Pharmacological enhancement of exposure-based treatment in PTSD: a qualitative review

Kleine, Rianne A. de; Rothbaum, Barbara O.; Minnen, Agnes van

doi:10.3402/ejpt.v4i0.21626

Cited by 59 publications

(52 citation statements)

References 79 publications

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“…To improve both response and dropout, TFT programmes have been augmented in various ways (de Kleine, Rothbaum, & van Minnen, 2013; Kehle-Forbes et al, 2013). However, these modifications have not resulted in clinically significant improvement of either outcome or dropout rates.…”

Section: Introductionmentioning

confidence: 99%

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

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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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.

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Section: Introductionmentioning

confidence: 99%

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

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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“…As approximately one-third of PTSD patients completing treatment still meet criteria for PTSD (Bradley et al, 2005), there is a need for new or improved interventions to boost treatment response (de Kleine et al, 2013). Because of its anxiolytic and prosocial properties, the neuropeptide oxytocin (OT) may be a promising agent for medication-enhanced psychotherapy in PTSD (Koch et al, 2014;Olff et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Intranasal Oxytocin Normalizes Amygdala Functional Connectivity in Posttraumatic Stress Disorder

Koch

Zuiden

Nawijn

et al. 2016

Neuropsychopharmacol

125

106

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The neuropeptide oxytocin (OT) has been suggested as a promising pharmacological agent for medication-enhanced psychotherapy in posttraumatic stress disorder (PTSD) because of its anxiolytic and prosocial properties. We therefore investigated the behavioral and neurobiological effects of a single intranasal OT administration (40 IU) in PTSD patients. We conducted a randomized, placebo-controlled, cross-over resting-state fMRI study in male and female police officers with (n = 37, 21 males) and without PTSD (n = 40, 20 males). We investigated OT administration effects on subjective anxiety and functional connectivity of basolateral (BLA) and centromedial (CeM) amygdala subregions with prefrontal and salience processing areas. In PTSD patients, OT administration resulted in decreased subjective anxiety and nervousness. Under placebo, male PTSD patients showed diminished right CeM to left ventromedial prefrontal cortex (vmPFC) connectivity compared with male trauma-exposed controls, which was reinstated after OT administration. Additionally, female PTSD patients showed enhanced right BLA to bilateral dorsal anterior cingulate cortex (dACC) connectivity compared with female trauma-exposed controls, which was dampened after OT administration. Although caution is warranted, our findings tentatively suggest that OT has the potential to diminish anxiety and fear expression of the amygdala in PTSD, either via increased control of the vmPFC over the CeM (males) or via decreased salience processing of the dACC and BLA (females). Our findings add to accumulating evidence that OT administration could potentially enhance treatment response in PTSD.

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“…The consequences of untreated PTSD include increased rates of functional impairment 3 , poor quality of life, chronicity and, at times, mortality 4 . Although a number of efficacious behavioral and Evren C, Dalbudak E, Aydemir O, Koroglu E, Evren B, Ozen S, Coskun KS pharmacological treatments were developed 5 , PTSD is frequently underrecognized and untreated 6 . Improving detection of PTSD is a necessary first step to addressing the mental health burden of this disorder experienced by these patients 1 .…”

Section: Introductionmentioning

confidence: 99%

Psychometric Properties of the Turkish PTSD-Short Scale in a Sample of Undergraduate Students

Evren

Dalbudak²,

Aydemi̇r

et al. 2016

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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ABSTRACT:Psychometric properties of the Turkish PTSD-Short Scale in a sample of undergraduate students Objective: The National Stressful Events Survey for Posttraumatic Stress Disorder (PTSD)-Short Scale (NSESSS-PTSD) allows dimensional self-rating assessment of PTSD according to the DSM-5. The aim of the present study was to evaluate psychometric properties of this scale as Turkish PTSD-Short Scale (PTSD-SS) in a sample of undergraduate students in Turkey.Method: Participants included 415 university students, among which 351 (84.8%) reported trauma and thus were included in the analysis. Participants were evaluated with the PTSD-SS and the PTSD Checklist Civilian (PCL-C) version.Results: Turkish version of the PTSD-SS was found to be psychometrically sound PTSD screening measure with high convergent validity when compared with PCL-C (r=0.79) and having a Cronbach's α of 0.87. In addition, a single component accounted for 49.94% of total variance for PTSD-SS. The PTSD-SS had sensitivity and specificity scores of 0.91 and 0.77, respectively, when using the optimal cut-off score of 24. Additionally, the PTSD-SS showed good discriminant validity as it significantly differentiated students with high risk of PTSD from those with low risk of PTSD. Conclusion:These findings supported the Turkish PTSD-SS as reliable and valid PTSD screening instrument with a unidimensional scale construct.

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Pharmacological enhancement of exposure-based treatment in PTSD: a qualitative review

Cited by 59 publications

References 79 publications

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

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

Intranasal Oxytocin Normalizes Amygdala Functional Connectivity in Posttraumatic Stress Disorder

Psychometric Properties of the Turkish PTSD-Short Scale in a Sample of Undergraduate Students

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