support the notion that treatment outcome is related to CRF.

A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT

Background High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months. Objectives The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT). Design Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention. Setting This study was set in NHS adult, general critical care units. Participants The participants were adult patients who were &gt; 48 hours in a critical care unit, receiving level 3 care and able to consent. Interventions The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed. Main outcome measures Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of &gt; 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness. Results (1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: &gt; 80% of patients received two or more stress support sessions and all 12 sites achieved the target of &gt; 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses. Limitations There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium. Conclusions Among level 3 patients who stayed &gt; 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care. Future work Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data. Trial registration This trial is registered as ISRCTN61088114 and ISRCTN53448131. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information.

Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients

A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%. To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months. A multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom. Participants were critically ill patients who regained mental capacity following receipt of level 3 (intensive) care. A total of 2961 eligible patients were identified from September 2015 to January 2017. A total of 2048 were approached for participation in the ICU, of which 1458 provided informed consent. Follow-up was completed December 2017. Twenty four ICUs were randomized 1:1 to the intervention or control group. Intervention ICUs (n = 12; 669 participants) delivered usual care during a baseline period followed by an intervention period. The preventive, complex psychological intervention comprised promotion of a therapeutic ICU environment plus 3 stress support sessions and a relaxation and recovery program delivered by trained ICU nurses to high-risk (acutely stressed) patients. Control ICUs (n = 12; 789 participants) delivered usual care in both baseline and intervention periods. The primary clinical outcome was PTSD symptom severity among survivors at 6 months measured using the PTSD Symptom Scale-Self-Report questionnaire (score range, 0-51, with higher scores indicating greater symptom severity; the minimal clinically important difference was considered to be 4.2 points). Among 1458 enrolled patients (mean [SD] age, 58 [16] years; 599 women [41%]), 1353 (93%) completed the study and were included in the final analysis. At 6 months, the mean PTSD Symptom Scale-Self-Report questionnaire score in intervention ICUs was 11.8 (baseline period) compared with 11.5 (intervention period) (difference, -0.40 [95% CI, -2.46 to 1.67]) and in control ICUs, 10.1 (baseline period) compared with 10.2 (intervention period) (difference, 0.06 [95% CI, -1.74 to 1.85]) between periods. There was no significant difference in PTSD symptom severity at 6 months (treatment effect estimate [difference in differences] of -0.03 [95% CI, -2.58 to 2.52]; P = .98). Among critically ill patients in the ICU, a nurse-led preventive, complex psychological intervention did not significantly reduce patient-reported PTSD symptom severity at 6 months. These findings do not support the use of this psychological intervention. ISRCTN53448131.

The Prevalence of Post-Traumatic Stress Disorder Symptoms in Chronic Pain Patients in a Tertiary Care Setting: A Cross-Sectional Study

There is limited research regarding the prevalence of post-traumatic stress disorder (PTSD) in civilian multidisciplinary pain clinics. Controlled studies have only examined specific patient populations, such as those with motor vehicle accidents, war veterans, work-related injuries, back pain, and headache. The purpose of this study was to estimate the prevalence of PTSD symptoms in patients with chronic pain at a large multidisciplinary pain clinic. Three hundred consecutive new or newly referred patients with a self-reported history of chronic pain were recruited to complete an in-person screen for PTSD symptoms, which included the Brief Trauma Questionnaire and the PTSD Symptom-Scale Self-Report. Two hundred and sixty-five were eligible for the study. Seventy-four (28%) screened positive for PTSD symptoms, a value higher than the lifetime prevalence of PTSD in the general population (6.8%). Those who screened positive for PTSD symptoms were significantly younger (p = 0.007) and had higher levels of pain intensity (p = 0.0005) compared to those who screened negative for PTSD symptoms. The prevalence of PTSD symptoms in our chronic pain population (28%) exceeded the prevalence of PTSD in the general population (7%). Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger. This emphasizes the need for PTSD screening in the chronic pain population, as early identification and treatment may be effective in reducing the mounting health care costs and disease burden of comorbid chronic pain and PTSD.

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

ABSTRACTBackground: It is assumed that PTSD patients with a history of childhood sexual abuse benefit less from trauma-focused treatment than those without such a history.Objective: To test whether the presence of a history of childhood sexual abuse has a negative effect on the outcome of intensive trauma-focused PTSD treatment.Method: PTSD patients, 83% of whom suffered from severe PTSD, took part in a therapy programme consisting of 2 × 4 consecutive days of Prolonged Exposure (PE) and EMDR therapy (eight of each). In between sessions, patients participated in sport activities and psycho-education sessions. No prior stabilization phase was implemented. PTSD symptom scores of clinician-administered and self-administered measures were analysed using the data of 165 consecutive patients. Pre-post differences were compared between four trauma groups; patients with a history of childhood sexual abuse before age 12 (CSA), adolescent sexual abuse (ASA; i.e. sexual abuse between 12 and 18 years of age), sexual abuse (SA) at age 18 and over, or no history of sexual abuse (NSA).Results: Large effect sizes were achieved for PTSD symptom reduction for all trauma groups (Cohen’s d = 1.52–2.09). For the Clinical Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES), no differences in treatment outcome were found between the trauma (age) groups. For the PTSD Symptom Scale Self Report (PSS-SR), there were no differences except for one small effect between CSA and NSA.Conclusions: The results do not support the hypothesis that the presence of a history of childhood sexual abuse has a detrimental impact on the outcome of first-line (intensive) trauma-focused treatments for PTSD.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

ABSTRACTBackground: There is room for improvement regarding the treatment of severe post-traumatic stress disorder (PTSD). Intensifying treatment to increase patient retention is a promising development. Objective: The aim of this study was to determine the effectiveness of an intensive trauma-focused treatment programme over 8 days for individuals suffering from severe PTSD. Method: Treatment was provided for 347 PTSD patients (70% women; mean age = 38.32 years, SD = 11.69) and consisted of daily sessions of prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy (16 sessions in total), physical activity, and psycho-education. All participants had experienced multiple traumas, including sexual abuse (74.4%), and suffered from multiple comorbidities (e.g. 87.5% had a mood disorder). Suicidal ideation was frequent (73.9%). PTSD symptom severity was assessed by both clinician-rated [Clinician Administered PTSD Scale (CAPS)] and self-report [PTSD Symptom Scale Self Report (PSS-SR) and Impact of Event Scale (IES)] inventories. For a subsample (n = 109), follow-up data at 6 months were available. Results: A significant decline in symptom severity was found (e.g. CAPS intention-to-treat sample Cohen’s d = 1.64). At post-treatment, 82.9% showed a clinically meaningful response and 54.9% a loss of diagnosis. Dropout was very low (2.3%). Conclusions: Intensive trauma-focused treatment programmes including prolonged exposure, EMDR therapy, and physical activity can be effective for patients suffering from severe PTSD and are associated with low dropout rates.

Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD

ABSTRACTBackground: There is a widely-held belief in the trauma field that the presence of dissociative symptoms is associated with poor treatment response. However, previous research on the effect of dissociation in treatment outcomes pertained to specific patients and trauma populations.Objective: To test the hypothesis that the presence of the dissociative subtype of PTSD (DS) would have a detrimental effect on the outcome of an intensive trauma-focused treatment programme.Methods: PTSD symptom scores (Clinician Administered PTSD Scale [CAPS] and PTSD Symptom Scale Self-Report [PSS-SR]) were analysed using the data of 168 consecutive patients (70.6% female) who had been exposed to a wide variety of multiple traumas, including childhood sexual abuse, and of whom 98.2% were diagnosed with severe PTSD (CAPS > 65). Most of them suffered from multiple comorbidities and 38 (22.6%) met the criteria for DS. They took part in an intensive trauma-focused treatment programme for PTSD. Pre- and post-treatment differences were compared between patients with and without DS.Results: Large effect sizes were achieved for PTSD symptom reduction on CAPS and the PSS-SR, both for patients with DS and those without. Although patients with DS showed a significantly greater PTSD symptom severity at the beginning, and throughout, treatment, both groups showed equal reductions in PTSD symptoms. Of those who met the criteria for DS, 26 (68.4%) no longer fulfilled the criteria for this classification after treatment.Conclusion: The results provide no support for the notion that the presence of DS negatively impacts trauma-focused treatment outcomes. Accordingly, PTSD patients with DS should not be denied effective trauma-focused treatments.

A Double-Blind, Placebo-Controlled Randomized Trial of Vilazodone in the Treatment of Posttraumatic Stress Disorder and Comorbid Depression.

To determine the efficacy, safety, and tolerability of vilazodone in the treatment of posttraumatic stress disorder (PTSD) with comorbid mild-to-moderate depression. A 12-week randomized, double-blind, placebo-controlled trial was conducted in adult outpatients who met DSM-IV criteria for PTSD with comorbid depression between February 2013 and September 2015. Participants were randomly assigned to receive vilazodone 40 mg/d or placebo, and outcome measures were obtained at scheduled visits. Primary outcome measures included change in PTSD symptoms from baseline to end of study as indexed by the Clinician-Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self-Report (PSS-SR). Secondary outcome measures of anxiety, depression, and impairment were obtained, as well as biomarker assessment at baseline and end of study. A total of 59 patients were randomly assigned to receive vilazodone (n = 29) or placebo (n = 30). Of those who were randomized, there were 25 completers in the vilazodone group and 22 completers in the placebo group. No significant differences were observed between the groups on any of the primary or secondary outcome measures. Vilazodone was generally well tolerated with few differences in the rate of adverse events between groups. Treatment with vilazodone 40 mg/d did not improve symptoms of PTSD and comorbid depression. Further investigation of the biological mechanisms underlying PTSD may lead to identification of improved therapeutic targets. ClinicalTrials.gov identifier: NCT01715519.

Corticotropin-Releasing Factor Receptor 1 Antagonism Is Ineffective for Women With Posttraumatic Stress Disorder

BackgroundMedication and psychotherapy treatments for posttraumatic stress disorder (PTSD) provide insufficient benefit for many patients. Substantial preclinical and clinical data indicate abnormalities in the hypothalamic-pituitary-adrenal axis, including signaling by corticotropin-releasing factor, in the pathophysiology of PTSD. MethodsWe conducted a double-blind, placebo-controlled, randomized, fixed-dose clinical trial evaluating the efficacy of GSK561679, a corticotropin-releasing factor receptor 1 (CRF1 receptor) antagonist in adult women with PTSD. The trial randomized 128 participants, of whom 96 completed the 6-week treatment period. ResultsIn both the intent-to-treat and completer samples, GSK561679 failed to show superiority over placebo on the primary outcome of change in Clinician-Administered PTSD Scale total score. Adverse event frequencies did not significantly differ between GSK561679- and placebo-treated subjects. Exploration of the CRF1 receptor single nucleotide polymorphism rs110402 found that response to GSK561679 and placebo did not significantly differ by genotype alone. However, subjects who had experienced a moderate or severe history of childhood abuse and who were also GG homozygotes for rs110402 showed significant improvement after treatment with GSK561679 (n = 6) but not with placebo (n = 7) on the PTSD Symptom Scale–Self-Report. ConclusionsThe results of this trial, the first evaluating a CRF1 receptor antagonist for the treatment of PTSD, combined with other negative trials of CRF1 receptor antagonists for major depressive disorder, generalized anxiety disorder, and social anxiety disorder, suggest that CRF1 receptor antagonists lack efficacy as monotherapy agents for these conditions.

Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series

There is mounting evidence suggesting that by increasing the frequency of treatment sessions, posttraumatic stress disorder (PTSD) treatment outcomes significantly improve. As part of an ongoing research project, this study examined the safety and effectiveness of intensive eye movement desensitization and reprocessing (EMDR) therapy in a group of seven (four female) patients suffering from complex PTSD and multiple comorbidities resulting from childhood sexual abuse, physical abuse, and/or work and combat-related trauma. Treatment was not preceded by a preparation phase and consisted of 2 × 4 consecutive days of EMDR therapy administered in morning and afternoon sessions of 90 minutes each, interspersed with intensive physical activity and psychoeducation. Outcome measures were the Clinician-Administered PTSD Scale (CAPS) and the PTSD Symptom Scale Self-report questionnaire (PSS-SR). During treatment, neither personal adverse events nor dropout occurred. CAPS scores decreased significantly from pre- to posttreatment, and four of the seven patients lost their PTSD diagnosis as established with the CAPS. The results were maintained at 3-month follow-up. Effect sizes (Cohen’s d) on the CAPS and PSS-SR were large: 3.2, 1.7 (prepost) and 2.3, 2.1 (prefollow-up), respectively. The results of this case series suggest that an intensive program using EMDR therapy is a potentially safe and effective treatment alternative for complex PTSD. The application of massed, consecutive days of treatments using EMDR therapy for patients suffering from PTSD, particularly those with multiple comorbidities, merits more clinical and research attention.