An intensive outpatient program with prolonged exposure for veterans with posttraumatic stress disorder: Retention, predictors, and patterns of change.

Abstract

High rates of drop-out from treatment of PTSD have challenged implementation. Care models that integrate PTSD focused psychotherapy and complementary interventions may provide benefit in retention and outcome. The first 80 veterans with chronic PTSD enrolled in a 2-week intensive outpatient program combining Prolonged Exposure (PE) and complementary interventions completed symptom and biological measures at baseline and posttreatment. We examined trajectories of symptom change, mediating and moderating effects of a range of patient characteristics. Of the 80 veterans, 77 completed (96.3%) treatment and pre- and posttreatment measures. Self-reported PTSD (p < .001), depression (p < .001) and neurological symptoms (p < .001) showed large reductions with treatment. For PTSD, 77% (n = 59) showed clinically significant reductions. Satisfaction with social function (p < .001) significantly increased. Black veterans and those with a primary military sexual trauma (MST) reported higher baseline severity than white or primary combat trauma veterans respectively but did not differ in their trajectories of treatment change. Greater cortisol response to the trauma potentiated startle paradigm at baseline predicted smaller reductions in PTSD over treatment while greater reductions in this response from baseline to post were associated with better outcomes. Intensive outpatient prolonged exposure combined with complementary interventions shows excellent retention and large, clinically significant reduction in PTSD and related symptoms in two weeks. This model of care is robust to complex presentations of patients with varying demographics and symptom presentations at baseline.

Sleep disorder symptoms and massed delivery of prolonged exposure for posttraumatic stress disorder: Nodding off but not missing out.

“…Current findings provide no indication that concurrent or sequential treatment targeting daytime sleepiness, insomnia, or nightmares is required to respond effectively and suggest that massed PE is robust despite these indicators of disrupted sleep. The null effect of these sleep disorder symptoms on the slope of symptom change is consistent with findings from this sample that indicate PTSD change is not moderated by pretreatment quality of life, depression symptom severity, PTSD symptom severity, neurobehavioral symptom severity, alcohol use, and heart rate (Rauch, Yasinski, et al, 2020). However, given that patients with sleep problems in this sample reported higher PTSD symptom severity throughout treatment and posttreatment, future research should still examine how and why certain sleep disorders often result in poorer treatment outcomes.…”

“…Veterans were referred to the Emory Healthcare Veterans Program (EHVP), met diagnostic criteria for PTSD, and did not meet any exclusionary criteria: imminent risk of suicide, unmanaged psychosis, severe substance dependence, medical illness requiring immediate attention, and inability to establish a local treatment for follow-up care (see Rauch, Yasinski, et al, 2020 for a complete description of intake procedures and for detailed program offerings). The current study includes the first 80 patients to enter treatment.…”

“…The model was estimated using restricted maximum likelihood. Potential effects of demographic variables and comorbidities were not examined as a previous study using this sample found no notable moderators (Rauch, Yasinski, et al, 2020).…”

“…The current study examines whether sleep disorder symptoms interfere with optimal treatment outcome in an intensive outpatient program (IOP) involving massed PE and adjunctive interventions (Rauch, Yasinski, et al, 2020). Specifically, we examine the impact of daytime sleepiness, insomnia, and nightmares.…”

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

“…PTSD patients with severe symptoms may have more difficulty in tolerating CBT. However, intensive outpatient programs in which PTSD patients are seen daily may increase retention rates to over 90% 115,116 , with associated decreases in both PTSD symptoms and suicidal ideation 117 .…”