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C-PTSD therapies

Melanie S Harned, Sara C Schmidt
Difficulties with consumer engagement are a common barrier to implementing trauma-focused evidence-based psychotherapies (TF-EBPs). Potential methods of increasing engagement include utilizing a stage-based treatment approach, and involving consumers in implementation efforts. This mixed method study explored consumers' perspectives on a stage-based TF-EBP, Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure (DBT PE) protocol. Nineteen DBT consumers in two public mental health agencies targeted for implementation of DBT + DBT PE participated in focus groups and completed questionnaires assessing treatment preferences and expectancies...
December 7, 2018: Community Mental Health Journal
Kyle Possemato, Emily M Johnson, J Bronte Emery, Michael Wade, Michelle C Acosta, Lisa A Marsch, Andrew Rosenblum, Stephen A Maisto
OBJECTIVE: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive behavior therapy (CBT) targeting PTSD symptoms and hazardous drinking, called Thinking Forward. METHOD: Thirty primary care patients with PTSD and hazardous alcohol use were randomized to receive Thinking Forward with or without peer support...
November 29, 2018: Psychiatric Rehabilitation Journal
Andrew C Hale, Jessica L Rodriguez, Theodore P Wright, Scott A Driesenga, C Richard Spates
OBJECTIVE: Cognitive processing therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD); however, questions remain regarding variability in treatment response. METHOD: A total of 123 veterans participated in group-based cognitive processing therapy (CPT) in residential PTSD treatment. Change over time in PTSD symptoms was modeled as a function of selected demographic and clinical variables. RESULTS: PTSD checklist (PCL) scores decreased by an average of 1 point per session (standard deviation [SD] = 0...
November 28, 2018: Journal of Clinical Psychology
Natalie E Hundt, Anthony H Ecker, Karin Thompson, Ashley Helm, Tracey L Smith, Melinda A Stanley, Jeffrey A Cully
Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy...
November 26, 2018: Psychological Services
Laura D Wiedeman, Susan M Hannan, Kelly P Maieritsch, Cendrine Robinson, Gregory Bartoszek
Although common practice in Veterans Affairs (VA) PTSD clinics, it is unclear whether preparatory treatment improves trauma-focused treatment (TFT) completion and outcomes. Furthermore, little is known about whether treatment-seeking veterans in naturalistic settings would chose to prioritize preparatory treatment if given the option of a phase-based approach or direct access to TFT, and how substance-related problems (SRPs) influence this treatment choice. The first aim of this study was to explore how co-occurring SRPs (ranging from none to moderate/severe) influence PTSD treatment choices in a naturalistic setting where veterans were offered a choice between a phase-based approach (i...
November 26, 2018: Psychological Services
Sandra J Japuntich, Lewina O Lee, Suzanne L Pineles, Kristin Gregor, Celina M Joos, Samantha C Patton, Suchitra Krishnan-Sarin, Ann M Rasmusson
INTRODUCTION: Trauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD...
October 29, 2018: Addictive Behaviors
Julius C Pape, Tania Carrillo-Roa, Barbara O Rothbaum, Charles B Nemeroff, Darina Czamara, Anthony S Zannas, Dan Iosifescu, Sanjay J Mathew, Thomas C Neylan, Helen S Mayberg, Boadie W Dunlop, Elisabeth B Binder
BACKGROUND: We have previously evaluated the efficacy of the CRF1 receptor antagonist GSK561679 in female PTSD patients. While GSK561679 was not superior to placebo overall, it was associated with a significantly stronger symptom reduction in a subset of patients with probable CRF system hyperactivity, i.e., patients with child abuse and CRHR1 SNP rs110402 GG carriers. Here, we test whether blood-based DNA methylation levels within CRHR1 and other PTSD-relevant genes would be associated with treatment outcome, either overall or in the high CRF activity subgroup...
November 3, 2018: Clinical Epigenetics
Zoe R Feingold, Annie B Fox, Tara E Galovski
Adults with severe mental illness (SMI) who come into contact with the criminal justice system experience high rates of trauma exposure and posttraumatic stress disorder (PTSD). For individuals with SMI, symptoms of PTSD are associated with exacerbated psychiatric symptoms, higher risk of homelessness and-for those with a history of arrest-increased risk of recidivism. The goal of the present study was to assess the effectiveness of evidence-based psychotherapies (EBPs) for trauma-related distress in treating individuals with SMI who have been diverted from jail to receive community-based treatment services...
November 2018: Psychological Services
Marcela Ot'alora G, Jim Grigsby, Bruce Poulter, Joseph W Van Derveer, Sara Gael Giron, Lisa Jerome, Allison A Feduccia, Scott Hamilton, Berra Yazar-Klosinski, Amy Emerson, Michael C Mithoefer, Rick Doblin
BACKGROUND: Posttraumatic stress disorder often does not resolve after conventional psychotherapies or pharmacotherapies. Pilot studies have reported that 3,4-methylenedioxymethamphetamine (MDMA) combined with psychotherapy reduces posttraumatic stress disorder symptoms. AIMS: This pilot dose response trial assessed efficacy and safety of MDMA-assisted psychotherapy across multiple therapy teams. METHODS: Twenty-eight people with chronic posttraumatic stress disorder were randomized in a double-blind dose response comparison of two active doses (100 and 125 mg) with a low dose (40 mg) of MDMA administered during eight-hour psychotherapy sessions...
October 29, 2018: Journal of Psychopharmacology
Adam G Horwitz, Lynsey Miron, Kelly P Maieritsch
Posttraumatic stress disorder (PTSD) rates are higher in military veterans than in the civilian population. Meta-analyses have found strong and consistent associations between PTSD and suicide risk. Several studies have demonstrated a concurrent reduction in suicidal ideation (SI) with reduction of PTSD symptoms during trauma-focused treatment. However, it is unclear whether changes in specific PTSD symptom clusters are most strongly associated with these changes in SI. This study prospectively examined associations between PTSD symptom clusters and SI to better specify mechanisms of change during treatment...
October 25, 2018: Psychological Services
Eric C Meyer, Robyn Walser, Barbara Hermann, Heidi La Bash, Bryann B DeBeer, Sandra B Morissette, Nathan A Kimbrel, Oi-Man Kwok, Sonja V Batten, Paula P Schnurr
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD-AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness- and acceptance-based form of behavior therapy, has potential as a treatment option for PTSD-AUD. In this uncontrolled pilot study, we examined ACT for PTSD-AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i...
October 2018: Journal of Traumatic Stress
Siobhan Robinson, Christa C Christ, Margaret M Cahill, Sara J Aldrich, Elisa Taylor-Yeremeeva
Many people will experience at least one traumatic event in their lifetime, with up to 20% developing Post-Traumatic Stress Disorder (PTSD) or PTSD-like symptoms. In addition, the likelihood that females will develop PTSD after trauma is more than twice that of males. Despite its prevalence, current treatment strategies for trauma victims are limited and substantial portions of affected individuals remain resistant to treatment, suggesting that additional interventions are necessary. Using an animal model of traumatic stress, the present studies tested the hypothesis that either voluntary exercise and/or administration of the adrenergic beta-receptor antagonist propranolol, would ameliorate stress-related maladaptive behaviors...
October 16, 2018: Physiology & Behavior
Jonathan G Shalom, Eva Gilboa-Schechtman, Dana Atzil-Slonim, Eran Bar-Kalifa, Ilanit Hasson-Ohayon, Patricia van Oppen, Anton J L M van Balkom, Idan M Aderka
OBJECTIVE: Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms. METHOD: We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive-compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106)...
November 2018: Journal of Consulting and Clinical Psychology
Richard A Bryant
PURPOSE OF REVIEW: The aim of this review is to provide a summary of the current evidence pertaining to the course of acute and chronic posttraumatic stress, the diagnosis of acute stress disorder (ASD), and treatment of acute stress disorder and prevention of posttraumatic stress disorder (PTSD). RECENT FINDINGS: Although acute stress disorder was introduced partly to predict subsequent PTSD, longitudinal studies indicate that ASD is not an accurate predictor of PTSD...
October 13, 2018: Current Psychiatry Reports
Joan M Cook, Richard Thompson, Vanessa Simiola, Shannon Wiltsey Stirman, Paula P Schnurr
This study examined the role of attitudes toward evidence-based psychotherapies (EBPs) in predicting use of prolonged exposure (PE) and cognitive processing therapy (CPT), two EBPs for posttraumatic stress disorder (PTSD) among PTSD treatment providers within the Department of Veterans Affairs. Providers' general attitudes toward EBPs, as well as their specific perceptions of PE and CPT, were examined as potential predictors of use. One hundred fifty-nine providers from 38 Department of Veterans Affairs' residential PTSD programs across the United States completed an online survey that included the predictors listed as well as self-reported use of PE on an individual basis and CPT on an individual and on a group basis...
September 27, 2018: Psychological Services
Denise A Hien, Kathryn Z Smith, Max Owens, Teresa López-Castro, Lesia M Ruglass, Santiago Papini
OBJECTIVE: To advance understanding of the effectiveness of evidence-based treatments for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments and whether prolonged exposure techniques can be efficacious during active substance use. A data set that included patients with PTSD/subthreshold-PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients' substance use impacted PTSD change over treatment...
October 2018: Journal of Consulting and Clinical Psychology
Xi Zhu, Benjamin Suarez-Jimenez, Amit Lazarov, Liat Helpman, Santiago Papini, Ari Lowell, Ariel Durosky, Martin A Lindquist, John C Markowitz, Franklin Schneier, Tor D Wager, Yuval Neria
BACKGROUND: 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. METHODS: 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...
October 2018: Depression and Anxiety
Kelly R Peck, Scott F Coffey, Adam P McGuire, Andrew C Voluse, Kevin M Connolly
Dysfunctional trauma-related cognitions are important in the emergence and maintenance of posttraumatic stress disorder (PTSD) and the modification of such cognitions is a proposed mechanism of trauma treatment. However, the authors are not aware of any research examining trauma-related cognitions as a treatment mechanism in a sample of individuals with comorbid PTSD and substance use disorder (SUD). Accordingly, the present study sought to address this gap in the literature and examined the relationship between trauma-related cognitions and treatment outcomes within a sample of seventy-two veterans diagnosed with PTSD and SUD...
September 15, 2018: Journal of Anxiety Disorders
Candice M Monson, Norman Shields, Michael K Suvak, Jeanine E M Lane, Philippe Shnaider, Meredith S H Landy, Anne C Wagner, Iris Sijercic, Tasoula Masina, Sonya G Wanklyn, Shannon Wiltsey Stirman
This randomized controlled hybrid implementation/effectiveness trial aimed to compare the impact of three different models of training and consultation by examining the PTSD treatment outcomes achieved by therapists who were learning a front-line recommended psychotherapy for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2017). Therapists (N = 134) were randomized into one of three conditions after attending a standard CPT training workshop: No Consultation with delayed feedback on CPT fidelity, Standard Consultation involving discussion and conceptualization of cases without session audio review, and Consultation Including Audio Review, which included a review of segments of audiorecorded CPT sessions...
November 2018: Behaviour Research and Therapy
Anne L Malaktaris, Brian A Buzzella, Maya E Siegel, Ursula S Myers, Kendall C Browne, Sonya B Norman, Abigail C Angkaw
Introduction: Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment...
September 12, 2018: Military Medicine
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