Prolonged exposure, paroxetine and the combination in the treatment of PTSD following a motor vehicle accident. A randomized clinical trial – The “TRAKT” study

Popiel, Agnieszka; Zawadzki, Bogdan; Pragłowska, Ewa; Teichman, Yona

doi:10.1016/j.jbtep.2015.01.002

Cited by 59 publications

(54 citation statements)

References 43 publications

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“…Three RCTs investigated the efficacy of paroxetine to augment first‐line PTSD treatments (i.e., PE; Popiel, Zawadzki, Praglowska, & Teichman, ; Schneier et al, ; Simon et al, ). Paroxetine is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class and is itself recognized as a first‐line treatment for PTSD in international guidelines (e.g., NICE, ).…”

Section: Resultsmentioning

confidence: 99%

“…Paroxetine is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class and is itself recognized as a first‐line treatment for PTSD in international guidelines (e.g., NICE, ). A large, three‐arm RCT ( N = 228) of male and female motor vehicle accident survivors were randomized to receive PE alone, 20 mg/day of paroxetine alone, or PE concurrently with 20 mg/day of paroxetine (Popiel et al, ). PTSD remission rate in the augmentation condition (51.2%) did not differ from paroxetine alone (43.3%, p = .510) or PE alone (65.4%, p = .110) in ITT analyses.…”

Section: Resultsmentioning

confidence: 99%

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Treatment augmentation for posttraumatic stress disorder: A systematic review

Metcalf

Stone

Hinton

et al. 2019

Clin Psychol Sci Pract

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This systematic review examined the efficacy of all augmentation approaches for first‐line posttraumatic stress disorder (PTSD) interventions. From 9,890 records, 34 trials were eligible for inclusion, covering 28 different augmentation approaches. Overall, augmentation approaches were ineffective if they targeted a mechanism similar to the first‐line treatment. Augmentation approaches combining two guideline‐recommended treatments were largely ineffective, reflecting ceiling effects. Pharmacological augmentation approaches targeting fear extinction mechanisms were largely ineffective, or worsened outcomes relative to prolonged exposure alone, as these approaches may inadvertently strengthen fear memories. Augmentation approaches targeting general cognitive enhancement showed promise and provided support for augmentation interventions that require little cognitive or emotional work and target mechanisms different than the first‐line treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Treatment augmentation for posttraumatic stress disorder: A systematic review

Metcalf

Stone

Hinton

et al. 2019

Clin Psychol Sci Pract

View full text Add to dashboard Cite

show abstract

“…The second line of reasoning explaining observed results refers to the hypothesis that aging makes all study participants – including the control group – more susceptible to the emotional load imposed by accident photos. It is important to underline that our sample consisted of people who decided to seek help and undergo a psychiatric evaluation following an MVA (for a detailed description of the treatment program see: Popiel et al, 2015 ). Hence, for every subject in our study accident pictures related to a significant, emotionally charged personal experience.…”

Section: Discussionmentioning

confidence: 99%

“…It was conducted at the outpatient treatment center at the University of Warsaw during the screening phase of the program TRAKT. TRAKT (meaning “route” in Polish) was a clinical trial comparing the efficacy of different treatment modalities for PTSD (paroxetine vs. prolonged exposure vs. combined treatment) following MVA (for details: see Popiel et al, 2015 ).…”

Section: Methodsmentioning

confidence: 99%

Age As Moderator of Emotional Stroop Task Performance in Posttraumatic Stress Disorder (PTSD)

et al. 2017

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Emotional Stroop task (EST) has been extensively used to investigate attentional processes in posttraumatic stress disorder (PTSD). Even though aging significantly changes the dynamics of emotion-cognition interactions, very little is known about its role in shaping EST performance in PTSD patients. In the present study we tested a uniquely large sample of motor vehicle accident victims. Data of 194 participants (75.3% female; mean age = 36.64 years, SD = 12.3) were included in the analysis, out of which 136 (70.1%) were diagnosed with PTSD. Prior to the psychiatric assessment, participants completed the pictorial version of EST (neutral, positive, negative, and accidents photos were presented). Comparison of the PTSD and control groups revealed a specific increase in reaction times (RTs) related to the exposure of trauma-related material. At the same time, previously unreported, moderating effects of age were also discovered. Older participants, in contrast to the younger group, showed no increase in RTs and interference scores in trials where accident photos were presented. Our study points to the key role of age as a previously understudied factor modifying EST performance in PTSD patients.

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“…Recent considerations for the design of clinical trials focused on PTSD treatment have suggested that we identify target systems involved in fear extinction and explore medications that enhance the targeted approach of traumafocused therapies [45][46][47][48][49][50][51][52][53]. Emotional processing theory postulates that fear activation is an essential component of successful PTSD treatment, and the extent of emotional reactions during trauma-focused therapy (TFT) has been associated with the magnitude of clinical improvement [54].…”

Section: Introductionmentioning

confidence: 99%

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

et al. 2020

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Background Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy. Methods We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI. Discussion We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans. Trial registration NCT04280965.

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Prolonged exposure, paroxetine and the combination in the treatment of PTSD following a motor vehicle accident. A randomized clinical trial – The “TRAKT” study

Cited by 59 publications

References 43 publications

Treatment augmentation for posttraumatic stress disorder: A systematic review

Treatment augmentation for posttraumatic stress disorder: A systematic review

Age As Moderator of Emotional Stroop Task Performance in Posttraumatic Stress Disorder (PTSD)

Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study

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