Mild Traumatic Brain Injury and Treatment Response in Prolonged Exposure for PTSD

Abstract

A proportion of U.S. veterans returning from Iraq and Afghanistan have experienced mild traumatic brain injury (mTBI), which is associated with increased risk for developing posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) has proven effectiveness in the treatment of PTSD; however, some clinicians have reservations about using PE with individuals with a history of mTBI. We examined the impact of PE for veterans with PTSD and with or without a history of mTBI in a naturalistic sample of 51 veterans who received PE at a Veterans Health Administration PTSD clinic. We also analyzed previously collected data from a controlled trial of 22 veterans randomly assigned to PE or present centered therapy. For both sets of data, we found that PE reduced symptom levels and we also did not detect an effect for mTBI, suggesting that PE may be helpful for individuals with PTSD and a history of mTBI.

Prolonged Exposure Therapy With Veterans and Active Duty Personnel Diagnosed With PTSD and Traumatic Brain Injury

“…We used data only from individuals who had attended at least one session of PE. As with previous effectiveness studies (Goodson, Leftowitz, Helstrom, & Gawrysiak, ; Sripada et al., ), participants were considered to be therapy completers if they successfully negotiated at least eight sessions of PE. The demographic and clinical characteristics of the sample are summarized in Table .…”

“…Preliminary studies with veterans diagnosed with PTSD and mild TBI have suggested PE is safe, effective, and may yield additional benefits when implemented early in the TBI rehabilitation process (Sripada et al., ; Wolf, Strom, Kehle, & Eftekhari, ). These studies, however, did not evaluate the effectiveness of PE within a sample of veterans and active duty personnel with a range of TBI severity.…”

The influence of traumatic brain injury on treatment outcomes of Concurrent Treatment for PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) in veterans

“…In contrast to prior studies investigating the relation between mTBI and EBPs for PTSD, 19 the present study included a somewhat larger sample of patients with a history of TBI and LOC to more adequately test for differences in treatment response among those with and without TBI+LOC history. Although both groups demonstrated significant improvements in symptoms of PTSD and depression during the course of COPE, the control group evidenced significantly larger treatment improvements than the TBI+LOC-positive group.…”

“…In the only two studies to include a control group without TBI history, no differences were found between groups in outcomes for an EBP for PTSD. 19,21 However, the authors acknowledge that the sample size limited their ability to adequately test for group differences.…”

Mental Health Among Military Personnel and Veterans

“…VHA is a leader in dissemination and implementation of evidence-based psychotherapies [47,48]. Multiple studies have demonstrated effectiveness with evidence-based psychotherapies for PTSD, TBI, and other mental health conditions [49].…”