Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

Abstract

Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.

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

“…There are several possible explanations for this finding. First, this slow response trajectory may indicate that these patients needed more sessions, which is in line with previous findings showing that some patients need additional sessions to benefit from PE (Foa et al, 2005). Additionally or alternatively, the improvement in this subgroup might not necessarily result from the added exposure but rather from the spacing of the additional exposure sessions during the booster phase.…”

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

“…Separately, another outpatient study compared PE alone with PE plus cognitive restructuring, a therapy intended to address the patient's negative cognitive assumption. Results did not reveal any differences in outcomes between the two interventions [92]. This result suggests that successful outcomes from PE do not rely on the same cognitive mechanisms used by CPT, raising the possibility that PE would be an effective intervention for veterans with significant cognitive problems.…”

On the Road to Translation for PTSD Treatment: Theoretical and Practical Considerations of the Use of Human Models of Conditioned Fear for Drug Development

“…Chronic fluoxetine in rodents facilitates extinction learning and extinction memory recall, particularly in females (Deschaux et al 2011;Fitzgerald et al 2014;Lebron-Milad et al 2013), and escitalopram enhances extinction in healthy humans (Bui et al 2013), suggesting that examining effects of a drug on extinction may predict efficacy as an overall treatment beyond use as an adjunctive treatment with therapy. Paroxetine transiently enhanced effects of exposure therapy (Schneier et al 2012); however, other studies show no efficacy of SSRIs to enhance exposure therapy in PTSD (Foa et al 2005;Hetrick et al 2010). It should be noted that when undergoing exposure therapy, many opportunities for exposure are outside of the therapist's office via "homework" developed to promote in vivo exposure in the patient's environment [in addition to imaginal exposure in prolonged exposure]; thus, a drug that can be given chronically may actually be more effective than a drug limited to exposure session treatments.…”