Improving treatment for patients with childhood abuse related posttraumatic stress disorder (IMPACT study): protocol for a multicenter randomized trial comparing prolonged exposure with intensified prolonged exposure and phase-based treatment

Oprel, Danielle; Hoeboer, Chris M.; Schoorl, Maartje; Kleine, Rianne A. de; Wigard, I.G.; Cloitre, Marylène; Minnen, Agnes van; Does, A.J.W. van der

doi:10.1186/s12888-018-1967-5

Cited by 12 publications

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“…Clearly, long-term results of well-designed randomized clinical trials, directly comparing trauma-focused therapy, with and without a preceding stabilization phase, such as those that are currently underway (e.g. Oprel et al, 2018;Van Vliet, Huntjens, van Dijk, & De Jongh, 2018) should demonstrate whether a stabilization phase prior to trauma-focused therapy could still be beneficial to certain subgroups of trauma-exposed individuals, or not. Notes 1.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…This study used the data of a randomized controlled trial investigating three psychotherapies of CA-PTSD [ 16 , 27 ]. A total of 149 patients were recruited in two outpatient mental health services in The Hague and Rotterdam, the Netherlands.…”

Section: Methodsmentioning

confidence: 99%

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

Hoeboer

Oprel

Kleine

et al. 2021

JCM

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Background: Differences in effectiveness among treatments for posttraumatic stress disorder (PTSD) are typically small. Given the variation between patients in treatment response, personalization offers a new way to improve treatment outcomes. The aim of this study was to identify predictors of psychotherapy outcome in PTSD and to combine these into a personalized advantage index (PAI). Methods: We used data from a recent randomized controlled trial comparing prolonged exposure (PE; n = 48), intensified PE (iPE; n = 51), and skills training (STAIR), followed by PE (n = 50) in 149 patients with childhood-abuse-related PTSD (CA-PTSD). Outcome measures were clinician-assessed and self-reported PTSD symptoms. Predictors were identified in the exposure therapies (PE and iPE) and STAIR+PE separately using random forests and subsequent bootstrap procedures. Next, these predictors were used to calculate PAI and to retrospectively determine optimal and suboptimal treatment in a leave-one-out cross-validation approach. Results: More depressive symptoms, less social support, more axis-1 diagnoses, and higher severity of childhood sexual abuse were predictors of worse treatment outcomes in PE and iPE. More emotion regulation difficulties, lower general health status, and higher baseline PTSD symptoms were predictors of worse treatment outcomes in STAIR+PE. Randomization to optimal treatment based on these predictors resulted in more improvement than suboptimal treatment in clinician assessed (Cohens’ d = 0.55) and self-reported PTSD symptoms (Cohens’ d = 0.47). Conclusion: Personalization based on PAI is a promising tool to improve therapy outcomes in patients with CA-PTSD. Further studies are needed to replicate findings in prospective studies.

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“…All procedures involving patients were approved by the Medical Ethical Committee of Leiden University Medical Centre (NL57984.058.16). More detailed information about the design can be found in the published study protocol (Oprel et al, 2018). Participants were recruited in two outpatient mental health services specializing in the treatment of trauma-related disorders located in the Hague and Rotterdam, the Netherlands.…”

Section: Study Design and Participantsmentioning

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

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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...

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Improving treatment for patients with childhood abuse related posttraumatic stress disorder (IMPACT study): protocol for a multicenter randomized trial comparing prolonged exposure with intensified prolonged exposure and phase-based treatment

Cited by 12 publications

References 90 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?

Personalization of Treatment for Patients with Childhood-Abuse-Related Posttraumatic Stress Disorder

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

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