Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure.

Brown, Lily A.; Jerud, Alissa B.; Asnaani, Anu; Petersen, Julie M.; Zang, Yong; Foa, Edna B.

doi:10.1037/ccp0000292

Cited by 31 publications

(17 citation statements)

References 54 publications

(108 reference statements)

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“…Still, PE falls short in measures of treatment efficiency, since approximately one third of patients failed to respond to treatment (Popiel et al, 2015) and retained their PTSD diagnosis (Foa et al, 1999; Zoellner et al, 2019). Moreover, PE has a high burden of psychological demands on the patients (Kaysen et al, 2019), so therapy dropout rates can reach more than 30 % (Brown et al, 2018; Zoellner et al, 2019). Overall, evidence indicates that existing treatment options for PTSD are ineffective for a significant subset of patients who enter clinical trials, highlighting the need for new and improved treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Still, ET falls short in measures of treatment efficiency, since approximately one third of patients failed to respond to treatment (Popiel et al, 2015) and retained their PTSD diagnosis (Foa et al, 1999; Zoellner et al, 2019). Combined with the emotionally challenging nature of psychotherapy, this contributes to significant dropout rates registered for ET (Brown et al, 2018; Zoellner et al, 2019). Because of these limitations, researchers have developed a therapeutic approach in which ET is coupled with pharmacotherapy in an attempt to improve therapy outcomes among subjects with modest response to it.…”

Section: Introductionmentioning

confidence: 99%

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Hallucinogenic drugs and their potential for treating fear‐related disorders: Through the lens of fear extinction

Glavonic

Mitić

Adžić

2022

J of Neuroscience Research

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Fear‐related disorders, mainly phobias and post‐traumatic stress disorder, are highly prevalent, debilitating disorders that pose a significant public health problem. They are characterized by aberrant processing of aversive experiences and dysregulated fear extinction, leading to excessive expression of fear and diminished quality of life. The gold standard for treating fear‐related disorders is extinction‐based exposure therapy (ET), shown to be ineffective for up to 35% of subjects. Moreover, ET combined with traditional pharmacological treatments for fear‐related disorders, such as selective serotonin reuptake inhibitors, offers no further advantage to patients. This prompted the search for ways to improve ET outcomes, with current research focused on pharmacological agents that can augment ET by strengthening fear extinction learning. Hallucinogenic drugs promote reprocessing of fear‐imbued memories and induce positive mood and openness, relieving anxiety and enabling the necessary emotional engagement during psychotherapeutic interventions. Mechanistically, hallucinogens induce dynamic structural and functional neuroplastic changes across the fear extinction circuitry and temper amygdala's hyperreactivity to threat‐related stimuli, effectively mitigating one of the hallmarks of fear‐related disorders. This paper provides the first comprehensive review of hallucinogens' potential to alleviate symptoms of fear‐related disorders by focusing on their effects on fear extinction and the underlying molecular mechanisms. We overview both preclinical and clinical studies and emphasize the advantages of hallucinogenic drugs over current first‐line treatments. We highlight 3,4‐methylenedioxymethamphetamine and ketamine as the most effective therapeutics for fear‐related disorders and discuss the potential molecular mechanisms responsible for their potency with implications for improving hallucinogen‐assisted psychotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hallucinogenic drugs and their potential for treating fear‐related disorders: Through the lens of fear extinction

Glavonic

Mitić

Adžić

2022

J of Neuroscience Research

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“…In several studies focused on older adults with PTSD, some of the participants (58%-77%) were still qualified for diagnosis, whereas more than half did not feel a reduction in symptom severity [19][20][21][22]. There is also some evidence that prolonged exposure therapy can exaggerate symptoms in a fraction of PTSD participants [23]. Of course, there have been many far-reaching studies from this past decade which indicate that with refinement, prolonged exposure therapy is more effective in treating PTSD, across a wide range of traumas and comorbid symptoms, compared to traditional cognitive behavioral therapy (see Foa and McLean [13] for an in-depth review).…”

Section: Pavlovian Fear Conditioning and Exposure Therapiesmentioning

confidence: 99%

Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment

Markowitz

Fanselow

2020

Brain Sciences

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Recent research indicates that there is mixed success in using exposure therapies on patients with post-traumatic stress disorder (PTSD). Our study argues that there are two major reasons for this: The first is that there are nonassociative aspects of PTSD, such as hyperactive amygdala activity, that cannot be attenuated using the exposure therapy; The second is that exposure therapy is conceptualized from the theoretical framework of Pavlovian fear extinction, which we know is heavily context dependent. Thus, reducing fear response in a therapist’s office does not guarantee reduced response in other situations. This study also discusses work relating to the role of the hippocampus in context encoding, and how these findings can be beneficial for improving exposure therapies.

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“…It is characterized by distressed recollection of the traumatic events and hyper-vigilance [2]. PTSD is highly comorbid and approximately half of the individuals with PTSD usually report comorbid depressive symptoms across various epidemiological samples [3]. PTSD is manageable either with the pharmacotherapeutic or psychotherapeutic treatments, however, practitioners sometimes prefer psychotherapy, especially if the pharmacotherapy is not effective [4].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of eye movement desensitization & reprocessing versus cognitive behavioral therapy in Post-Traumatic Stress and Depressive Symptoms: Study protocol for a Randomized Controlled Trial

Khan¹,

Khan

Shah

2019

Contemporary Clinical Trials Communications

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Post-Traumatic Stress Disorder(PTSD) develops after exposure to or witnessing traumatic events. PTSD is highly comorbid and individuals with PTSD usually report Depressive Symptoms(DS). Common treatment choices for PTSD and DS are either EMDR or CBT, however, little is known about their comparative efficacy, especially in Pakistan. Therefore, this Randomized Controlled Trial(RCT) aims at determining the comparative efficacy of EMDR vs CBT in Pakistan. This study will also examine the association between reduction in symptoms of PTSD and DS over course of treatment. In this regard, two arms Crossover Randomized Controlled Trial(RCT) with Repeated Measures Design will be selected. This study will be conducted at two rehabilitation centers and patients will be screened at Time:01, baseline; Time:02, during treatment; Time:03, post treatment and Time:04, 06 months follow-up. All analyses will be performed according to intention-to-treat principle. Variations in symptoms will be analysed by using descriptive statistics, χ2 tests, t-tests, and one way ANOVA. To examine changes in PTSD and DS across time and to check efficacy of each treatment, a series of Linear Mixed Models will be run. Furthermore, a series of multi-level lagged mediation analysis will be performed to check bi-directional mediation between changes PTSD and DS over time. This protocol has outlined the rationale for determining efficacy of EMDR and CBT in Pakistan. It will help in answering a broad range of questions concerning efficacy of newly developed evidence-based treatments. Moreover, it may also guide future research on the treatment of PTSD and DS in the developing countries.

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Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure.

Abstract: The relationship between reductions in PTSD and depression during PE is transactional. Regardless of whether PTSD or depression decreases first, reduction in the other symptom cluster is likely to follow. (PsycINFO Database Record

Cited by 31 publications

References 54 publications

Hallucinogenic drugs and their potential for treating fear‐related disorders: Through the lens of fear extinction

Hallucinogenic drugs and their potential for treating fear‐related disorders: Through the lens of fear extinction

Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment

Efficacy of eye movement desensitization & reprocessing versus cognitive behavioral therapy in Post-Traumatic Stress and Depressive Symptoms: Study protocol for a Randomized Controlled Trial

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