Trajectories of Response to Treatment for Posttraumatic Stress Disorder

Stein, Nathan R.; Dickstein, Benjamin D.; Schuster, Jennifer; Litz, Brett T.; Resick, Patricia A.

doi:10.1016/j.beth.2012.04.003

Cited by 91 publications

(79 citation statements)

References 42 publications

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“…Our cluster analyses revealed four distinct trajectories based on change patterns: Fast, Slow, Partial, and Non-responders. Similar distinct response groups were also found by other researchers (Allan et al, 2016; Clapp et al, 2016; Galovski et al, 2016; Stein et al, 2012). We observed that for a small proportion of responders (13%) PTSD symptoms decreased immediately after completing the four days of iPE, i.e.…”

Section: Discussionsupporting

confidence: 88%

“…Finally, of all our participants, 29% showed no response to treatment (Non-responders), reporting severe PTSD symptoms at all time points. As other studies recorded a similar non-responders cluster (Allan et al, 2016; Stein et al, 2012), this raises the question whether, for some patients, extinction learning is not feasible (Lissek et al, 2005). …”

Section: Discussionmentioning

confidence: 73%

“…This variability might be explained by the fact that in most studies prediction analyses of associations were performed in entire and thus heterogeneous samples. In response to this methodology, researchers recently identified several distinct trajectories of treatment response based on change patterns, suggesting there are disparate, more homogeneous, response groups that might have differential predictors (Allan, Gros, Myers, Korte, & Acierno, 2016; Clapp, Kemp, Cox, & Tuerk, 2016; Galovski et al, 2016; Stein, Dickstein, Schuster, Litz, & Resick, 2012). …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

View full text Add to dashboard Cite

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“…Although our results are at odds with the widely held belief in the trauma field that patients with a history of CSA do worse in trauma-focused treatments than other groups of patients (Cloitre et al, 2012), these are in line with those of previous studies showing that patients suffering from PTSD with and without a history of CSA respond well to trauma-focused treatment (i.e. Resick et al, 2014; Stein, Dickstein, Schuster, Litz, & Resick, 2012). …”

Section: Discussionsupporting

confidence: 87%

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

Wagenmans¹,

Minnen

Sleijpen

et al. 2018

European Journal of Psychotraumatology

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Background: It is assumed that PTSD patients with a history of childhood sexual abuse benefit less from trauma-focused treatment than those without such a history. Objective: To test whether the presence of a history of childhood sexual abuse has a negative effect on the outcome of intensive trauma-focused PTSD treatment. Method: PTSD patients, 83% of whom suffered from severe PTSD, took part in a therapy programme consisting of 2 × 4 consecutive days of Prolonged Exposure (PE) and EMDR therapy (eight of each). In between sessions, patients participated in sport activities and psycho-education sessions. No prior stabilization phase was implemented. PTSD symptom scores of clinician-administered and self-administered measures were analysed using the data of 165 consecutive patients. Pre-post differences were compared between four trauma groups; patients with a history of childhood sexual abuse before age 12 (CSA), adolescent sexual abuse (ASA; i.e. sexual abuse between 12 and 18 years of age), sexual abuse (SA) at age 18 and over, or no history of sexual abuse (NSA). Results: Large effect sizes were achieved for PTSD symptom reduction for all trauma groups (Cohen’s d = 1.52–2.09). For the Clinical Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES), no differences in treatment outcome were found between the trauma (age) groups. For the PTSD Symptom Scale Self Report (PSS-SR), there were no differences except for one small effect between CSA and NSA. Conclusions: The results do not support the hypothesis that the presence of a history of childhood sexual abuse has a detrimental impact on the outcome of first-line (intensive) trauma-focused treatments for PTSD.

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“…Recent CPT dismantling studies indicate that CR may be the more potent component of the treatment package (Resick et al, 2008;Stein, Dickstein, Schuster, Litz, & Resick, 2012). At this point the most parsimonious conclusion is that the CR component of CPT and prolonged exposure produce similar changes in PTSD so that the average person with PTSD can benefit from either treatment (Stein et al, 2012).…”

Section: Component Analysismentioning

confidence: 99%

Cognitive Restructuring

Clark¹

2013

The Wiley Handbook of Cognitive Behavioral Therapy

119

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Cognitive restructuring is the core therapeutic ingredient of cognitive therapy that was first introduced to the psychotherapy community by A. T. Beck and colleagues. This chapter provides a detailed breakdown and elaboration of cognitive restructuring and how it is implemented to effect symptom change. The nature of cognitive restructuring and its multifaceted therapeutic components are discussed. A critical review of the empirical research on its treatment efficacy is presented, as well as the evidence for cognitive mediation from component and mediation process research. It is concluded that cognitive restructuring is an effective treatment strategy for psychological disorders, especially anxiety and depression. However, superiority to other “less cognitive” interventions has not been demonstrated, even though the effectiveness of cognitive restructuring does occur by inducing cognitive change. Various research issues are raised that would advance a greater understanding of the mechanisms of change associated with cognitive restructuring. With greater knowledge of the change processes that characterize cognitive restructuring, clinicians will be better equipped to employ this powerful therapeutic intervention.

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Trajectories of Response to Treatment for Posttraumatic Stress Disorder

Cited by 91 publications

References 42 publications

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

Cognitive Restructuring

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