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

Schnurr, Paula P.; Lunney, Carole A.

doi:10.1002/da.22871

Cited by 71 publications

(77 citation statements)

References 39 publications

(113 reference statements)

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“…Among those with PTSD, increased sleep disturbance is associated with increased PTSS severity [16]. Sleep disturbance often remains after successful treatment for PTSD [7,17,18] and greater residual sleep disturbance is predictive of smaller PTSD treatment gains [19]. Conversely, pharmacologic treatments for sleep [20][21][22] and non-pharmacologic treatments for sleep [23][24][25] improve sleep and PTSS.…”

Section: Introductionmentioning

confidence: 99%

Post traumatic stress symptom variation associated with sleep characteristics

et al. 2020

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Background: Post traumatic stress disorder (PTSD) and sleep problems are highly related. The relationship between nighttime sleep characteristics and next day post traumatic stress symptoms (PTSS) is not well known. This study examined the relationship between the previous night's sleep duration, number of awakenings, sleep quality, trouble falling asleep, and difficulty staying asleep and PTSS the following day. Methods: Using an ecological momentary assessment methodology, individuals with probable PTSD (N = 61) reported their nighttime sleep characteristics daily and PTSS four times per day for 15 days. Univariate and multivariate linear mixed models were used to examine the previous night's (within-subjects) and person's mean (between-subjects) associations between sleep characteristics and PTSS. Results: The previous night's sleep duration (p < .001), sleep quality (p < .001), trouble falling asleep (p < .001), and difficulty staying asleep (p < .001) significantly predicted the next day's PTSS. When examined in a multivariate model including all characteristics simultaneously, previous night's sleep duration (p = .024), trouble falling asleep (p = .019), and difficulty staying asleep (p < .001) continued to predict PTSS, but sleep quality (p = .667) did not. When considering a person's mean, trouble falling asleep (p = .006) and difficulty staying asleep (p = .001) predicted PTSS, but only difficulty staying asleep (p = .018) predicted PTSS in a multivariate model. Conclusions: Among individuals with PTSD, the previous night's sleep duration, trouble falling asleep, and difficulty staying asleep predict next day PTSD symptoms. Interventions that facilitate falling and staying asleep and increase time slept may be important for treating PTSD.

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Section: Introductionmentioning

confidence: 99%

Post traumatic stress symptom variation associated with sleep characteristics

et al. 2020

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“…Furthermore, trials should focus on identifying residual symptoms which are common even in those who are substantially assisted by treatment. Not all symptoms of PTSD are equally responsive to particular interventions (Larsen, Fleming, & Resick, ; Schnurr & Lunney, ), and research is needed on variables that predict treatment resistance such as duration of illness and types of neurobiological dysregulation (McFarlane, ).…”

Section: Resultsmentioning

confidence: 99%

Treatment augmentation for posttraumatic stress disorder: A systematic review

Metcalf

Stone

Hinton

et al. 2019

Clin Psychol Sci Pract

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This systematic review examined the efficacy of all augmentation approaches for first‐line posttraumatic stress disorder (PTSD) interventions. From 9,890 records, 34 trials were eligible for inclusion, covering 28 different augmentation approaches. Overall, augmentation approaches were ineffective if they targeted a mechanism similar to the first‐line treatment. Augmentation approaches combining two guideline‐recommended treatments were largely ineffective, reflecting ceiling effects. Pharmacological augmentation approaches targeting fear extinction mechanisms were largely ineffective, or worsened outcomes relative to prolonged exposure alone, as these approaches may inadvertently strengthen fear memories. Augmentation approaches targeting general cognitive enhancement showed promise and provided support for augmentation interventions that require little cognitive or emotional work and target mechanisms different than the first‐line treatment.

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“…Our finding's discrepancy from prior studies could be explained by the long time interval between the trauma exposure and our surveyfive and a half years after the disaster, which reflects chronic PTSD symptoms. Previous studies have reported elevated residual externalizing symptoms such as anger/irritability in patients who had meaningful reductions in overall PTSD symptom severity over time (Schnurr & Lunney, 2019). Therefore, it is possible that externalizing symptoms might demonstrate high centrality in a network of chronic PTSD symptoms.…”

Section: Discussionmentioning

confidence: 97%

An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network

Wang

Cao

et al. 2020

European Journal of Psychotraumatology

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Background: Both the latent variable model and the network model have been widely used to conceptualize mental disorders. However, it has been pointed out that there is no clear dichotomy between the two models, and a combination of these two model could enable a better understanding of psychopathology. The recently proposed latent network model (LNM) has provided a statistical framework to enable this combination. Evidence has shown that posttraumatic stress disorder (PTSD) could be a suitable candidate disorder to study the combined model. In the current study, we initiated the first investigation of the latent network of PTSD symptoms. Methods: The latent network of DSM-5 PTSD symptoms was estimated in 1196 adult survivors of China's 2008 Wenchuan earthquake. Validation testing of the latent network was conducted in a replication sample of children and adolescent who experienced various trauma types. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The latent network was estimated using the seven-factor hybrid model of DSM-5 PTSD symptoms, analysed using the R package lvnet. Results: The latent network model demonstrated good fit in both samples. A strong weighted edge between the intrusion and avoidance dimensions was identified (regularized partial correlation = 0.75). The externalizing behaviour dimension demonstrated the highest centrality in the latent network. Conclusions: This study is the first to investigate the latent network of DSM-5 PTSD symptoms. Results suggest that both latent symptom dimension and associations between the dimensions should be considered in future PTSD studies and clinical practices.

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

Cited by 71 publications

References 39 publications

Post traumatic stress symptom variation associated with sleep characteristics

Post traumatic stress symptom variation associated with sleep characteristics

Treatment augmentation for posttraumatic stress disorder: A systematic review

An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network

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