A randomized clinical trial of prolonged exposure and applied relaxation for the treatment of Latinos with posttraumatic stress disorder

Abstract

Robust evidence supports the use of prolonged exposure therapy (PE) as a first‐line treatment for posttraumatic stress disorder (PTSD). However, Latinos have not benefitted equally from advancements in the treatment of PTSD and continue to face barriers to receiving care. There is consensus that it is necessary to support the expansion of high‐quality culturally and linguistically appropriate treatment to address disparities experienced by racial and ethnic minorities in behavioral health care. The current study was a randomized controlled trial comparing a culturally adapted PE intervention with applied relaxation (AR) among Spanish‐speaking Latinos with PTSD in Puerto Rico. Eligible participants (N = 98) were randomly assigned to PE (n = 49) or AR (n = 49). Both treatments included 12–15 weekly sessions each lasting 60–90 min. The primary outcome, clinician‐rated PTSD symptom severity, was assessed using the Clinician‐Administered PTSD Scale for DSM‐5 at baseline, posttreatment, and 3‐month follow‐up. Secondary outcomes were assessed using the Patient Health Questionnaire and State–Trait Anxiety Inventory. Results showed a large within‐group effect of treatment on PTSD symptoms, PE: d = 1.29, 95% CI [1.12, 2.05]; AR: d = 1.38, 95% CI [1.21, 2.19]. The between‐group effect on PTSD symptoms was small, d = −0.09, 95% CI [−0.48, 0.31]. Participants in both treatment conditions reported significant decreases in PTSD symptoms from baseline to follow‐up; additionally, significant within‐group reductions in depression and anxiety symptoms were observed. These findings underscore the potential benefit of PE and AR for the treatment of Spanish‐speaking Latinos with PTSD.

Body‐and movement‐oriented interventions for posttraumatic stress disorder: An updated systematic review and meta‐analysis

“…(2022) had a significant baseline imbalance, which might reflect a problem with the randomization process. Risk of bias resulting from deviations in the intended interventions was deemed low in three studies (Kahn et al., 2016; Thorp et al., 2019; Vera et al., 2022), we noted some concerns in 18 studies and categorized eight studies as high risk. Risk of bias resulting from missing outcome data was rated low for all studies except Brom et al.…”

“…Heterogeneity tests indicated a very large degree of heterogeneity, Q = 263.43, p < .001, I 2 = 88.6% 95% PI [−1.07, 2.07]. We detected six studies as outliers, with the 95% confidence intervals entirely outside the 95% confidence intervals of the pooled effect (Descilo et al., 2009; Jindani et al., 2015; Lang et al., 2019; Nordbrandt et al., 2020, for the Basic Body Awareness Therapy condition; Thorp et al., 2019; Vera et al., 2022). An additional analysis excluding these studies resulted in a Hedges’ g effect size of 0.46, 95% CI [0.30, 0.61], which is considered moderate.…”

“…(2022), Vera et al. (2022), and Zaccari et al. (2022) reported different secondary outcome measures than what was listed in the preregistered protocol.…”

“…A summary of the risk of bias assessment based on RoB2 (Sterne et al, 2019) 2022) had a significant baseline imbalance, which might reflect a problem with the randomization process. Risk of bias resulting from deviations in the intended interventions was deemed low in three studies (Kahn et al, 2016;Thorp et al, 2019;Vera et al, 2022), we noted some concerns in 18 studies and categorized eight studies as high risk. Risk of bias resulting from missing outcome data was rated low for all studies except Brom et al (2017), Kelly et al (2021), Reinhardt et al (2018), and Zaccari et al (2022); these studies had an imbalance in dropout rates between intervention groups.…”

“…In 11 studies, the presented data were in accordance with a prespecified analysis plan, and we had no reason to assume they were selectively reported (Hall et al, 2020;Kahn et al, 2016;Kelly et al, 2021;Lang et al, 2019;Nakamura et al, 2017;Nordbrandt et al, 2020;Reinhardt et al, 2018;Rosenbaum et al, 2015;Thorp et al, 2019;van der Kolk et al, 2014). The studies by Gibert et al (2022), Vera et al (2022), and Zaccari et al (2022) reported different secondary outcome measures than what was listed in the preregistered protocol. For the other studies, we did not find a prespecified analysis plan, leading to a categorization of "some concerns," but we had no reason to assume selective reporting.…”