Residual sleep disturbances following PTSD treatment in active duty military personnel.

Pruiksma, Kristi E.; Taylor, Daniel J.; Wachen, Jennifer Schuster; Mintz, Jim; Young‐McCaughan, Stacey; Peterson, Alan L.; Yarvis, Jeffrey S.; Borah, Elisa V.; Dondanville, Katherine A.; Litz, Brett T.; Hembree, Elizabeth A.; Resick, Patricia A.

doi:10.1037/tra0000150

Cited by 127 publications

(95 citation statements)

References 19 publications

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“…Using symptom retention, rather than improvement, as a criterion for examining treatment outcome resulted in a smaller number of symptoms for which PE had a unique effect. The conditional probability of symptom retention in both PE and PCT was highest for difficulty falling asleep (81%), replicating the findings of investigations that have examined additional treatments (e.g., Belleville et al, 2011;Gutner et al, 2013;Larsen et al, 2018;Pruiksma et al, 2016;Woodward et al, 2017;Zayfert & DeViva, 2004). In PE, exposure is used to activate dysfunctional perceptions and beliefs associated with the traumatic event in order to modify emotional processing of the traumatic event (e.g., Foa & Kozak, 1986;Foa et al, 2007).…”

Section: Discussionsupporting

confidence: 53%

“…The literature suggests that residual symptoms are common, as in depression, but few studies (Larsen et al, 2018;Zayfert & DeViva, 2004) have examined all PTSD symptoms. Prior studies of residual symptoms in PTSD had focused on female civilians (e.g., Gutner et al, 2013;Larsen et al, 2018), mixed samples of civilians (e.g., Belleville et al, 2011;Woodward et al, 2017;Zayfert & DeViva, 2004), and largely male samples of veterans or military personnel (e.g., Pruiksma et al, 2016). Because of this focus, there is incomplete knowledge about which symptoms persist following specific treatments and treatment in general.…”

Section: Introductionmentioning

confidence: 99%

“…For example, the practice guideline recently But despite these effective treatments, some symptoms persist in some patients. Most research has focused on the persistence of sleep problems following psychotherapy (e.g., Belleville, Guay, & Marchand, 2011;Gutner, Casement, Gilbert, & Resick, 2013;Pruiksma et al, 2016;Woodward et al, 2017;Zayfert & DeViva, 2004). Although treatment improves sleep problems and nightmares, these symptoms remain to some degree.…”

Section: Introductionmentioning

confidence: 99%

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Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers

Schnurr

Lunney

2018

Depress Anxiety

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Background: Despite the effectiveness of evidence-based treatments for posttraumatic stress disorder (PTSD), some symptoms, such as sleep disturbance, can be difficult to treat regardless of treatment type. Methods:We examined residual PTSD symptoms in 235 female veterans and soldiers who were randomized to receive 10 weekly sessions of either Prolonged Exposure (PE) or Present-Centered Therapy (PCT). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale.Analyses examined the effects of PE and the effects of clinically significant improvement (loss of diagnosis, operationalized as meaningful symptom reduction and no longer meeting diagnostic criteria).Results: Both treatments resulted in reductions in PTSD symptoms. PE had lower conditional probabilities than PCT of retaining intrusive memories, avoidance of people/places, detachment/estrangement, and restricted range of affect. Loss of diagnosis had lower conditional probabilities of almost all symptoms, although hyperarousal symptoms-especially irritability/anger (60.7%) and sleep difficulties (50.9%)-were the most likely to remain. Conclusions:Results are consistent with previous findings on sleep difficulties being difficult to treat, but also show that hyperarousal symptoms overall may not be resolved even after substantial improvement. Additional strategies may be needed to treat the full range of PTSD symptoms in some patients. K E Y W O R D Scognitive-behavioral therapy, PTSD, veterans, women 162

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers

Schnurr

Lunney

2018

Depress Anxiety

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“…However, the present study found an interaction between these two factors (residual sleep disruptions post-treatment and synergistic relations) that also influenced treatment, in that smaller improvements in sleep symptoms were predictive of smaller improvements in symptoms of PTSD and MDD above and beyond other factors. These findings add to the growing literature on comorbid or co-occurring sleep disorders and related residual sleep disturbances following evidence-based psychotherapies for various psychiatric disorders (Pruiksma et al, 2016; McHugh et al, 2014) as well as medical conditions (Stepanski & Rybarczyk, 2006). …”

Section: Discussionsupporting

confidence: 52%

Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD

López

Lancaster

Grös

et al. 2017

J Psychopathol Behav Assess

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Objective(s) While evidence-based treatments exist for posttraumatic stress disorder (PTSD), a significant sub-set of veterans continue to meet criteria for PTSD after treatment. Sleep problems may affect treatment retention and predict efficacy for PTSD treatments. Methods The present study used data from a clinical trial of Prolonged Exposure therapy (PE) administered to veterans (N=154) to evaluate whether residual sleep symptoms remained after treatment completion, and if so, whether these residual sleep symptoms were associated with higher levels of PTSD and comorbid depression at the end of treatment. Participants (ages 20 to 75 years old; 35.7% Black; 54.5% married) completed demographic questions, symptom assessments, and engagement-related surveys. Results Hierarchical multiple linear regression models demonstrated that changes in sleep were significant predictors of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Conclusions Greater residual sleep symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of sleep during the course of PTSD treatment, leading to several important clinical assessment and treatment implications.

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“…However there are persisting concerns about this modality due to high rates of non-response and dropout [3–5]. Moreover, sleep disturbance is a core feature of PTSD [6] and a predictor of worse global functionality [7], yet sleep improvement is typically elusive after completion of PTSD-specific behavioral therapies [8, 9]. While SSRI and other medication prescriptions are common, the overall evidence for the efficacy of psychopharmacological agents for individuals with PTSD is generally considered to be modest at best [1, 10].…”

Section: Introductionmentioning

confidence: 99%

Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress

et al. 2017

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BackgroundThe objective of this pilot study was to explore the use of a closed-loop, allostatic, acoustic stimulation neurotechnology for individuals with self-reported symptoms of post-traumatic stress, as a potential means to impact symptomatology, temporal lobe high frequency asymmetry, heart rate variability (HRV), and baroreflex sensitivity (BRS).MethodsFrom a cohort of individuals participating in a naturalistic study to evaluate use of allostatic neurotechnology for diverse clinical conditions, a subset was identified who reported high scores on the Posttraumatic Stress Disorder Checklist (PCL). The intervention entailed a series of sessions wherein brain electrical activity was monitored noninvasively at high spectral resolutions, with software algorithms translating selected brain frequencies into acoustic stimuli (audible tones) that were delivered back to the user in real time, to support auto-calibration of neural oscillations. Participants completed symptom inventories before and after the intervention, and a subset underwent short-term blood pressure recordings for HRV and BRS. Changes in temporal lobe high frequency asymmetry were analyzed from baseline assessment through the first four sessions, and for the last four sessions.ResultsNineteen individuals (mean age 47, 11 women) were enrolled, and the majority also reported symptom scores that exceeded inventory thresholds for depression. They undertook a median of 16 sessions over 16.5 days, and 18 completed the number of sessions recommended. After the intervention, 89% of the completers reported clinically significant decreases in post-traumatic stress symptoms, indicated by a change of at least 10 points on the PCL. At a group level, individuals with either rightward (n = 7) or leftward (n = 7) dominant baseline asymmetry in temporal lobe high frequency (23–36 Hz) activity demonstrated statistically significant reductions in their asymmetry scores over the course of their first four sessions. For 12 individuals who underwent short-term blood pressure recordings, there were statistically significant increases in HRV in the time domain and BRS (Sequence Up). There were no adverse events.ConclusionClosed-loop, allostatic neurotechnology for auto-calibration of neural oscillations appears promising as an innovative therapeutic strategy for individuals with symptoms of post-traumatic stress.Trials registrationClinicalTrials.gov #NCT02709369, retrospectively registered on March 4, 2016.

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Residual sleep disturbances following PTSD treatment in active duty military personnel.

Cited by 127 publications

References 19 publications

Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers

Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers

Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD

Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress

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