Assessing Treatment-Resistant Posttraumatic Stress Disorder: The Emory Treatment Resistance Interview for PTSD (E-TRIP)

Dunlop, Boadie W.; Kaye, Joanna L.; Youngner, Cole; Rothbaum, Barbara O.

doi:10.3390/bs4040511

Cited by 47 publications

(27 citation statements)

References 81 publications

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“…Additionally, the results of the exploratory cluster and prediction analyses should be interpreted with caution given the low number of participants per cluster. Also, although our participants had a history of multiple treatment attempts, we did not use a standard measure to quantify the degree of treatment resistance per participant (Dunlop, Kaye, Youngner, & Rothbaum, 2014). Another limitation is that we assessed suicidal ideation, self-harm, aggressive behaviour, and a sense of losing control with Likert scales rather than validated measures.…”

Section: Discussionmentioning

confidence: 99%

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.

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Section: Discussionmentioning

confidence: 99%

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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“…The Emory Treatment Resistance Interview for PTSD was used to quantify level of treatment resistance to evidence-based psychological and pharmacological treatments [37]. Points for non-response were given based on available evidence for that treatment (3 points for high evidence to 0 points for no evidence; range 0-19 for pharmacological treatments and 0-38 for psychotherapeutic interventions).…”

Section: Outcome Measures Clinical Interviewsmentioning

confidence: 99%

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Gelderen

Nijdam

Haagen

et al. 2020

Psychother Psychosom

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Background: Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. Objective: To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. Method: In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. Results: The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. Conclusions: In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

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“…Whether TEAS treatment outcomes are related to patient expectation and whether similar treatment outcomes could be achieved in PTSD children and adolescents needs further investigation. Finally, this study did not conduct follow‐up measurements and did not examine the effects of TEAS in treatment‐resistant PTSD, which is often observed in CBT and pharmacotherapy . Whether TEAS could serve as a long‐term maintenance therapy and benefit refractory PTSD deserves further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by re‐experiencing the traumatic event, avoidance, and hyperarousal . Although selective serotonin re‐uptake inhibitors (SSRI), such as sertraline, and cognitive behavioral therapy (CBT) are the mainstay of the management of PTSD, a large portion of the patients cannot obtain satisfactory treatment response . This is probably because the pathogenesis of PTSD is associated with multiple neurobiological systems, in particular serotonergic (5‐HT), noradrenergic (NA), and neuropeptidergic systems, as well as the hypothalamic–pituitary adrenal axis …”

mentioning

confidence: 99%

Transcutaneous electrical acupoint stimulation for post‐traumatic stress disorder: Assessor‐blinded, randomized controlled study

Feng

Zhang

Wu³

et al. 2019

Psychiatry Clin Neurosci

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Aim Transcutaneous electrical acupoint stimulation (TEAS) has the potential to alleviate post‐traumatic 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 (60 in each group) were assigned to receive simulated TEAS combined with sertraline (group A) or with CBT (group B), active TEAS combined with CBT (group C), or active TEAS combined with CBT plus sertraline (group D) for 12 weeks. The outcomes were measured using the Clinician‐Administered PTSD Scale, PTSD Check List‐Civilian Version, and 17‐item Hamilton Rating Scale for Depression. Results While PTSD symptoms reduced over time in all patients, groups C and D had markedly greater improvement in both PTSD and depressive measures than groups A and B in all post‐baseline measurement points, with moderate to very large effect sizes of 0.484–2.244. Groups C and D also had a significantly higher rate than groups A and B on clinical response (85.0% and 95.0% vs 63.3% and 60.0%, P < 0.001) and on remission (15.0% and 25.0% vs 3.3% and 1.7%, P < 0.001). The incidence of adverse events was similar between groups A and D and between groups B and C. Conclusions Additional TEAS augments the anti‐PTSD and antidepressant efficacy of antidepressants or CBT, without increasing the incidence of adverse effects. TEAS could serve as an effective intervention for PTSD and comorbid depression. This trial was registered with http://www.chictr.org (no.: ChiCTR1800017255).

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Assessing Treatment-Resistant Posttraumatic Stress Disorder: The Emory Treatment Resistance Interview for PTSD (E-TRIP)

Cited by 47 publications

References 81 publications

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Transcutaneous electrical acupoint stimulation for post‐traumatic stress disorder: Assessor‐blinded, randomized controlled study

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