A Window Into the Evolution of Trauma-Focused Psychotherapies for Posttraumatic Stress Disorder

Hoge, Charles W.; Chard, Kathleen M.

doi:10.1001/jama.2017.21880

Cited by 38 publications

(30 citation statements)

References 14 publications

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“…Our finding that Seeking Safety plus TAU and RPT plus TAU led to similar reductions in PTSD severity is congruent with the literature indicating that no or only small significant differences exist between active treatments in the PTSD, SUD and PTSD/SUD fields (e.g. Hoge & Chard, 2018;Imel et al, 2008;Simpson et al, 2017). With regard to PTSD/SUD treatment in particular, several RCTs using trauma-focused therapies have found no significant difference on PTSD or SUD at end of treatment compared to active controls such as supportive therapy (Foa et al, 2013;Sannibale et al, 2013) and RPT (Ruglass et al, 2017).…”

Section: Discussionsupporting

confidence: 91%

“…Among the subset of comparisons of active treatments, however, there were no significant differences. This latter finding mirrors the larger literature on comparisons of active treatment models for PTSD alone, SUD alone, and PTSD/SUD, which consistently show no significant differences between them (Hoge & Chard, 2018;Imel, Wampold, Miller, & Fleming, 2008;Simpson, Lehavot, & Petrakis, 2017). Lenz et al (2016) also noted in their meta-analysis of Seeking Safety that their results are limited by the characteristics of the available evidence, e.g.…”

Section: Introductionsupporting

confidence: 68%

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A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

Schäfer

Lotzin

Hiller

et al. 2019

European Journal of Psychotraumatology

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Background : Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA. Objective : To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone. Method : In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment. Results : Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions. Conclusions : With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 68%

A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

Schäfer

Lotzin

Hiller

et al. 2019

European Journal of Psychotraumatology

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“…Participants in GPCT may have attended a greater number of group sessions because of the non-trauma-focused nature of the treatment compared to the more intensive, trauma-focused format of GCBT. Taken together, the current study adds to the emerging literature that suggests structured non-trauma-focused treatment can be helpful for individuals with chronic PTSD, particularly military veterans and service members, and is associated with a higher level of treatment retention (for a commentary on this issue, see Hoge & Chard, 2018).…”

Section: Discussionmentioning

confidence: 86%

A Randomized Controlled Trial of Group Cognitive Behavioral Treatment for Veterans Diagnosed With Chronic Posttraumatic Stress Disorder

Sloan

Unger

Lee

et al. 2018

Journal of Traumatic Stress

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Relative to advances in the literature that have examined individual treatment approaches for posttraumatic stress disorder (PTSD), scientific knowledge about group treatment approaches has lagged, resulting in no currently available group treatment for PTSD despite the frequency with which this format is used. Our goal was to build upon the existing literature by examining the efficacy of a group cognitive-behavioral treatment (GCBT) for PTSD relative to group present-centered treatment (GPCT). The sample consisted of 198 male veterans with PTSD who were recruited at two Department of Veteran Affairs medical centers and randomly assigned to either GCBT (n = 98) or GPCT (n = 100); both treatments were 14 sessions. Assessments occurred at baseline, midtreatment, posttreatment and 3-, 6-, and 12-month follow-ups. Findings indicated significant reductions in PTSD severity and PTSD diagnostic status following treatment for both GCBT, d = 0.97, and GPCT, d = 0.61. In addition, we observed significant reductions for depression symptoms, anxiety symptoms, and functional impairment for both group treatments as well as a reduction in the percentage of veteran participants who met diagnostic status for co-occurring major depression disorder and generalized anxiety disorder. Notably, these treatment gains were maintained at 12-month follow-up. Contrary to expectations, there were no significant differences between treatment conditions. Veterans diagnosed with PTSD were successfully treated using a group approach. Consistent with a growing body of evidence, the findings also suggest GPCT is as equally efficacious as group trauma-focused treatment. The trial was registered at clinicaltrials.gov (NCT01544088).

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“…In addition, a mean 25% drop-out rate was reported and high dropout rates severely impact the mental health needs of veterans (Imel et al, 2013). Therefore, the testing of other evidence- based approaches, such as EMDR therapy, has been recommended (Steenkamp et al, 2015; Yehuda and Hoge, 2016; Kudler, 2017; Hoge and Chard, 2018). …”

Section: Introductionmentioning

confidence: 99%

Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches

Hurley¹

2018

Front. Psychol.

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The effectiveness of EMDR therapy in treating veterans diagnosed with PTSD was evaluated in this study using two treatment formats: intensive daily EMDR treatment provided twice a day during a 10-day period and a second format of one session each week. The study used archived outcome data previously collected and stored at Soldier Center. Both formats provided 18–20 treatment sessions of EMDR therapy to veterans diagnosed with PTSD that included dissociative exhibitions and moral injury issues. Questions addressed included: (1) does EMDR therapy administered twice daily ameliorate veterans’ PTSD symptoms; (2) does EMDR therapy administered twice daily provide equivalent outcome results as EMDR therapy administered weekly for 18–20 sessions; and (3) does the treatment outcome persist. The effectiveness of the weekly treatment group was also evaluated. Both groups’ results were assessed at pre-treatment, post-treatment and 1-year follow-up. The results indicated that both weekly treatment and intensive daily treatment groups produced statistically significant treatment effects (p < 0.001) that were maintained at 1-year follow-up. The10-day EMDR intensive daily treatment (EMDR therapy twice a day for 10 days) produced a similar outcome as to that of the weekly treatment with a 1-year follow-up. Results support the effectiveness of EMDR therapy when offered in both weekly treatment format as well as the intensive 10-day format on an outpatient basis. While recognizing the limitations of this study the results are significant to warrant additional research.

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A Window Into the Evolution of Trauma-Focused Psychotherapies for Posttraumatic Stress Disorder

Cited by 38 publications

References 14 publications

A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

A Randomized Controlled Trial of Group Cognitive Behavioral Treatment for Veterans Diagnosed With Chronic Posttraumatic Stress Disorder

Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches

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