Exposure Therapy for Chronic PTSD: Efficacy and Mechanisms
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/17/2019 |
| Start Date: | January 2008 |
| End Date: | July 2010 |
The goals of the proposed research are to produce preliminary evidence of PE with OEF/OIF
veterans with PTSD and to examine cognitive, psychophysiological, and neuroendocrine
mechanisms of change in PTSD treatment. In brief, 36 OEF/OIF veterans with chronic PTSD or
PTSS of at least 3 months duration will be randomly assigned to 15 sessions of either PE or
TAU (see below for descriptions of the interventions). All veterans will receive
psychobiological assessments at pre treatment, mid treatment, post treatment, 3 months, and 6
months follow-up. Each of these assessments will cover in 2 sessions on separate days and
will include interview and self-report of symptoms (i.e., PTSD, depression, and general
anxiety severity), self-report of PTSD-related cognitions, psychophysiological (i.e., heart
rate, skin conductance, respiration, and end-tidal CO2) assessment during neutral and trauma
scripts, and assessment of salivary cortisol during neutral and trauma scripts. Also, on the
morning prior to each laboratory assessment, patients will collect salivary cortisol at the
moment of waking and 30 and 45 minutes post-walking. In addition to these assessments,
patients assigned to PE will collect salivary cortisol during three imaginal exposure
sessions (sessions 3, 9, and 15).
veterans with PTSD and to examine cognitive, psychophysiological, and neuroendocrine
mechanisms of change in PTSD treatment. In brief, 36 OEF/OIF veterans with chronic PTSD or
PTSS of at least 3 months duration will be randomly assigned to 15 sessions of either PE or
TAU (see below for descriptions of the interventions). All veterans will receive
psychobiological assessments at pre treatment, mid treatment, post treatment, 3 months, and 6
months follow-up. Each of these assessments will cover in 2 sessions on separate days and
will include interview and self-report of symptoms (i.e., PTSD, depression, and general
anxiety severity), self-report of PTSD-related cognitions, psychophysiological (i.e., heart
rate, skin conductance, respiration, and end-tidal CO2) assessment during neutral and trauma
scripts, and assessment of salivary cortisol during neutral and trauma scripts. Also, on the
morning prior to each laboratory assessment, patients will collect salivary cortisol at the
moment of waking and 30 and 45 minutes post-walking. In addition to these assessments,
patients assigned to PE will collect salivary cortisol during three imaginal exposure
sessions (sessions 3, 9, and 15).
Effective treatments for PTSD are available, with exposure therapy (ET) programs, including
Prolonged Exposure (PE), having the most empirical evidence for effectiveness (Rothbaum et
al., 2000). However, among people receiving treatment for PTSD, many are not receiving
psychotherapies with empirically proven efficacy. In one VA VISN, only 10% of PTSD specialist
therapists reported using ET routinely (Rosen et al., 2004). They suggested that a lack of
training and human resources to provide ET, as well as misconceptions about exposure therapy
may drive the deficit. Training efforts would be substantially more cost-effective of the
proven treatments could be delivered in group formats. Development and proof of efficacy of a
group-based PE would provide far more veterans with access to a treatment that can truly
foster recovery from the devastating impact of PTSD. This is a central goal of this proposal.
Little is known about the mechanisms through which PE leads to recovery. Delineation of its
mechanisms is a critical step towards the development of treatment refinements to improve
effectiveness and efficiency of the treatment. We plan to examine the potential roles of
cognitive, psychophysiologic and neuroendocrine factors in symptom improvement. The
mechanistic component will provide preliminary data on interactions between cognitive change
(increased sense of self-competence and control over negative outcomes), psychophysiological
habituation (reduced reactivity to trauma related stimuli), and reduced neuroendocrine
sensitivity (reduced hypothalamic-pituitary-adrenal (HPA) axis reactivity). We predict that
cognitive change, psychophysiological habituation and reduced HPA reactivity will all be
related to symptom improvement with effective treatment.
Thirty-six OEF/OIF veterans with chronic PTSD of at least 3 months duration will be randomly
assigned to 15 weeks of twice weekly PE-G or TAU. All veterans will receive psychobiological
assessments at pre treatment, mid treatment, post treatment, 3 months and 6 months follow-up.
Each of these assessments will include interview and self-report of symptoms (i.e., PTSD,
depression, and general anxiety severity), self-report of PTSD-related cognitions,
psychophysiological (i.e., heart rate, skin conductance, respiration, and end-tidal CO2)
assessment during neutral and trauma scripts, and assessment of salivary cortisol during
neutral and trauma scripts. Also, on the morning prior to each laboratory assessment,
patients will collect salivary cortisol at the moment of waking and 30 and 45 minutes
post-walking. The results from this study will be used as pilot data for VA Merit Award and
NIMH R01 applications for larger follow-up studies.
Prolonged Exposure (PE), having the most empirical evidence for effectiveness (Rothbaum et
al., 2000). However, among people receiving treatment for PTSD, many are not receiving
psychotherapies with empirically proven efficacy. In one VA VISN, only 10% of PTSD specialist
therapists reported using ET routinely (Rosen et al., 2004). They suggested that a lack of
training and human resources to provide ET, as well as misconceptions about exposure therapy
may drive the deficit. Training efforts would be substantially more cost-effective of the
proven treatments could be delivered in group formats. Development and proof of efficacy of a
group-based PE would provide far more veterans with access to a treatment that can truly
foster recovery from the devastating impact of PTSD. This is a central goal of this proposal.
Little is known about the mechanisms through which PE leads to recovery. Delineation of its
mechanisms is a critical step towards the development of treatment refinements to improve
effectiveness and efficiency of the treatment. We plan to examine the potential roles of
cognitive, psychophysiologic and neuroendocrine factors in symptom improvement. The
mechanistic component will provide preliminary data on interactions between cognitive change
(increased sense of self-competence and control over negative outcomes), psychophysiological
habituation (reduced reactivity to trauma related stimuli), and reduced neuroendocrine
sensitivity (reduced hypothalamic-pituitary-adrenal (HPA) axis reactivity). We predict that
cognitive change, psychophysiological habituation and reduced HPA reactivity will all be
related to symptom improvement with effective treatment.
Thirty-six OEF/OIF veterans with chronic PTSD of at least 3 months duration will be randomly
assigned to 15 weeks of twice weekly PE-G or TAU. All veterans will receive psychobiological
assessments at pre treatment, mid treatment, post treatment, 3 months and 6 months follow-up.
Each of these assessments will include interview and self-report of symptoms (i.e., PTSD,
depression, and general anxiety severity), self-report of PTSD-related cognitions,
psychophysiological (i.e., heart rate, skin conductance, respiration, and end-tidal CO2)
assessment during neutral and trauma scripts, and assessment of salivary cortisol during
neutral and trauma scripts. Also, on the morning prior to each laboratory assessment,
patients will collect salivary cortisol at the moment of waking and 30 and 45 minutes
post-walking. The results from this study will be used as pilot data for VA Merit Award and
NIMH R01 applications for larger follow-up studies.
Inclusion Criteria:
- OEF/OIF Veterans with combat related posttraumatic stress disorder (PTSD) or
posttraumatic stress symptoms (PTSS) of at least 3 months duration with significant
impairment (PSSI greater than or equal to 15).
Exclusion Criteria:
- Any current level of personality disorder or suicidal risk that in the judgment of the
investigator makes it unlikely or contraindicated that the patient can adhere to the
study regimen.
- Psychosis
- Alcohol or substance dependence in the past 3 months
- Working night-shifts
- Changes to psychoactive medication in the past 8 weeks
- Taking medication that makes HPA axis measures difficult to interpret
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