Prolonged Exposure for PTSD in a Veteran group: A pilot effectiveness study

Smith, Erin R.; Porter, Katherine E.; Messina, Michael; Beyer, Jonathan A.; Defever, Mahrie E.; Foa, Edna B.; Rauch, Sheila A. M.

doi:10.1016/j.janxdis.2014.12.008

Cited by 26 publications

(19 citation statements)

References 27 publications

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“…Note that these peer behaviors are those encouraged and used when delivering exposure-based therapies in-group settings 16 and with supportive family members. Specifically, we encourage group members to work together during in vivo exposure trials in between sessions as supportive and encouraging partners.…”

Section: Peer Logistics and Supervision: Getting Startedmentioning

confidence: 99%

Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Hernandez‐Tejada

Acierno

Sánchez-Carracedo

2017

Military Psychology

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Section: Peer Logistics and Supervision: Getting Startedmentioning

confidence: 99%

Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Hernandez‐Tejada

Acierno

Sánchez-Carracedo

2017

Military Psychology

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“…Two evidence-based treatments for PTSD, Prolonged Exposure (PE; Foa, Hearst, Dancu, Hembree, & Jaycox, 1994) and Cognitive Processing Therapy (Resick & Schnicke, 1993), effectively reduce comorbid depression symptoms (Resick et al, 2015;Resick et al, 2017;Smith et al, 2015;Yuen et al, 2015). Integrated treatments for comorbid PTSD and substance use disorder (SUD)/AUD, such as Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE; Back et al, 2012Back et al, , 2014, simultaneously reduce comorbid PTSD, depression, and AUD/SUD symptoms Jaconis, Ana, Killeen, Badour, & Back, 2017;Mills et al, 2012;Persson et al, 2017).…”

mentioning

confidence: 99%

Heterogeneity of treatment dropout: PTSD, depression, and alcohol use disorder reductions in PTSD and AUD/SUD treatment noncompleters

Szafranski

Grös

Acierno

et al. 2018

Clin Psychology and Psychoth

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Treatment dropout is often assumed to be due to worsening or lack of symptom improvement, despite minimal research examining symptom change among treatment dropouts. Thus, the present study examined symptom change in veterans who discontinued evidence‐based treatment for comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Participants were veterans who completed at least one session of a 12‐session Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) for comorbid PTSD/AUD. The study analyses investigated the 43% of the sample (n = 22) that did not complete the full 12‐session protocol and were therefore considered treatment dropouts. Symptom changes in PTSD, AUD, and depression were examined among dropouts using two methods: (a) clinically significant change criteria and (b) good end‐state criteria. Results indicated that a significant proportion of treatment dropouts displayed clinically significant improvement and/or met good end‐state criteria for PTSD (40–59%), AUD (66%), and depression (45–68%) prior to dropping out. The results revealed that participants who displayed symptom improvement attended more treatment sessions and completed more imaginal exposures than participants who did not experience significant improvement. Together, the findings add to a growing body of literature suggesting that a large proportion of treatment dropouts may actually improve. Although preliminary, the findings challenge the notion that treatment dropout is always associated with negative outcomes.

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“…Third, PE is typically delivered in an individual format (although group formats and individual‐group hybrid formats of this treatment have recently been developed; see Smith et al., and Sutherland et al., ), which can be resource‐intensive. A group adaptation of PE would thus require fewer clinicians per patient and would have the added benefit of providing veterans with an opportunity to support one another and learn from one another's experiences.…”

mentioning

confidence: 99%

Description and Preliminary Outcomes of an In Vivo Exposure Group Treatment for Posttraumatic Stress Disorder

Porter

Romero

Barone

2018

Journal of Traumatic Stress

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Prolonged exposure (PE) therapy is traditionally delivered individually to patients. To engage more veterans in care, an in vivo exposure group treatment was developed in an urban VA medical center. This treatment represented a modification of the in vivo exposure portion of PE, with the addition of in-session, therapist-assisted in vivo exposures. Here, we describe this 12-week treatment and present preliminary outcome data. Demographics and pre-and posttreatment scores on the PTSD Checklist-Specific (PCL-S) and Beck Depression Inventory-II (BDI-II) were extracted from a program evaluation database. The sample included veterans with a diagnosis of posttraumatic stress disorder (PTSD) who participated in the in vivo exposure group between October 2010 and March 2014 and had available treatment outcome data (N = 43). The majority of participants in the sample were male (n = 41, 95.3%) and Black (n = 34, 79.1%). Participation in the in vivo group was associated with a significant decrease in PCL-S scores, with a medium-large effect size, t(42) = 5.35, p < .001, d = 0.73, and a significant decrease in BDI-II scores, with a small effect size, t(38) = 2.55, p = .015, d = 0.23. Previous participation in an evidenced-based treatment (EBT) was not associated with symptom change following the in vivo group. Findings suggest that in vivo exposure group therapy constitutes a promising intervention for individuals who decline EBTs or remain symptomatic after completing an EBT for PTSD. Further study of this treatment using a randomized controlled trial design is warranted.

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Prolonged Exposure for PTSD in a Veteran group: A pilot effectiveness study

Cited by 26 publications

References 27 publications

Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Heterogeneity of treatment dropout: PTSD, depression, and alcohol use disorder reductions in PTSD and AUD/SUD treatment noncompleters

Description and Preliminary Outcomes of an In Vivo Exposure Group Treatment for Posttraumatic Stress Disorder

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