Adjusting the Timeframe of Evidence-Based Therapies for PTSD-Massed Treatments

Wachen, Jennifer Schuster; Dondanville, Katherine A.; Evans, Wyatt R.; Morris, Kris; Cole, Allison

doi:10.1007/s40501-019-00169-9

Cited by 31 publications

(25 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another explanation for the relapse might be that individuals suffering from severe PTSD are also those with many vulnerabilities and comorbidities; that is, they can easily end up in circumstances that are potentially traumatic again, and thus easily fall prey to revictimization. Yet, it is important to note that the overall size of the effect of the intensive treatment programme between pre-treatment and six month follow-up was still quite large (Cohen's d = 0.84), and comparable to other brief and intensive treatment programmes for PTSD (for an overview see Wachen, Dondanville, Evans, Morris, and Cole, 2019).…”

Section: Discussionmentioning

confidence: 73%

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Toorenburg

Sanches

Linders

et al. 2020

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from posttreatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

show abstract

Section: Discussionmentioning

confidence: 73%

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Toorenburg

Sanches

Linders

et al. 2020

European Journal of Psychotraumatology

View full text Add to dashboard Cite

show abstract

“…The effectiveness of intensive ESTs for PTSD is an emerging area of research (see Wachen et al., 2019, for a narrative review); however, these treatments have already been examined across various populations, including veterans, adolescents, and civilians; trauma types, such as combat exposure, childhood sexual abuse, and interpersonal trauma (Ehlers et al., 2014; Foa et al., 2018; Hendriks et al., 2018; Jarero et al., 2015); and formats, including standalone delivery of a standalone EST, combinations of ESTs and adjunctive interventions (Foa et al., 2018; Zalta et al., 2018). Intensive ESTs for PTSD have also been implemented in several treatment settings and across levels of care (e.g., Norman et al., 2016; Wagenmans et al., 2018).…”

mentioning

confidence: 99%

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

Sciarrino

Warnecke

Teng

2020

Journal of Traumatic Stress

View full text Add to dashboard Cite

Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence‐based psychotherapies (EBPs)—prolonged exposure (PE) and cognitive processing therapy (CPT)—as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or “massed,” treatments for PTSD. Due to variability among intensive treatments, including treatment delivery format, fidelity to the EST, and the population studied, we conducted a systematic review to summarize and integrate the literature on the impact of intensive treatments on PTSD symptoms. A review of four major databases, with no restrictions regarding publication date, yielded 11 studies that met all inclusion criteria. The individual study findings denoted a large impact of treatment on reduction of PTSD symptoms, ds = 1.15–2.93, and random‐effects modeling revealed a large weighted mean effect of treatment, d = 1.57, 95% CI [1.24, 1.91]. Results from intensive treatments also noted high rates of treatment completion (i.e., 0%–13.6% dropout; 5.51% pooled dropout rate across studies). The findings suggest that intensive delivery of these treatments can be an effective alternative to standard delivery and contribute to improved treatment response and reduced treatment dropout.

show abstract

“…Future research can explore adjunctive treatments that can be used with EBPs to increase uptake or additional treatments that can be used that could lead to meaningful improvements in PTSD symptoms and functioning. Furthermore, recent studies have demonstrated that massed or intensive treatments provided in a shorter timeframe can be beneficial and assist with engagement and completion rates (Wachen, Dondanville, Evans, Morris, & Cole, ). Massed or intensive treatments are often provided on a daily rather than weekly basis and remove some of the logistical barriers associated with weekly travel to an outpatient clinic.…”

Section: Discussionmentioning

confidence: 99%

Evidence‐based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014

et al. 2019

View full text Add to dashboard Cite

Background Although evidence‐based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) were implemented starting in 2005 in the veterans health administration (VHA), the largest national healthcare system in the U.S., the rate of initiation (uptake) and prevalence of these treatments in each calendar year have not been determined. We aimed to elucidate two metrics of EBP utilization, uptake and prevalence, following implementation. Methods Cohort study of Iraq and Afghanistan veterans in VHA (N = 181,620) with a PTSD diagnosis and ≥1 psychotherapy‐coded outpatient visit from 2001 to 2014. Using natural language processing techniques, annual and cumulative uptake and prevalence rates from 2001 to 2014 were calculated for each of the two EBPs for PTSD, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. Results Annual uptake of CPT increased during most years, reaching a maximum of 11.1%. Annual uptake of PE showed little change until 2008 and then increased, reaching a maximum of 4.4%. The annual prevalence of CPT increased throughout the study, reaching a maximum of 14.6%. The annual prevalence of PE increased to a maximum of 5.0% in 2010, but then flattened and declined. Annual uptake of minimally adequate CPT increased a to maximum of 5% in 2014. Annual uptake of minimally adequate PE increased to a maximum of 1.2% in 2010. The cumulative prevalence of CPT was 19.9% and cumulative prevalence for PE was 7.5%. Conclusions Access to EBPs for PTSD modestly increased for Iraq and Afghanistan veterans after nationwide implementation efforts. Further expanding the reach to veterans is critical, given low rates of minimally adequate EBPs for PTSD.

show abstract

Adjusting the Timeframe of Evidence-Based Therapies for PTSD-Massed Treatments

Cited by 31 publications

References 27 publications

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder

Evidence‐based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014

Contact Info

Product

Resources

About