A meta-analytic review of prolonged exposure for posttraumatic stress disorder

Powers, Mark B.; Halpern, Jacqueline M.; Ferenschak, Michael P.; Gillihan, Seth J.; Foa, Edna B.

doi:10.1016/j.cpr.2010.04.007

Cited by 865 publications

(597 citation statements)

References 49 publications

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“…Aberrant plasticity is believed to underlie the hypersensitivity and abnormal memory retention that accompanies PTSD [93,94], and reversal of this maladaptive plasticity may reduce the exaggerated fear response [95]. Prolonged exposure therapy, which involves repeated recall of an anxiety-inducing situation in a safe environment, provides a degree of desensitization that reduces the fearful response [96,97]. VNS may represent an adjunctive strategy to potentiate the effects of exposure therapy to normalize the hypersensitive responses and improve the symptoms of PTSD [98].…”

Section: Preclinical Studies For Post-traumatic Stress Disordermentioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

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Section: Preclinical Studies For Post-traumatic Stress Disordermentioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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“…To bridge the knowledge gap concerning the effectiveness of TFT for more complex patient populations, we developed a highly intensive TFT programme for those patients with a likely diagnosis of ICD-11 Complex PTSD after multiple interpersonal trauma that had a history of multiple treatment attempts as a next step in their treatment. The intervention is offered in a massed format of 12 × 90-minute sessions during four days and is based on PE, a first line treatment for PTSD (Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010) and recommended in available treatment guidelines (e.g. National Institute for Health and Clinical Excellence Guidelines on PTSD (NICE), 2005; International Society for Traumatic Stress Studies, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…In standard weekly TFT programmes, patients characteristics are not found to be stable predictors of treatment outcome (Ehlers et al, 2013; Ehring et al, 2014; Powers et al, 2010; van Minnen, Arntz, & Keijsers, 2002; van Minnen, Harned, Zoellner, & Mills, 2012) and findings concerning (early) treatment process variables, such as fear habituation, are inconsistent (Bluett, Zoellner, & Feeny, 2014; Sripada & Rauch, 2015; van Minnen & Hagenaars, 2002). This variability might be explained by the fact that in most studies prediction analyses of associations were performed in entire and thus heterogeneous samples.…”

Section: Introductionmentioning

confidence: 99%

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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“…1 Prolonged exposure is a theory-driven approach that involves 2 forms of therapeutic exposure: gradually increasing contact with situations and cues that trigger PTSD symptoms (in vivo exposure) and the voluntary recall of the traumatic event in as much detail as possible (imaginal exposure). 2 The patient is led through both forms of exposure by the therapist in session, and only then are patient-led, exposure-based homework assignments given.…”

Section: Prolonged Exposure Therapy For Ptsd In Sexually Abused Adolementioning

confidence: 99%

“…No further preparation of the patient for exposure (eg, extensive training in arousal reduction skills) is required for PE therapy to be safe, tolerable, and effective with adults. 1,2 In this issue of JAMA, Foa et al 3 report findings from the first trial of PE therapy for PTSD in adolescents who had experienced sexual abuse. Patients (N = 61, all female, aged 13-18 years) were recruited from a rape trauma center, had a history of sexual assault, and had 5 or more current symptoms of PTSD.…”

Section: Prolonged Exposure Therapy For Ptsd In Sexually Abused Adolementioning

confidence: 99%

Prolonged Exposure Therapy for PTSD in Sexually Abused Adolescents

Perrin

2013

JAMA

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rience symptom relief as a result of delayed treatment, they (and their parents) may disengage from therapy.Findings from the current report by Foa et al 3 should allay therapist concerns about any potential harmful effects of exposure and the need for extensive preparation of the patient for exposure. The heightened arousal that accompanies exposure to traumatic reminders in session usually dissipates within a few sessions and leads to rapid reductions in symptoms between sessions. Thus, the heightened arousal that many therapists fear causing by leading the patients through exposure exercises is an expected and integral part of the recovery progress.In the future, greater efforts are needed to increase awareness about the safety, tolerability, and effectiveness of treatments like PE. 9 Research is also needed to determine the minimum amount of training and supervision for therapists to effectively deliver PE and similar exposure-focused treatments to patients with PTSD and other anxiety disorders.

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A meta-analytic review of prolonged exposure for posttraumatic stress disorder

Cited by 865 publications

References 49 publications

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

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

Prolonged Exposure Therapy for PTSD in Sexually Abused Adolescents

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