Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future

Koek, Ralph J.; Schwartz, Holly N; Scully, Stephenie; Langevin, Jean-Philippe; Spangler, Shana L.; Korotinsky, Arkady; Jou, Kevin; Leuchter, Andrew F.

doi:10.1016/j.pnpbp.2016.01.015

Cited by 59 publications

(41 citation statements)

References 446 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies that have considered the efficacy of psychotherapeutic interventions following unsuccessful evidencebased PTSD treatment for veterans and other TR-PTSD populations are very scarce [51]. Results of multiple trials with 3,4-methylenedioxymethamphetamine (MDMA)assisted psychotherapy for TR-PTSD were encouraging with large effect sizes [52][53][54][55], and deep brain stimulation shows promise as well, with two positive case reports [56].…”

Section: Interpretation and Comparison To Existing Studiesmentioning

confidence: 99%

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Gelderen

Nijdam

Haagen

et al. 2020

Psychother Psychosom

View full text Add to dashboard Cite

Background: Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context. Objective: To study the efficacy of 3MDR for veterans with treatment-resistant PTSD. Method: In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores. Results: The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86. Conclusions: In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

show abstract

Section: Interpretation and Comparison To Existing Studiesmentioning

confidence: 99%

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Gelderen

Nijdam

Haagen

et al. 2020

Psychother Psychosom

View full text Add to dashboard Cite

show abstract

“…Furthermore, in clinical practice drop-out rates for veterans with PTSD are high, up to 78% ( 7 ). Recent evidence from a review on treatment-resistant PTSD (TR-PTSD) suggested that veterans are at high risk for their PTSD to be an unremitting illness ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

2018

View full text Add to dashboard Cite

Despite an array of evidence-based psychological treatments for patients with a posttraumatic stress disorder (PTSD), a majority of patients do not fully benefit from the potential of these therapies. In veterans with PTSD, up to two-thirds retain their diagnosis after psychotherapy and often their disorder is treatment-resistant, which calls for improvement of therapeutic approaches for this population. One of the factors hypothesized to underlie low response in PTSD treatment is high behavioral and cognitive avoidance to traumatic reminders. In the current paper we explore if a combination of personalized virtual reality, multi-sensory input, and walking during exposure can enhance treatment engagement, overcome avoidance, and thereby optimize treatment effectiveness. Virtual reality holds potential to increase presence and in-session attention and to facilitate memory retrieval. Multi-sensory input such as pictures and music can personalize this experience. Evidence for the positive effect of physical activity on fear extinction and associative thinking, as well as embodied cognition theories, provide a rationale for decreased avoidance by literally approaching cues of the traumatic memories. A dual-attention task further facilitates new learning and reconsolidation. These strategies have been combined in an innovative framework for trauma-focused psychotherapy, named Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR). In this innovative treatment the therapeutic setting is changed from the face-to-face sedentary position to a side-by-side activating context in which patients walk toward trauma-related images in a virtual environment. The framework of 3MDR has been designed as a boost for patients with treatment-resistant PTSD, which is illustrated by three case examples. The intervention is discussed in context of other advancements in treatment for treatment-resistant PTSD. Novel elements of this approach are activation, personalization and empowerment. While developed for veterans with PTSD who do not optimally respond to standardized treatments, this innovative framework holds potential to also be used for other patient populations and earlier stages of treatment for patients with PTSD.

show abstract

“…This learning process likely requires plasticity in the BLn, in part induced by modulation from the mPFC [ 2 ], whereby a larger population of extinction cells is activated relative to fear cells. In this sense, the BLn can be seen as an emotional receptive field modulated by the mPFC, the hippocampus and several other regions [ 7 ]. The relative population of active fear cells and extinction cells can therefore determine the specific response to a reminder.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation of the Basolateral Amygdala: Targeting Technique and Electrodiagnostic Findings

et al. 2016

Self Cite

View full text Add to dashboard Cite

The amygdala plays a critical role in emotion regulation. It could prove to be an effective neuromodulation target in the treatment of psychiatric conditions characterized by failure of extinction. We aim to describe our targeting technique, and intra-operative and post-operative electrodiagnostic findings associated with the placement of deep brain stimulation (DBS) electrodes in the amygdala. We used a transfrontal approach to implant DBS electrodes in the basolateral nucleus of the amygdala (BLn) of a patient suffering from severe post-traumatic stress disorder. We used microelectrode recording (MER) and awake intra-operative neurostimulation to assist with the placement. Post-operatively, the patient underwent monthly surveillance electroencephalograms (EEG). MER predicted the trajectory of the electrode through the amygdala. The right BLn showed a higher spike frequency than the left BLn. Intra-operative neurostimulation of the BLn elicited pleasant memories. The monthly EEG showed the presence of more sleep patterns over time with DBS. BLn DBS electrodes can be placed using a transfrontal approach. MER can predict the trajectory of the electrode in the amygdala and it may reflect the BLn neuronal activity underlying post-traumatic stress disorder PTSD. The EEG findings may underscore the reduction in anxiety.

show abstract

Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future

Cited by 59 publications

References 446 publications

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

Deep Brain Stimulation of the Basolateral Amygdala: Targeting Technique and Electrodiagnostic Findings

Contact Info

Product

Resources

About