Disorders - Post Traumatic Stress Disorder
Kuckertz, J. M., Amir, N., Boffa, J. W., Warren, C. K., Rindt, S. E. M., Norman, S., Ram, V., Ziajko, L., Webb-Murphy, J., McLay, R.
Attention bias modification (ABM) may be an effective treatment for anxiety disorders (Beard, Sawyer, & Hofmann, 2012). As individuals with
PTSD possess an attentional bias towards threat-relevant information ABM may prove effective in reducing PTSD symptoms. We examined the efficacy of
ABM as an adjunct treatment for PTSD in a real-world setting. We administered ABM in conjunction with prolonged exposure or cognitive-processing
therapy and medication in a community inpatient treatment facility for military personnel diagnosed with PTSD. Participants were randomized to either
ABM or an attention control condition (ACC). While all participants experienced reductions in PTSD symptoms, participants in the ABM group
experienced significantly fewer PTSD and depressive symptoms at post-treatment when compared to the ACC group. Moreover, change in plasticity of
attentional bias mediated this change in symptoms and initial attentional bias moderated the effects of the treatment. These results suggest that ABM
may be an effective adjunct treatment for PTSD.
Behaviour Research & Therapy, 63 : 25-
35
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Attention/cognitive bias
modification
Jacob, N., Neuner, F., Maedl, A., Schaal, S., Elbert, T.
Background: Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health
disasters in conflict regions. We tested a trainthe- trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD).
\rMethods: We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET)
treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/ NET-2, n = 38). Expert therapists trained a
first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the
supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a
second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure
was the Clinician-Administered PTSD Scale total score before therapy and at 3- and 12-month follow-ups.\rResults: At the 3-month follow-up, the NET-1
participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1
were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the
second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with
an effect size of Cohen's d = 1.37 at the 12-month follow-up.\rConclusions: A TTT model of PTSD treatment dissemination can be effective in
resourcepoor postconflict societies.
Psychotherapy & Psychosomatics, 83(6) : 354-
363
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Narrative exposure therapy (NET)
Jensen, T.
K., Holt, T., Ormhaug, S. M., Egeland,
K., Granly, L., Hoaas, L. C., Hukkelberg, S. S., Indregard, T., Stormyren, S. D., Wentzel-Larsen, T.
The
efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have
been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United
States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-
six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed
effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95%
CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50,
4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -
1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant
(est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder
compared to youths in the TAU condition, (chi)2(1, N = 116) = 4.61, p =.031, Phi =.20). Findings indicate that TF-CBT is effective in treating
traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United
States. (copyright) 2014 Copyright Tine K. Jensen, Tonje Holt, Silje M. Ormhaug, Karina Egeland, Lene Granly, Live C. Hoaas, Silje S. Hukkelberg,
Tore Indregard, Shirley D. Stormyren, and Tore Wentzel-Larsen.
Journal of Clinical Child & Adolescent Psychology, 43(3) : 356-
369
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Joseph, J. S., Gray, M. J.
Efforts to regain a sense of safety and
security following a highly distressing life event are commonly observed. The attribution process is one such effort that has been studied
extensively in the context of posttraumatic stress disorder (PTSD). The content of causal explanations often receives attention as a risk factor for
PTSD, even though there is some disagreement regarding what constitutes a harmful attribution. Recently, degree of flexibility in generating causal
explanations has been examined as well. Prevention and intervention efforts targeting explanatory style and flexibility for depression populations
have found success. However, this approach has yet to be evaluated among PTSD populations. Randomized assignment to immediate treatment or a delayed
treatment control group was used to provide information about the efficacy of attribution retraining. Intervention resulted in significant
alterations in causal attributions that were associated with large decreases in PTSD symptoms. Implications of these findings and suggestions for
future research are presented and discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Psychological Trauma: Theory, Research, Practice, & Policy, 6(6) : 708-
715
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Brownlow, J. A., McLean, C. P., Gehrman, P. R., Ross, R. J., Foa, E. B.
Introduction: Chronic
insomnia and nightmares are prominent features of posttraumatic stress disorder (PTSD). There is evidence that these sleep disturbances may not
respond to trauma-focused therapies for PTSD and may be associated with poor functional outcomes. Little is known about the effects of trauma-focused
treatment on sleep disturbance and general functioning in adolescents with PTSD. The present study examined the effects of trauma-focused therapy on
sleep-related PTSD symptoms, and the effect of disturbed sleep on general functioning. Methods: Sixty-one adolescent females ages 13-18 (M = 15.34,
SD = 1.54) seeking treatment at a rape crisis center for PTSD related to sexual assault participated in a single-blind randomized clinical trial of
prolonged exposure for adolescents (PE-A; n = 30) compared to clientcentered therapy (CCT; n = 31). Both treatments consisted of fourteen 60-90
minute sessions. The Child PTSD Symptom Scale-Interview (CPSS-I) was used to diagnosis PTSD and to assess frequency of insomnia and nightmares; it
was completed at baseline, post-treatment, and at 6- and 12- months follow-ups. The Children's Global Assessment Scale (CGAS) was used to assess
general functioning. The CPSS-I and CGAS were administered by independent evaluators who were blind to participants' treatment condition. Results:
General Linear Model (GLM) repeated measures analyses were conducted on insomnia and nightmare symptoms with treatment condition (PE-A/CCT) as the
between subjects variable. No signiicant time by condition interactions were found; however, statistically and clinically signiicant effects of time
(p < .001) were found for frequency of nightmares and insomnia, with symptoms decreasing from baseline to post-treatment. Both nightmare and insomnia
symptoms signiicantly predicted general functioning and accounted for 20.3%-28.9% of the variance in this measure over time. Conclusion: Both
treatments produced signiicant improvements in sleep-related PTSD symptoms; however, these sleep symptoms continued to impair general functioning
over time.
Sleep, 37 : A273
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Other Psychological Interventions
Beyer, J. A., Lumley, M. A., Latsch, D. V., Oberleitner, L. M., Carty, J. N., Radcliffe, A. M.
Standard written
emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance
to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED - advance
guidance (before sessions) and real-time guidance (during sessions, through instant messaging) - to both standard WED and control writing; it also
tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized
to conditions, had three, 30-min computer-based writing sessions, and were reassessed six weeks later. Contrary to hypotheses, real-time guidance WED
had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses
revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We
conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for
people whose personalities have poor fit with this interactive form of WED.
Anxiety, Stress &
Coping, 27(5) : 477-493
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Chen, Y-R., Hung, K-
W., Tsai, J-C., Chung, M-H., Chen, S-R., Liao, Y-M., Ou, K-L., Chang, Y-C., Chou, K-R.,
Background: We performed the first meta-analysis of clinical studies by investigating the effects of
eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and
subjective distress in PTSD patients treated during the past 2 decades.; Methods: We performed a quantitative meta-analysis on the findings of 26
randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013, which were identified through the ISI Web of Science, Embase,
Cochrane Library, MEDLINE, PubMed, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature electronic databases, among
which 22, 20, 16, and 11 of the studies assessed the effects of EMDR on the symptoms of PTSD, depression, anxiety, and subjective distress,
respectively, as the primary clinical outcome.; Results: The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of
PTSD (g =?-0.662; 95% confidence interval (CI): -0.887 to -0.436), depression (g =?-0.643; 95% CI: -0.864 to -0.422), anxiety (g =?-0.640; 95% CI: -
0.890 to -0.390), and subjective distress (g =?-0.956; 95% CI: -1.388 to -0.525) in PTSD patients.; Conclusion: This study confirmed that EMDR
therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients. The subgroup analysis indicated
that a treatment duration of more than 60 min per session was a major contributing factor in the amelioration of anxiety and depression, and that a
therapist with experience in conducting PTSD group therapy was a major contributing factor in the reduction of PTSD symptoms.;
PLoS ONE, 9(8) : e103676-e103676
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Eye movement desensitisation and reprocessing (EMDR)
Chen, Y., Shen, W. W., Gao, K., Lam, C. S., Chang, W. C., Deng, H.
Objective: Many children who lost
parents in the 2008 earthquake in Sichuan Province China, experienced symptoms of posttraumatic stress disorder (PTSD) and depression. This
randomized controlled study compared the treatment effectiveness of short-termcognitivebehavioral therapy (CBT) with a general supportive
intervention and with a control group of nontreatment. Methods: Thirty-two Chinese adolescents were randomly assigned to three treatment groups.
Participants were compared for psychological resilience (Connor-Davidson Resilience Scale), symptoms of PTSD (Children's Revised Impact of Events
Scale), and depression (Center for Epidemiologic Studies Depression Scale) at baseline, after treatment, and three-month follow-up. Results: CBT was
effective in reducing PTSD and depressive symptoms and improved psychological resilience. General support was more effective than no intervention in
improving psychological resilience. Conclusions: Short-term CBT group intervention seems to be a robust intervention for natural disaster victims.
Shortterm CBT group intervention was more effective than the general supportive intervention and the notreatment group in enhancing psychological
resilience and reducing PTSD and depression among adolescents who had lost parents in the earthquake. The general supportive intervention was
effective only in improving psychological resilience.
Psychiatric
Services, 65(2) : 259-262
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy
Baldwin, D.S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den-Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O'Neill, C, Scott, J., van-der-Wee, N., Wittchen, H-U.,
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based
pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute
treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A
consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting
evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants,
and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source
of information for patients, their carers, and medicines management and formulary committees.;
Journal of
Psychopharmacology, 28(5) : 403-439
- Year: 2014
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Dorsey, S., Pullmann, M. D., Berliner, L., Koschmann, E., McKay, M., Deblinger, E.
The goal of this study was to examine the impact of supplementing Trauma-focused
Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in
treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus
evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance,
engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who
received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to
drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on
treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements
with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing
likelihood of treatment completion.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Child Abuse & Neglect, 38(9) : 1508-1520
- Year: 2014
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT), Other service delivery and improvement
interventions
De-Arellano, M. A. R., Lyman, R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., Delphin-Rittmon, M. E.
Objective: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment
developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic
stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base.
Methods: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social
Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of
research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described
the evidence of effectiveness. Results: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted
independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although
it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns
about investigator bias and exclusion of vulnerable populations. Conclusions: TF-CBT is a viable treatment for reducing trauma-related symptoms among
some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service
in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various
racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.
Psychiatric Services, 65(5) : 591-
602
- Year: 2014
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Trauma-focused cognitive behavioural therapy (TF-
CBT)
Foa, Edna B., McLean, Carmen P., Capaldi, Sandra, Rosenfield, David
Importance:E Evidence-based treatments for posttraumatic stress disorder
(PTSD) have not been established for adolescents despite high prevalence of PTSD in this population. Objective: To examine the effects of counselor-
delivered prolonged exposure therapy compared with supportive counseling for adolescents with PTSD. Design, Setting and Participants: A single-blind,
randomized clinical trial of 61 adolescent girls with PTSD using a permuted block design. Counselors previously naive to prolonged exposure therapy
provided the treatments in a community mental health clinic. Data collection lasted from February 2006 through March 2012. Interventions:
Participants received fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30). Main Outcomes and
Measures: All outcomes were assessed before treatment, at mid-treatment, and after treatment and at 3-, 6-, and 12-month follow-up. The primary
outcome, PTSD symptom severity, was assessed by the Child PTSD Symptom Scale - Interview (range, 0-51; higher scores indicate greater severity).
Secondary outcomes were presence or absence of PTSD diagnosis assessed by the DSM-IV Schedule for Affective Disorders and Schizophrenia for School-
Age Children and functioning assessed by the Children's Global Assessment Scale (range, 1-100; higher scores indicate better functioning).
Additional secondary measures, PTSD severity assessed by the Child PTSD Symptom Scale - Self-Report (range, 0-51; higher scores indicate greater
severity) and depression severity assessed by the Children's Depression Inventory (range, 0-54; higher scores indicate greater severity), were also
assessed weekly during treatment. RESULTS Data were analyzed as intent to treat. During treatment, participants receiving prolonged exposure
demonstrated greater improvement on the PTSD symptom severity scale (difference between treatments in improvement, 7.5; 95% CI, 2.5-12.5; P <
.001) and on all secondary outcomes (loss of PTSD diagnosis: difference, 29.3%, 95% CI, 20.2%-41.2%; P = .01; self-reported PTSD severity:
difference, 6.2; 95% CI, 1.2-11.2; P = .02; depression: difference, 4.9; 95% CI, 1.6-8.2; P = .008; global functioning: difference, 10.1; 95% CI,
3.4-16.8; P = .008). These treatment differences were maintained through the 12-month follow-up: for interviewer-assessed PTSD (difference, 6.0; 95%
CI, 1.6-10.4; P = .02), loss of PTSD diagnosis (difference, 31.1; 95% CI, 14.7-34.8; P = .01), self-reported PTSD (difference, 9.3; 95% CI, 1.2-16.5;
P = .02), depression (difference, 7.2; 95% CI, 1.4-13.0; P = .02), and global functioning (difference, 11.2; 95% CI, 4.5-17.9; P = .01). Conclusion
and Relevance: Adolescents girls with sexual abuse - related PTSD experienced greater benefit from prolonged exposure therapy than from supportive
counseling even when delivered by counselors who typically provide supportive counseling. (PsycINFO Database Record (c) 2014 APA, all rights
reserved). (journal abstract)
JAMA, 310(24) : 2650-2657
- Year: 2013
- Problem: Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Supportive
therapy