Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Abstract

Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

“…These findings are in accordance with a wide array of previous studies on massed treatment showing the feasibility, safety, and effectiveness of such an approach (e.g. Ehlers et al, 2014; Hendriks et al, 2018, 2016; Zepeda Méndez et al, 2018; Zoellner et al, 2017). …”

“…Indeed, several studies investigating the feasibility of intensive CBT in these populations have shown positive results regarding the treatment of PTSD (e.g. Hendriks, De Kleine, Broekman, Hendriks, & Van Minnen, 2018; Zoellner et al, 2017; for a review see Hendriks, De Kleine, Hendriks, & Van Minnen, 2016). In a meta-analysis, EMDR was found to be effective for complex trauma (Chen et al, 2018) but little is known about the effects of intensive EMDR therapy.…”

Impact of Oxytocin on the neural correlates of fearful face processing in PTSD related to childhood Trauma

“…By utilizing both analyses, this exploratory study examined both overall outcomes and addressed an important question of how overall results are modulated by trauma exposure severity. Existing literature indicates that trauma exposure severity and chronicity may be important considerations in the maintenance and treatment of PTSD symptoms in various populations (Bedard-Gilligan et al, 2015;Hendriks, De Kleine, Broekman, Hendriks, & Van Minnen, 2018;Jakob, Lamp, Rauch, Smith, & Buchholz, 2017). The current findings, although preliminary and exploratory, add to the developing literature by showing that oxytocin dampens amygdala reactivity to fear cues among more severely childhood-trauma exposed individuals with PTSD, thus providing modest support for the premise that oxytocin may target neural mechanisms of resilience and recovery in this particularly highrisk population.…”

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…None of the patients dropped out during the intensive phase, and 5% of the patients dropped out during the booster phase. The specific details on the population and treatment effects are reported elsewhere (Hendriks, Kleine, Broekman, Hendriks, & Minnen, 2018). …”