A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD

Thorp, Steven R.; Glassman, Lisa H.; Wells, Stephanie Y.; Walter, Kristen H.; Gebhardt, Heather M.; Twamley, Elizabeth W.; Golshan, Shahrokh; Pittman, James O. E.; Penski, Kendra; Allard, Carolyn B.; Morland, Leslie A.; Wetherell, Julie Loebach

doi:10.1016/j.janxdis.2019.02.003

Cited by 40 publications

(45 citation statements)

References 52 publications

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“…This RCT is, to our knowledge, the first to investigate a psychotherapy programme for Holocaust survivors, and the third to investigate a PTSD treatment approach in old age. The two previous RCTs investigated an internet-based writing therapy called Integrative Testimonial Therapy (ITT) with WWII survivors combining cognitive-behavioural and life review elements [8,9] and a prolonged exposure therapy with older veterans with military service-related PTSD [10,11]. While the latter did not try to modify the prolonged exposure approach to this age group, ITT integrates trauma-focused and life review elements, which is similar in our approach.…”

Section: Discussionmentioning

confidence: 99%

“…An internet-based writing therapy called Integrative Testimonial Therapy (ITT) with WWII survivors combining cognitive-behavioural and life review elements found moderate decreases in PTSD symptoms [8,9]. A prolonged exposure therapy with older veterans with PTSD as a result of their military service found treatment gains from pre-to posttest, but those gains were lost in the follow-up [10,11].…”

Section: State Of Treatment Research Established Ptsd Treatmentsmentioning

confidence: 99%

“…One approach to the treatment of older PTSD patients is to apply the established psychological therapies described above with minor adaptations [e.g., [11,18]]. However, the question arises whether an age-specific treatment of PTSD would be more adequate.…”

Section: Life Review Therapy As An Age-specific Treatment Of Ptsdmentioning

confidence: 99%

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Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

Forstmeier

Hal²,

Auerbach³

et al. 2020

BMC Psychiatry

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Background: The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. Methods: The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). Discussion: Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples.

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Section: Discussionmentioning

confidence: 99%

Section: State Of Treatment Research Established Ptsd Treatmentsmentioning

confidence: 99%

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Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

Forstmeier

Hal²,

Auerbach³

et al. 2020

BMC Psychiatry

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“…A total of 74.1% of participants completed the treatment, and the average number of therapy sessions attended was 9.41 ( SD = 4.52). Additional demographic information and study methodology have been published elsewhere (Thorp et al., 2019).…”

Section: Methodsmentioning

confidence: 99%

“…Both PE and RT have demonstrated initial effectiveness in treating PTSD and depression symptoms among older adult male veterans, especially during active treatment (Thorp et al., 2019). However, there is an absence of data examining the influence of comorbid depression symptoms on PTSD treatment outcomes among older veterans.…”

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confidence: 99%

The Impact of Depression Severity on Treatment Outcomes Among Older Male Combat Veterans with Posttraumatic Stress Disorder

Walter

Glassman

Wells

et al. 2020

Journal of Traumatic Stress

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Posttraumatic stress disorder (PTSD) and depression are highly comorbid within the veteran population. Research studies have yielded divergent findings regarding the effect of depression on PTSD treatment outcomes. The present study investigated the influence of pretreatment depression severity on PTSD and depression symptom trajectories among 85 older (i.e., ≥ 60 years) male veterans with military‐related PTSD who received either prolonged exposure or relaxation training as part of a randomized controlled trial. Participants were categorized as having no/mild depression (n = 23) or moderate/severe depression (n = 62). The PTSD Checklist (PCL‐S) and Patient Health Questionnaire (PHQ‐9) were completed at pretreatment, each of 12 therapy sessions, posttreatment, and 6‐month follow‐up, for a total of up to 15 data points per participant. Multilevel modeling (MLM) was used to evaluate the impact of pretreatment depression severity on piecewise symptom trajectories (i.e., active treatment and follow‐up periods) over time and to determine whether treatment condition moderated the trajectories. The final MLM results showed significant main effects of depression severity on PCL‐S scores, B = 10.84, p = .043 and PHQ‐9 scores, B = 7.09, p = .001, over time. No significant interactions emerged for either the PCL‐S or PHQ‐9, indicating that although older veterans with more severe depression endorsed higher PTSD and depression scores across time, the symptom trajectories were not moderated by depression severity, treatment condition, or their interaction.

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Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people

Hendriks,

Janssen,

Robertson

et al. 2024

Cochrane Database of Systematic Reviews

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A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD

Cited by 40 publications

References 52 publications

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

The Impact of Depression Severity on Treatment Outcomes Among Older Male Combat Veterans with Posttraumatic Stress Disorder

Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people

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