Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults

Abstract

Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).

From Pathology to Intervention and Beyond. Reviewing Current Evidence for Treating Trauma-Related Disorders in Later Life

“…Disconfirming these stereotypes, however, older and younger adults were found to benefit in equal measure from mental health care ( 52 ). Similarly, older and younger adults benefitted equally from high intensive EMDR treatment ( 53 ). Emerging evidence on trauma-focused exposure therapy in later life ( 37 – 40 , 42 , 44 ) has yielded encouraging findings on various clinically relevant variables.…”

“…Extending routine assessments with cognitive and physiological measures (blood pressure or heart rate) could provide additional evidence on risks and outcomes of psychotherapy in older adults ( 29 , 46 ). Finally, e-health applications for assessment and/or intensive treatment formats ( 53 ) could bring interesting innovations and allow access to additional groups of patients.…”

“…Regarding resilience measures, data from one of the selected RCTs showed that posttraumatic growth was significantly associated with treatment outcome (54). Additionally, numerous case reports (31,46,(55)(56)(57)(58), and uncontrolled trials (53,54,(59)(60)(61) have suggested likewise.…”

The feasibility of eye movement desensitization and reprocessing (EMDR) for older adults with posttraumatic stress disorder (PTSD) and comorbid psychiatric and somatic disorders.

“…International guidelines on the treatment of PTSD recommend trauma-focused treatment; especially prolonged exposure (PE), Cognitive Processing Therapy (CPT), and eye movement desensitization and reprocessing (EMDR) are recommended treatments (International Society for Traumatic Stress Studies (ISTSS) Prevention and Treatment Guidelines, 2018). In older adults (>55 years) trauma-focused treatment has proven to be effective with moderate to large effect sizes (randomized control trials: Bichescu et al, 2007; Bowland et al, 2012; Kearney et al, 2021; Knaevelsrud et al, 2017; Lely et al, 2019; Thorp et al, 2019; pilot/outcome studies: Gamito et al, 2010; Gielkens et al, 2021; Strous et al, 2005; Thorp et al, 2012). However, guideline treatments are sparse (PE: Thorp et al, 2019, 2012, CPT: Kearney et al, 2021, Narrative Exposure Therapy: Bichescu et al, 2007; Lely et al, 2019, combination of EMDR and PE: Gielkens et al, 2021).…”

“…In older adults (>55 years) trauma-focused treatment has proven to be effective with moderate to large effect sizes (randomized control trials: Bichescu et al, 2007; Bowland et al, 2012; Kearney et al, 2021; Knaevelsrud et al, 2017; Lely et al, 2019; Thorp et al, 2019; pilot/outcome studies: Gamito et al, 2010; Gielkens et al, 2021; Strous et al, 2005; Thorp et al, 2012). However, guideline treatments are sparse (PE: Thorp et al, 2019, 2012, CPT: Kearney et al, 2021, Narrative Exposure Therapy: Bichescu et al, 2007; Lely et al, 2019, combination of EMDR and PE: Gielkens et al, 2021). Age in these studies was relatively low ( M age ≤ 65 in 5/6 studies; Gielkens et al, 2021; Kearney et al, 2021; Lely et al, 2019; Thorp et al, 2019, 2012; M age = 69 in 1/6 studies; Bichescu et al, 2007), and no information was given about comorbid somatic conditions, generalizability to older adults with comorbid pathology was not clear.…”