Advances in PTSD Treatment Delivery: Evidence Base and Future Directions for Intensive Outpatient Programs

Ragsdale, Katie A.; Watkins, Laura E.; Sherrill, Andrew M.; Zwiebach, Liza; Rothbaum, Barbara O.

doi:10.1007/s40501-020-00219-7

Cited by 35 publications

(44 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first was an intensified version of PE (iPE). We expected that offering several sessions per week would lead to faster improvement and lower drop-out rates (Ragsdale, Watkins, Sherrill, Zwiebach, & Rothbaum, 2020). In patients with (non-CA) PTSD, iPE led to faster improvement (Ehlers et al, 2014;Foa, McLean, Zang, & Consortium, 2018) and noninferior post-treatment outcomes (Foa et al, 2018) compared to standard (weekly) PE.…”

Section: Introductionmentioning

confidence: 99%

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Oprel

Hoeboer

Schoorl

et al. 2021

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity.Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen's d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t 135 = −2.85, p = .005, d = .49) but not clinician-assessed symptoms (t 135 = −1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t 135 = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t 135 = −2.77, p = .006, Cohen's d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions.Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes.The trial is registered at the clinical trial registry, number NCT03194113, https://clinical trials.gov/ct2/show/NCT03194113 Efecto de la Exposición Prolongada, la Exposición Prolongada intensificada y STAIR + la Exposición Prolongada en pacientes con TEPT relacionado con el abuso infantil: un ensayo controlado aleatorioAntecedentes: No está claro si los tratamientos basados en la evidencia para el TEPT son tan efectivos en pacientes con TEPT relacionado con abuso infantil (TEPT-AI). Objetivo: Nuestro objetivo fue investigar la efectividad de tres variantes de la terapia de exposición prolongada.Método: Reclutamos adultos con TEPT-AI. Los participantes fueron asignados aleatoriamente a Exposición Prolongada (EP; 16 sesiones en 16 semanas), Exposición Prolongada intensificada (EPi; 12 sesiones en 4 semanas seguidas de dos sesiones de refuerzo) o un tratamiento basado en fases, en el que 8 sesiones de EP fueron precedidas por 8 sesiones de Entrenamiento de Habilidades en Regulación Afectiva e Interpersonal (STAIR+EP; 16 sesiones en 16 semanas). Las evaluaciones se llevaron a cabo en la semana 0 (línea de base), semana 4, semana 8, semana...

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Oprel

Hoeboer

Schoorl

et al. 2021

European Journal of Psychotraumatology

View full text Add to dashboard Cite

show abstract

“…zero drop-out rate during the treatment programme, albeit three patients were lost at the follow-up assessment). This is in sharp contrast with regular outpatient traumafocused treatment programmes (Ragsdale et al, 2020;ranging from 30% to 62%). The high retention level may be due to the condensed format of frequently scheduled sessions conducted within a shorter time frame (Mevissen et al, 2020;Ragsdale et al, 2020;Sciarrino et al, 2020;Silverstone et al, 2016), the clear view and perspective as to when treatment ends and the fact that the patients stayed in the clinic during the treatment days (van Woudenberg et al, 2018).…”

Section: Discussionmentioning

confidence: 81%

“…As a consequence, a significant number of patients ultimately do not receive treatment they could benefit from. There is evidence suggesting that retention in treatment decreases when treatment is intensified: that is, applying a higher frequency of therapy sessions within a shorter time frame (Mevissen, Ooms-Evers, Serra, de Jongh, & Didden, 2020;Ragsdale, Watkins, Sherrill, Zwiebach, & Rothbaum, 2020;Sciarrino, Warnecke, & Teng, 2020;Silverstone, Greenspan, Silverstone, Sawa, & Linder, 2016). For instance, Hendriks et al (2017) and her colleagues developed an intensive PE therapy programme and explored the effectiveness of this programme in 10 adolescent patients with severe PTSD and comorbid disorders following multiple interpersonal trauma.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder

Pelt¹,

Fokkema²,

Roos

et al. 2021

European Journal of Psychotraumatology

View full text Add to dashboard Cite

show abstract

“…Since PTSD interferes with social and occupational functioning [ 29 ], it is desirable for patients to make rapid progress. Several intensive treatment programs have been set up, with good results and significantly lower drop-out rates of below 10% [ 30 ]. The current study aims to determine the predictive value of treatment response on treatment outcome in such an intensive treatment program, which consists of two weeks of treatment for three consecutive days each.…”

Section: Introductionmentioning

confidence: 99%

Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures

Geusau

Mulder

Matthijssen

2021

JCM

View full text Add to dashboard Cite

It is useful to investigate factors that could predict treatment outcomes for PTSD. The current study aims to investigate the relationship between daily measured PTSD symptoms during an intensive six-day treatment program and overall post-treatment outcomes. The treatment program combines eye movement desensitization with reprocessing and prolonged exposure, as well as physical activity and psychoeducation. It was expected that for the entire duration of treatment, as well as the first half of the treatment, a greater decline in daily PTSD symptoms would be a predictor for a greater decline in PTSD symptoms at a four-week follow-up. Data from 109 PTSD-patients (87.2% female, mean age = 36.9, SD = 11.5) were used. PTSD symptoms were measured with the CAPS-5 and the self-reported PTSD checklist for DSM-5 (PCL-5). Daily PTSD symptoms were measured with an abbreviated version of the PCL-5 (8-item PCL). Latent growth curve models were used to describe changes in daily PTSD symptoms and predict treatment outcome. Results show that a greater decline in daily PTSD symptoms measured by the 8-item PCL predicts better treatment outcome (CAPS-5 and PCL-5), but that a patient’s PTSD symptoms on the first day of treatment has no predictive effect. A decline in PTSD symptoms only during the first half of treatment was also found to predict treatment outcomes. Future research should be focused on replicating the results of the current study.

show abstract

Advances in PTSD Treatment Delivery: Evidence Base and Future Directions for Intensive Outpatient Programs

Cited by 35 publications

References 26 publications

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder

Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures

Contact Info

Product

Resources

About