STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations

Peterson, Alan L.; Young‐McCaughan, Stacey; Roache, John D.; Mintz, Jim; Litz, Brett T.; Williamson, Douglas E.; Resick, Patricia A.; Foa, Edna B.; McGeary, Donald D.; Dondanville, Katherine A.; Taylor, Daniel J.; Wachen, Jennifer Schuster; Fox, Peter T.; Bryan, Craig J.; McLean, Carmen P.; Pruiksma, Kristi E.; Yarvis, Jeffrey S.; Niles, Barbara L.; Abdallah, Chadi G.; Averill, Lynnette A.; Back, Sudie E.; Baker, Monty T.; Blount, Tabatha H.; Borah, Adam M.; Borah, Elisa V.; Brock, Matthew S; Brown, Lily A.; Burg, Matthew M.; Cigrang, Jeffrey A.; DeBeer, Bryann B.; DeVoe, Ellen R.; Fina, Brooke A; Flanagan, Julianne C.; Fredman, Steffany J.; Gardner, Cubby L.; Gatchel, Robert R.; Goodie, Jeffrey L.; Gueorguieva, Ralitza; Higgs, Jay B.; Jacoby, Vanessa M.; Kelly, Kevin M.; Krystal, John H.; Lapiz-Bluhm, M. Danet; López-Roca, Argelio L; Marx, Brian P.; Maurer, Douglas; McDevitt-Murphy, Meghan E.; McGeary, Cindy A.; Meyer, Eric C.; Miles, Shannon R.; Monson, Candice M.; Morilak, David A.; Moring, John C.; Mysliwiec, Vincent; Nicholson, Karin L.; Rauch, Sheila A. M.; Riggs, David S.; Rosen, Craig S.; Rudd, M. David; Schobitz, Richard P.; Schrader, Christian C.; Shinn, Antoinette M.; Shiroma, Paulo; Sloan, Denise M.; Stern, Stephen L.; Strong, Randy; Vannoy, Steven D.; Young, Keith A.; Keane, Terence M.

doi:10.1016/j.cct.2021.106583

Cited by 24 publications

(18 citation statements)

References 24 publications

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“…The parent study was conducted in affiliation with the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR Consortium), a multi-institutional and multidisciplinary research consortium of investigators focused on the diagnosis, treatment, and epidemiology of combat-related PTSD and comorbid conditions. By being affiliated with STRONG STAR, the study was able to employ trained research staff and use standardized procedures for the recruitment, screening, assessment, and monitoring of research participants (Peterson et al, 2021). The parent study was approved by Institutional Review Boards at the University of Texas Health Science Center at San Antonio, the VA Boston Health Care System, and Duke University School of Medicine.…”

Section: Methodsmentioning

confidence: 99%

“…combat-related PTSD and comorbid conditions. By being affiliated with STRONG STAR, the study was able to employ trained research staff and use standardized procedures for the recruitment, screening, assessment, and monitoring of research participants (Peterson et al, 2021) The methods and main outcomes for the study have been described in detail elsewhere (Resick et al, 2021;Wachen et al, 2019). Briefly, participants received CPT twice weekly in 50-minute sessions with a trained research therapist.…”

Section: Methodsmentioning

confidence: 99%

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Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

Lindgren¹,

Jaffe²,

Kaysen³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: This study evaluated implicit associations (i.e., associations in memory that are automatically activated and difficult to control consciously) related to trauma and one's self in the context of a clinical trial for active duty service members seeking treatment for posttraumatic stress disorder (PTSD). Previous studies with nontreatment-seeking community samples found that implicit trauma identity

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

Lindgren¹,

Jaffe²,

Kaysen³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

Self Cite

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“…In collaboration with the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR) Consortium (Peterson et al., 2021), data were collected as part of a clinical trial evaluating variable-length CPT among 127 active-duty U.S. Army Soldiers stationed at Fort Hood in Killeen, Texas (see Resick et al., 2021 & Wachen et al., 2019; for detailed study methods and procedures). Participants were military personnel age 18 years or older who had deployed in support of combat operations following 9/11, experienced a Criterion A traumatic event as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM–5 ; American Psychiatric Association, 2013), and met full criteria for PTSD as determined by the Clinician-Administered PTSD Scale for DSM–5 (CAPS-5; Weathers et al., 2013).…”

Section: Methodsmentioning

confidence: 99%

Treatment responder status and time to response as a function of hazardous drinking among active-duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder.

LoSavio¹,

Straud²,

Dondanville³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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“…11 Over 2 decades, more than 20 clinical trials have evaluated various PTSD treatments. 12 One treatment that has been extensively investigated is prolonged exposure (PE) therapy. 13 The first randomized clinical trial (RCT) to evaluate the efficacy of PE for combat-related PTSD in active-duty US military personnel 14,15 compared the standard treatment format of PE (ie, spaced PE, which includes 10 weekly 90-minute sessions) to a massed treatment format (massed-PE, which includes 10 daily 90-minute sessions over 2 weeks).…”

Section: Introductionmentioning

confidence: 99%

“…When the wars in Iraq and Afghanistan began, there were no published PTSD clinical trials in active-duty US military personnel to inform clinicians treating this population . Over 2 decades, more than 20 clinical trials have evaluated various PTSD treatments . One treatment that has been extensively investigated is prolonged exposure (PE) therapy .…”

Section: Introductionmentioning

confidence: 99%

Massed vs Intensive Outpatient Prolonged Exposure for Combat-Related Posttraumatic Stress Disorder

et al. 2023

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ImportanceImproved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD).ObjectiveTo determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD.Design, Setting, and ParticipantsThis randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022.InterventionsThe interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE.Main Outcomes and MeasuresCoprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes.ResultsAmong 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, −13.85 [95% CI, −16.47 to −11.23]; P &lt; .001; massed-PE: mean difference, −14.13 [95% CI, −16.63 to −11.62]; P &lt; .001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P = .02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, −3.72 to 1.27]; P = .33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, −21.81 [95% CI, −25.57 to −18.04]; P &lt; .001; massed-PE: mean difference, −19.96 [95% CI, −23.56 to −16.35]; P &lt; .001) and were maintained at 6 months (IOP-PE: mean change, −0.21 [95% CI, −3.47 to 3.06]; P = .90; massed-PE: mean change, 3.02 [95% CI, −0.36 to 6.40]; P = .08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up.Conclusions and RelevanceThese findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms.Trial RegistrationClinicalTrials.gov Identifier: NCT03529435

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STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations

Cited by 24 publications

References 24 publications

Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

Implicit trauma identity associations in treatment-seeking U.S. military personnel do not predict or change in response to cognitive processing therapy for PTSD.

Treatment responder status and time to response as a function of hazardous drinking among active-duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder.

Massed vs Intensive Outpatient Prolonged Exposure for Combat-Related Posttraumatic Stress Disorder

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