Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial

Abstract

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, 'gold standard' treatments for PTSD/SUD comorbidity are currently available. The present pilot randomized clinical trial was designed to evaluate the feasibility and preliminary efficacy of a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS), as compared to standard cognitive-behavioral treatment (CBT) for SUD. The TIPSS program integrates cognitive processing therapy with CBT for SUD for the treatment of co-occurring PTSD/SUD. Both treatment conditions are comprised of 12, 60-minute individual psychotherapy sessions, delivered twice-weekly over six weeks. Primary aims examine whether TIPSS, compared to standard CBT for SUD, reduces: (1) PTSD symptoms and (2) substance use outcomes (i.e., self-report, objective). Secondary aims examine whether (a) trauma- and substance cue reactivity and (b) distress tolerance (i.e., actual or perceived ability to withstand uncomfortable emotional or physical states) are significant mechanisms of change. The study was recently closed to new enrollment. Participants included adults with substance dependence and at least four symptoms of PTSD.

Baseline resting heart rate variability predicts post‐traumatic stress disorder treatment outcomes in adults with co‐occurring substance use disorders and post‐traumatic stress

“…The current study is a secondary analysis of data collected from a pilot clinical trial (Vujanovic, Smith, Green, et al, ) investigating a novel treatment for comorbid PTSD and SUD (ClinicalTrials.gov Identifier: NCT02461732). Procedures relevant to the current investigation are reported here, with the main design published elsewhere (Vujanovic, Green, Lane, & Schmitz, ). The relevant institutional review boards approved all procedures, which were conducted in accord with the Declaration of Helsinki.…”

“…Specific topics covered in CBT included problem thinking, changing problem thinking, lifestyle balance, increasing nonsubstance activities, enhancing social support, and relapse prevention. TIPSS (see Vujanovic, Smith, Green, et al, ; Vujanovic, Smith, Tipton, et al, ) incorporated motivational interviewing, key topics relevant to CBT for SUD, and psychoeducation on the link between PTSD and substance use. Cognitive‐emotional processing techniques were used including identification of trauma‐related maladaptive beliefs related to trust, intimacy, esteem, power/control, and safety; Socratic questioning techniques to challenge those beliefs; and a written account of the trauma with in‐session review and discussion.…”

“…The current study examined baseline resting HF‐HRV in an early‐phase clinical trial of a novel treatment for trauma‐exposed individuals with SUD who also displayed clinically significant PTSD symptoms (at least four PTSD symptoms; Vujanovic, Smith, Green, Lane, & Schmitz, ; Vujanovic, Smith, Tipton, & Schmitz, ). Individuals were allocated to two conditions: standard cognitive‐behavioral therapy for substance use (CBT) or the treatment of integrated post‐traumatic stress and substance use (TIPSS).…”

Importance of Behavioral Therapy in Patients Hospitalized for Post-Traumatic Stress Disorder (PTSD) with Opioid Use Disorder

“…Previous research has highlighted the importance of both psychotropic medications and BT in improving outcomes in the treatment of PTSD with OUD [ 11 , 12 ]. There was significantly positive outcome with combined therapy in remission and post treatment outcomes [ 13 , 14 , 15 , 16 , 17 ].…”

A Novel, Integrated Cognitive-Behavioral Therapy for Co-Occurring Posttraumatic Stress and Substance Use Disorders: A Case Study

“…The SUD treatment components are based upon cognitive-behavioral relapse prevention principles that are intended to facilitate awareness and management of cravings, review coping skills for high-risk substance-related cognitions and situations, and provide a greater understanding of the associations between thoughts, feelings, and substance use behaviors and cravings via functional analyses (Carroll, 1998;Marlatt & Donovan, 2007). The purpose of the present article is to depict this new treatment approach via a case study presentation, drawn from the context of a randomized controlled trial (NCT02461732; Vujanovic, Smith, Green, Lane, & Schmitz, 2018).…”