Examining the effectiveness of an intensive, 2‐week treatment program for military personnel and veterans with PTSD: Results of a pilot, open‐label, prospective cohort trial

Bryan, Craig J.; Leifker, Feea R.; Rozek, David C.; Bryan, AnnaBelle O.; Reynolds, Mira L.; Oakey, D. Nicolas; Roberge, Erika M.

doi:10.1002/jclp.22651

Cited by 48 publications

(40 citation statements)

References 40 publications

(57 reference statements)

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“…The relapse of PTSD symptoms at six month follow-up isalbeit undesirable not fully unexpected as it is in accordance with earlier findings among a similar sample of individuals undergoing the same treatment programme (Van Woudenberg et al, 2018), and has been observed in other treatment programmes with a massed format as well (e.g. Bryan et al, 2018). Possibly, there is a subgroup of patients with complex trauma histories who tend to show a slight relapse in the long term.…”

Section: Discussionsupporting

confidence: 90%

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Toorenburg

Sanches

Linders

et al. 2020

European Journal of Psychotraumatology

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Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from posttreatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

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Section: Discussionsupporting

confidence: 90%

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Toorenburg

Sanches

Linders

et al. 2020

European Journal of Psychotraumatology

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“…The results also support the practice of engaging individuals with SI in PTSD treatment rather than considering SI a contraindication for treatment. A significant proportion of the sample had remitted SI and decreased severity across treatment, consistent with prior literature (Bryan, Leifker, Rozek et al, 2018; Gradus et al, 2013; Stayton et al, 2019).…”

Section: Discussionsupporting

confidence: 87%

“…These very treatments (e.g., CPT and PE) are those that have shown effects on SI (e.g., Stayton et al, 2019), so it could be particularly helpful to emphasize treatment matching to enhance outcomes. There could be modifications made for residential treatments to enhance effectiveness for this population including intensive daily format (e.g., Bryan et al, 2018) or variable length treatment (Galovski et al, 2012); these more intensive treatments could reduce length of stay while still providing an adequate dose of therapy. Length of stay, although not a significant factor related to SI course in this study, has important implications for veterans’ ability to participate in the treatment (e.g., logistical barriers), cost, and resources; as such, determining length of stays as well as doses of treatment associated with better outcomes should remain a priority.…”

Section: Discussionmentioning

confidence: 99%

“…Change in PTSD was significantly associated with change in SI even after controlling for baseline depression and change in hopelessness. SI also decreased following CPT among veterans in both an intensive outpatient treatment program and a residential PTSD program (Bryan, Leifker, Rozek et al, 2018; Stayton, Martin, Pease, & Chard, 2019). Overall, these studies indicate that PTSD treatment delivered in individual and group modalities is associated with reductions in SI.…”

Section: Introductionmentioning

confidence: 99%

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Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

et al. 2020

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Background Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. Methods A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self‐report measures at admission and discharge were included. Results The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre‐posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma‐focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. Conclusions Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.

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“…Intensive treatment programmes (ITPs) are being used increasingly to address posttraumatic stress disorder (PTSD) (Held, Bagley, Klassen, & Pollack, 2019a). In ITPs, evidence-based treatments for PTSD, such as Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Cognitive Therapy for PTSD (CT-PTSD), and Eye Movement Desensitization and Reprocessing (EMDR) are condensed into one (Ehlers et al, 2014;Held et al, 2019b;Hendriks, Kleine, Broekman, Hendriks, & van Minnen, 2018;Méndez, Nijdam, June ter Heide, van der Aa, & Olff, 2018), two (Bryan et al, 2018;Harvey et al, 2017), or three (Zalta et al, 2018) weeks with daily sessions rather than traditional weekly psychotherapy (Held et al, 2019a). Although still relatively new, intensive treatment delivery formats have shown robust reductions in patients' PTSD and depression symptoms in a matter of days (e.g., Beidel, Frueh, Neer, & Lejuez, 2017;Ehlers et al, 2014;Foa et al, 2018;Held et al, 2019b;Zalta et al, 2018).…”

Section: 针对退伍军人为期三周的基于认知加工疗法的强化Ptsd治疗计划之后治疗获益的维持时间长达12个月mentioning

confidence: 99%

Maintenance of treatment gains up to 12-months following a three-week cognitive processing therapy-based intensive PTSD treatment programme for veterans

Held

Zalta

Smith

et al. 2020

European Journal of Psychotraumatology

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Examining the effectiveness of an intensive, 2‐week treatment program for military personnel and veterans with PTSD: Results of a pilot, open‐label, prospective cohort trial

Abstract: Daily administration of CPT is associated with significant reductions in PTSD and suicide ideation.

Cited by 48 publications

References 40 publications

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Maintenance of treatment gains up to 12-months following a three-week cognitive processing therapy-based intensive PTSD treatment programme for veterans

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