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

Abstract

Background The co-occurrence of posttraumatic stress disorder (PTSD), substance use disorders (SUD), and traumatic brain injury (TBI) in veterans of Operations Enduring/Iraqi Freedom and New Dawn has received much attention in the literature. Although hypotheses have been presented and disseminated that TBI history will negatively influence treatment response, little data exist to support these claims. The present study investigates the influence of TBI history on response to COPE (Concurrent Treatment of PTSD and SUD Using Prolonged Exposure), a 12-session, integrated psychotherapy designed to address co-occurring PTSD and SUD. Method Participants were 51 veterans with current PTSD and SUD enrolled in a clinical trial examining COPE. Assessments of PTSD symptoms, substance use, and depression were collected at baseline and each treatment session. A TBI measure was used to dichotomize veterans into groups with and without a history of TBI (ns = 30 and 21, respectively). Results Participants with and without TBI history demonstrated significant improvements in PTSD and depression symptoms during the course of treatment. However, participants with TBI history experienced less improvement relative to participants without TBI history. Conclusions The present findings suggest that, although patients with a TBI history respond to treatment, their response to treatment was less so than that observed in patients without a TBI history. As such, identification, symptom monitoring, and treatment practices may require alteration and further special consideration in individuals with PTSD, SUD and TBI.

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

“… Notes a Two research articles [ 67 , 100 ] reported two studies of different study designs and as such, data reported on study design are for 61 studies b All case studies c Excludes case studies; two before-after without control group, three controlled interventions d All conducted in the United States e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU f Some studies include more than one type of treatment and as such, the number of articles reported across treatment types exceeds 49 studies ED: Emergency department; MHSU: Mental health disorders or substance use; OT: Occupational therapy; PTSD: Post-traumatic stress disorder; rTMS: Repetitive transcranial magnetic stimulation; TBI: Traumatic brain injury …”

“… e Sixteen studies [ 49 – 51 , 53 , 62 , 67 , 68 , 74 , 76 , 83 , 89 , 90 , 92 , 99 , 103 , 104 ] examined integrated care for individuals with TBI and more than one type of MHSU …”

“…While screening and the receipt of a diagnosis may provide opportunities to access treatments, MHSU diagnosis may also be a barrier to TBI treatment. Indeed, some RCTs included in this review had exclusion criteria based on types of MHSU or severity of TBI [ 52 , 54 , 58 , 59 , 66 , 67 , 71 , 72 , 74 , 76 , 79 , 82 , 84 , 90 , 95 , 103 , 107 ]. As such, potential negative consequences of TBI and/or MHSU diagnosis should be considered when implementing screening as a form of integrated care.…”

“…Apart from case studies, which predominantly comprised participants of a single sex or gender, none of the articles in this review reported sex- or gender-stratified data. Furthermore, two studies reported findings on men and women but were described as ‘sex’ [ 55 , 56 ] while 12 studies reported findings on males and females but were described as ‘gender’ [ 69 , 74 – 76 , 85 , 86 , 92 , 95 , 98 , 103 – 105 ]. Clear reporting of sex and gender data are needed to inform gender transformative integrated care.…”

Neurocognitive predictors of treatment outcomes in psychotherapy for comorbid PTSD and substance use disorders.

“…As sensitivity analyses, we reran analyses while including depression symptoms (PHQ-9) as a covariate. We also reran analyses while including mTBI history as a potential explanatory variable (see Supplemental Methods), given prior research (Gros et al, 2017).…”