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C-PTSD therapies

Benjamin Suarez-Jimenez, Xi Zhu, Amit Lazarov, J John Mann, Franklin Schneier, Andrew Gerber, Jacques P Barber, Dianne L Chambless, Yuval Neria, Barbara Milrod, John C Markowitz
BACKGROUND: The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)]...
February 18, 2019: Psychological Medicine
Jessica A Chen, John C Fortney, Hannah E Bergman, Kendall C Browne, Kathleen M Grubbs, Teresa J Hudson, Patrick J Raue
Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) are not widely utilized. Clinicians report concerns that direct discussion of traumatic experiences could undermine the therapeutic alliance, which may negatively impact retention and outcome. Studies among adolescents with PTSD found no difference in alliance between trauma-focused and non-trauma-focused psychotherapies, but this has not been tested among adults. The present study is a secondary analysis of a randomized trial of collaborative care, also known as care management, for PTSD...
February 11, 2019: Psychological Services
G Turrini, M Purgato, C Acarturk, M Anttila, T Au, F Ballette, M Bird, K Carswell, R Churchill, P Cuijpers, J Hall, L J Hansen, M Kösters, T Lantta, M Nosè, G Ostuzzi, M Sijbrandij, F Tedeschi, M Valimaki, J Wancata, R White, M van Ommeren, C Barbui
AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers...
February 11, 2019: Epidemiology and Psychiatric Sciences
Jenna N Parrish, Megan L Bertholomey, Hong W Pang, Robert C Speth, Mary M Torregrossa
Post-traumatic stress disorder (PTSD) is more prevalent in women than men, yet much remains to be determined regarding the mechanism underlying this sex difference. Clinical and preclinical studies have shown that low estradiol levels during extinction of fear conditioning in rodents (i.e., cue exposure therapy in humans) leads to poor extinction consolidation and increased fear during extinction recall. The renin-angiotensin system (RAS) is also associated with stress-related pathologies, and RAS antagonists can enhance extinction consolidation in males...
January 29, 2019: Translational Psychiatry
Meredith E Charney, Louis Chow, Rafaella J Jakubovic, Lydia E Federico, Elizabeth M Goetter, Allison L Baier, David Riggs, Jennifer Phillips, Eric Bui, Naomi M Simon
OBJECTIVE: Extensive research supports the use of prolonged exposure (PE) and cognitive processing therapy (CPT), for posttraumatic stress disorder (PTSD) in veterans and service members. PE and CPT have been disseminated nationally across the Department of Veterans Affairs (VA) facilities. Many service members and veterans receive care outside the VA where access to these gold standard psychotherapies can be limited. This paper presents a novel program developed to train community providers in the use of PE and CPT and their application to veterans with PTSD through the use of a medium-touch approach to consultation...
January 28, 2019: Psychological Trauma: Theory, Research, Practice and Policy
Karina P M Zorzella, Robert T Muller, Robert A Cribbie, Veerpal Bambrah, Catherine C Classen
OBJECTIVE: Alexithymia is a personality trait that reflects deficits in the cognitive processing and regulation of emotions (Taylor & Bagby, 2013). It has been closely linked to childhood trauma and reported by individuals presenting with other trauma-related conditions, such as posttraumatic stress disorder (PTSD), dissociation, and interpersonal problems (Powers, Etkin, Gyurak, Bradley, & Jovanovic, 2015). Addressing the emotional deficits associated with alexithymia is fundamental to resolving issues of childhood trauma and, therefore, is at the core of many trauma therapy models (e...
January 28, 2019: Psychological Trauma: Theory, Research, Practice and Policy
Eric A Dedert, Patricia A Resick, Paul A Dennis, Sarah M Wilson, Scott D Moore, Jean C Beckham
OBJECTIVE/BACKGROUND: Posttraumatic stress disorder (PTSD) and smoking are often comorbid. Combining PTSD and smoking cessation treatments could increase access to each treatment and could provide improved rates of smoking cessation through reductions in PTSD and depressive symptoms. PARTICIPANTS: Participants were veterans with current PTSD who smoked cigarettes and were willing to initiate treatment for both problems. METHOD: We conducted a randomized pilot trial (n = 40) to explore feasibility and estimate effect sizes of a treatment combining trauma-focused Cognitive Processing Therapy (CPT) with smoking cessation counseling and pharmacotherapy, relative to the same smoking cessation treatment without CPT...
January 17, 2019: Journal of Addiction Medicine
Jennifer E Tribble, Michael S Fanselow
Posttraumatic stress disorder (PTSD) is an extremely debilitating disease with a broad array of associated symptoms, making the disorder difficult to diagnose and treat. In humans, patients seem to benefit from group therapy or other means of promoting social behavior. To test these effects on our rodent model of PTSD, adult, male rats were housed in either single or pair conditions prior to and during an acute stressor to induce PTSD-like behaviors in these rats. Subsequently, rats were assessed for PTSD-like symptoms to determine the effect of social housing on stress-induced phenotypes...
January 10, 2019: Behavioral Neuroscience
Cynthia R Pearson, Debra Kaysen, David Huh, Michele Bedard-Gilligan
An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks...
January 3, 2019: AIDS and Behavior
Benjamin Buck, Aaron Norr, Andrea Katz, Gregory A Gahm, Greg M Reger
While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms...
December 12, 2018: Psychiatry Research
Dunja Tutus, Lutz Goldbeck, Elisa Pfeiffer, Cedric Sachser, Paul L Plener
OBJECTIVE: Trauma-therapy in children and adolescents often involves the inclusion of their parents. A multi-informant approach was used to investigate whether trauma-focused cognitive-behavioral therapy (TF-CBT) changes dysfunctional posttraumatic cognitions (PTCs) in participating parents. This, in turn, may mediate their child's posttraumatic stress symptoms (PTSS) posttreatment. METHOD: Children and adolescents (6-17 years old) were assigned to either a TF-CBT ( n = 57) or a waitlist ( n = 56) condition, within a multisite randomized controlled trial conducted in Germany...
December 20, 2018: Psychological Trauma: Theory, Research, Practice and Policy
Bin Feng, Ying Zhang, Li-Yuan Luo, Jian-Yong Wu, Sen-Jun Yang, Ning Zhang, Qing-Rong Tan, Hua-Ning Wang, Nan Ge, Fan Ning, Zi-Li Zheng, Rui-Ming Zhu, Min-Cai Qian, Zhi-Yu Chen, Zhang-Jin Zhang
AIM: Transcutaneous electrical acupoint stimulation (TEAS) has the potential to alleviate posttraumatic stress disorder (PTSD). The purpose of this study was to determine whether adding TEAS to sertraline or cognitive behavioral therapy (CBT) could improve the anti-PTSD efficacy. METHODS: In this randomized controlled trial, 240 PTSD patients with 60 each group were assigned to receive simulated TEAS combined with sertraline (Group A) or CBT (Group B), active TEAS combined with CBT (Group C), and active TEAS combined with CBT plus sertraline (Group D) for 12 weeks...
December 19, 2018: Psychiatry and Clinical Neurosciences
Craig S Rosen, Nancy C Bernardy, Kathleen M Chard, Barbara Clothier, Joan M Cook, Jill Crowley, Afsoon Eftekhari, Shannon M Kehle-Forbes, David C Mohr, Siamak Noorbaloochi, Robert J Orazem, Josef I Ruzek, Paula P Schnurr, Brandy N Smith, Nina A Sayer
The United States Department of Veterans Affairs (VA) provides Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) for PTSD at all of its facilities, but little is known about systematic differences between patients who do and do not initiate these treatments. VA administrative data were analyzed for 6,251 veterans receiving psychotherapy over one year in posttraumatic stress disorder (PTSD) specialty clinics at nine VA medical centers. CPT and PE were initiated by 2,173 (35%) patients. Veterans' probability of initiating either CPT or PE (considered together) was 29% lower (adjusted odds ratio = ...
November 20, 2018: Journal of Anxiety Disorders
Catrin Lewis, Neil P Roberts, Andrew Bethell, Lindsay Robertson, Jonathan I Bisson
BACKGROUND: Therapist-delivered trauma-focused psychological therapies are an effective treatment for post-traumatic stress disorder (PTSD). These have become the accepted first-line treatments for the disorder. Despite the established evidence-base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the limited number of qualified therapists to deliver the interventions, cost, and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments...
December 14, 2018: Cochrane Database of Systematic Reviews
Dawson Church, Peta Stapleton, Phil Mollon, David Feinstein, Elizabeth Boath, David Mackay, Rebecca Sims
Clinical EFT (Emotional Freedom Techniques) is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The approach has been validated in more than 100 clinical trials. Its efficacy for post-traumatic stress disorder (PTSD) has been investigated in a variety of demographic groups including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters...
December 12, 2018: Healthcare (Basel, Switzerland)
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
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