Posttraumatic Stress Disorder and Chronic Pain Arising from Motor Vehicle Accidents: Efficacy of Interoceptive Exposure Plus Trauma-Related Exposure Therapy

Abstract

Preliminary data are presented on the pattern of treatment response of combining interoceptive exposure (IE) with trauma-related exposure therapy (TRE) in five female patients with posttraumatic stress disorder (PTSD) and comorbid chronic musculoskeletal pain originating from motor vehicle accidents. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Four participants reported a reduction in PTSD symptoms after completing treatment, and three no longer met diagnostic criteria for PTSD. Although both interventions were associated with reductions in PTSD symptoms, TRE was associated with greater reductions in PTSD symptoms than IE and was particularly effective at reducing avoidance. IE was associated with larger reductions in anxiety sensitivity than TRE. Pain symptoms lessened slightly during IE and then worsened following TRE. Anxiety decreased after completing treatment, whereas panic and depressive symptoms responded less so. Three individuals completed a 3-month follow-up assessment. There was no change in their PTSD diagnostic status, and all experienced a slight loss of pre-post gains, particularly involving the return of pain. Clinical and research implications are discussed.

Pain-related anxiety influences pain perception differently in men and women: A quantitative sensory test across thermal pain modalities

“…The need to further explore the association between pain-related anxiety constructs and pain perception in both sexes has been explicitly mentioned in recent literature [55], and Fillingim et al recently concluded in a comprehensive review that ''whether depression influences pain perception differently among women vs men is not yet known'' [21]. Advances in this area may inform which long-lasting predispositions (ie, as opposed to state anxiety) could contribute to hyperalgesia or hypoalgesia (ie, reduced pain perception) differently between sexes, guiding contemporary theory [4,5,35,57] and chronic pain interventions targeting these predispositions [14,56,58].…”

Chronic Pain and the Anxiety Disorders: Epidemiology, Mechanisms and Models of Comorbidity, and Treatment

“…This suggests that the combination of IE followed by TRE therapy is not effective for pain and that pain must be addressed directly during therapy for improvements to occur. Wald et al [ 150 ] suggest that the IE-induced reduction in anxiety sensitivity decreased patients' physiological arousal thereby reducing muscle tension which, in turn, decreased their pain severity but the reduction in pain severity was negligible; moreover, this does not explain why even these negligible gains were neither maintained, nor augmented, at the 3 month follow-up in contrast to the observed changes in anxiety sensitivity and PTSD.…”

“…The study by Wald et al [ 150 ] presented above, has important theoretical implications for the nature of the relationships between anxiety sensitivity and pain/ PTSD. As described above, anxiety sensitivity is better viewed as co-maintaining factor than a mutual maintenance factor.…”

“…For example, Asmundson et al [ 7 ] suggest that pain triggers anxiety, which in turn is reacted to with alarm due to high anxiety sensitivity. Wald et al [ 150 ] imply that the physiological arousal associated with anxiety sensitivity produces increased muscle tension, which in turn produces pain.…”

“…Wald et al [ 150 ] examined the effi cacy of a 12-week course of treatment involving 4 weeks of interceptive exposure (IE) to anxiety-like symptoms (e.g., running on the spot, hyperventilating) followed by 8 weeks of trauma-related exposure (TRE) therapy for fi ve patients with comorbid pain and PTSD subsequent to motor vehicle collisions. The results showed that after 4 weeks of IE, anxiety sensitivity was reduced signifi cantly whereas PTSD symptoms and pain improved only negligibly.…”